PGR-1
Amnesic Syndrome Following a Suspected AVM in a 14 year old Female: Course of Recovery, Etiology, and MRI Findings

Abstract

Objective: Presentation of an unusual case of amnesic syndrome following a suspected AVM. The subject was a 14-year-old female (N) who suffered a large right temporo-parietal intra-parenchymal hemorrhage with extension into the ventricular system requiring surgical evacuation. She presented with a significant anterograde amnesic disorder that was generalized and not circumscribed to the visual domain. A neuropsychological assessment was recommended to investigate the nature and extent of her amnesic symptoms. Two aspects were found to be fundamental in this case, firstly, the inconsistency between the image findings of acute cerebral injury and her general amnesic disorder, and secondly, her capacity to keep up with academic demands despite persisting memory impairment. Method: N was assessed on four occasions over a period of 4 years to monitor her recovery. The initial assessment was comprehensive and covered intellectual functions, attention, processing speed, general memory, and executive functions. The subsequent reviews targeted for the most part the areas of impairment to evaluate the recovery process. Follow-up MRI findings were also reviewed. Results: The initial neuropsychological findings 5-6 weeks post-injury confirmed the presence of a moderate to severe impairment in general memory. Subsequent reviews indicated some gains overall, but she demonstrated persisting mild memory dysfunctions particularly in the area of visual memory. Conclusions: Ns general memory impairment was surprising given her right hemispheric injury. Her profile suggested some probable left hemispheric injury. Ns grades at school indicated that her mild memory impairments were not affecting her ability to keep up academically at a level that was consistent with her intellectual ability. The etiology of her memory impairment as well as the course of recovery over time will discussed.

PGR-2
Severe Social Impairment Does Not Always Mean Autism Spectrum Disorder (ASD): A Case of Suspected Fetal Alcohol Spectrum Disorder (FASD)

Abstract

Objective: Clinicians often assume ASD when a school-aged child presents with severe social difficulties. However, there are a host of alternative etiologies that should be entertained when social impairment is a primary referral concern. Methods: A 9-year-old girl was referred for a neuropsychological assessment given severe social impairment, immaturity, poor frustration tolerance, and significant attentional difficulties. She was described as desiring friends, but not knowing how to develop or maintain friendships. She was a term infant, although there was a strong suspicion of alcohol exposure during pregnancy. She was delayed with the acquisition of all milestones. Medical history was essentially unremarkable. She was attending 3rd grade and receiving support under Emotional Impairment. Results: She demonstrated Borderline intellectual abilities with a relative weakness in Working Memory. Abstract spatial processing was a weakness. Fine motor speed was impaired bilaterally. Multiple trial visual and verbal learning were impaired while recall for prose was a relative strength. Speech and language abilities were a relative strength, although articulation difficulties were evident. Deficits in reaction time, problem-solving, and mental flexibility were also apparent. Affect recognition was impaired. Caregiver report measures revealed a Social Communication Questionnaire score of 23, and peak T-score elevations on the Conner's Parent Rating Scale of 90 and 98 for Peer Relations and the ADHD Index, respectively. Conclusions: Although the referral suggested possible ASD and ADHD, suspected FASD was thought to be a more parsimonious diagnostic consideration. This case presentation will illuminate the differences in social and neuropsychological impairment in these three phenotypically similar disorders.

PGR-3
Multidisciplinary Management of Complex Concussion in a 15-Year-Old Female

Abstract

Objective: 14% of pediatric concussions persist >3 months (Barlow et al., 2010), often requiring multidisciplinary intervention. Method: KP was a healthy 15-year-old left-handed female with normal development and no concussion, ADHD, LD, or behavior problems. She was in 10th Grade with 4.1 GPA and 95th-98th percentile rank on pre-injury testing. KP sustained two concussions within 2 weeks with severe symptoms but continued playing 6 weeks with no improvement before presenting for management. Results: At 6 weeks status post injury the neurologist obtained MRI (normal), prescribed analgesics, and restricted physical activities. At 9 weeks s/p she completed neuropsychological evaluation; symptoms were severe and increased within 30 min of starting testing. Psychomotor speed and memory/learning (SS=84-97) were well below other domains and pre-injury estimates (SS=112-130). Activity restrictions were extended and she was removed from school 4 weeks with no improvement; headache persisted with rest and naproxen (3 months) and amitriptyline (2 months). At 17 weeks s/p, Sports Medicine and Physical Therapy implemented Leddy's (2010) sub-symptom threshold exercise protocol. Over 12 weeks, Post-Concussion Symptom Scale-Revised Total Score (post-exercise) steadily improved from 72 (pre-Leddy) to 25 after 17 weeks treatment (34 weeks s/p injury), but KP remained symptomatic and computerized cognitive screening was still below preseason baseline. For persistent neck pain at 30 weeks s/p, KP underwent successful radiofrequency denervation. Conclusions: This case illustrates the intractable symptoms that can result from multiple concussions in rapid succession in children, the need for multidisciplinary management, and potential benefit of sub-symptom threshold aerobic exercise.

AGR-1
Charles Bonnet Syndrome Following Penetrating TBI in an OEF/OIF/OND Active Duty Service Member

Abstract

Objective: Present clinical course and neuropsychological findings of Charles Bonnet syndrome (CBS) following penetrating injury sustained in combat. A paucity of literature exists sufficiently describing CBS. It is traditionally observed following visual impairment. Persons with CBS experience complex visual hallucinations with intact psychological and cognitive status. CBS has been reported most commonly in association with degenerative conditions such as glaucoma, macular degeneration, and multiple sclerosis and almost exclusively among the elderly. This case is unique in CBS etiology and age of onset. Methods: The patient is a 30-year-old active duty man who sustained a GSW during combat with initial GCS of 11. Neuroimaging revealed right optic nerve transection, left optic nerve compression from edema, and orbital blowout fractures with the disruption of the optic chiasm. Other abnormalities included SAH, IVH, right frontal EDH, and intraparenchymal contusions in the right uncus and temporal lobe. He underwent bilateral frontal craniectomy with wound debridement. Two months post-injury, he was transferred to a VA-Polytrauma Rehabilitation Center. Following cranioplasty, the patient emerged from PTA. He reported elaborate visual hallucinations which interfered with therapy participation but diminished with time. Results: Neuropsychological testing at 6 months post-injury was significant primarily for impairments in memory (CVLT-II and WMS-IV) and executive functioning (Oral Trails B and Verbal Fluency). He endorsed minimal emotional distress (BDI-II and PCL). Conclusions: This unique case highlights the presentation and course of a traumatically induced CBS in a young individual with no premorbid history of cognitive, psychiatric, or degenerative condition affecting the visual system.

graphic

Post-Craniectomy

AGR-2
Neuropsychological Outcomes Post-Lightning Strike: A Case Study

Abstract

Objective: Although believed to be underestimated, the incidence of lightning strikes is reported as 375–1500 annually (Duclos & Sanderson, 1990). Neurologic complications range vastly from momentary to permanent. Most survivors report an immediate loss of consciousness, confusion, or paralysis of limbs; however, empirical evidence suggests the potential for neural abnormalities, cognitive deficits, and behavioral alterations. Cognitive impairments frequently present as visual-motor, attention, memory, executive functioning, and language deficits (van Zomeren et al., 1998), while behavioral reports include increased aggression and depression. The objective of this single-case study is to explore the effects of a lightning strike on neuropsychological function. Methods: This case describes a right-handed, 36-year-old woman who was referred for a neuropsychological evaluation secondary to being struck by lightning and reports of significant cognitive and emotional disturbance which negatively impacted the work. Neuropsychological data, de-identified history, and neurologist report will be organized and presented in a single-case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed significant weaknesses in sustained attention, processing speed, cognitive flexibility, working memory, picture naming, verbal memory, and non-verbal reasoning. With regard to mood, there was evidence of severe depression and anxiety. Conclusions: The patient presented with deficits consistent with the effects of lightning on neurocognitive function. Neuropsychological assessment can be extremely helpful in clarifying the exact nature and extent of difficulties, thereby guiding intervention.

AGR-3
Cerebellar Cognitive Affective Syndrome and Beyond: The Neuropsychology of the Cerebellum

Abstract

Objective: Understanding of the cerebellum's role in the human cognitive system is undergoing an exciting, controversial evolution. Clinical experience has raised the possibility that the cerebellum may contribute to higher cognitive function in ways not appreciated previously. This presentation carefully examines the academic and practical merit of this idea. Methods: The change in cerebellar cognitive theory over time is examined by briefly reviewing the contributions of pertinent theorists from the late 1700s to current. The structure and neuroanatomical correlates of the recently proposed Cerebellar Cognitive Affective Syndrome (CCAS) are discussed in light of this history, and the current “State of the Theory” is evaluated in a small population of stroke patients (n = 9) with cerebellar infarctions. Results: Evidence for the cerebellum's potential role in executive functioning is the most reliable finding between the current small sample and data presently available in the literature. However, the most striking finding in the present sample was verbal memory impairment, which is not considered by the CCAS construct. In addition, the mechanism causing the verbal/language impairments involved in the CCAS construct is not yet satisfactorily explained. Finally, the most severe cognitive impairment in the current sample occurred after right superior cerebellar artery infarction, which perfuses territory purportedly not involved in cognitive functioning. Conclusions: The data available neither confirm nor conclusively discredit the construct of CCAS. Although it is difficult to disentangle broader theory from this proposed syndrome, doing so lends much greater utility to our understanding of the brain's cognitive networks than adopting or rejecting a single syndrome.

FGR-1
Neuropsychological Consultation Regarding Possible “Low IQ” in a Spanish Speaker: Ethical Considerations in a Cross-Cultural Forensic Context

Abstract

Objective: Referral for neuropsychological (NP) evaluation was made by subject's criminal defense attorney to determine whether multiple concussions may have resulted in any lasting effect and/or any cognitive or psychological dysfunction making her susceptible to coercion. Subject was a 36-year-old, Mexican woman with 6 years of formal education, who was charged with Drug Sales and Distribution, which was documented by wiretaps. Methods: Medical records documented multiple concussions and an anxiety disorder. An NP evaluation was conducted, consisting of clinical interviews, symptom validity testing, and NP tests in Spanish. The prosecution's Spanish-speaking neuropsychologist audio taped his evaluation. Neuropsychologists were not permitted to share their raw data, but the audio tape was shared with the defense team's neuropsychologist. Results: Subject performed well on embedded and free-standing symptom validity measures. Intellectual functioning was identified as low average (FSIQ = 82 and WAIS-III from Spain) by defense and estimated as average by prosecution (without tests of intellectual functioning). NP scores ranged from borderline impaired to average, and there were historical reports of problems in school (repeated first and third grades). Prosecution NP evaluation resulted in scores in the average range. Review of audio tape revealed extensive coaching. Axis I disorders included PTSD by defense versus Adjustment Disorder by prosecution. Conclusions: Subject's performance and history were consistent with lifelong low IQ and correspondent increase in susceptibility to coercion. After sentencing, the prosecution neuropsychologist was contacted to informally resolve ethical concerns. The present case is used as a model for discussion about the evaluation of Spanish speakers and relevant ethical standards.

FGR-2
A Capital Case Involving the Atkins Defense

Abstract

Objective: Referral was made by the State of Louisiana in a capital case in which the defendant raised the issue of mental retardation (MR). Methods: Subject was a 35-year-old man incarcerated in Baton Rouge, LA with charges of First-Degree Murder and Armed Robbery. He left high school in the 11th grade and has worked as a motorcycle mechanic. In the Louisiana Code of Criminal Procedure Article 905.5.1, the State has the right to an independent examination of the defendant concerning issues pertaining to the diagnosis of MR/Intellectual Disability (ID) under Atkins. Results: The findings from the Defense and the State revealed IQ scores in the low-mid 1970s, with evidence for adequate adaptive functioning (albeit with some inadequacies), and little evidence for developmental delays. The Defense raised the issue of the Flynn Effect (FE), a phenomenon of upward progression of IQ scores over time. The controversy over the FE is explored. The focus on a single IQ score was seen as an impediment to the understanding of the defendant's overall intellectual functioning. The difficulties of assessing adaptive functioning in the jail/prison environment are discussed. Validity issues were not problematic in this particular case. Conclusions: Broader examination of the defendant's intellectual abilities, adaptive functioning, and developmental period indicated that a diagnosis of MR/ID was not appropriate in his case.

DGR-1
Intra-operative Language Mapping in a native-Greek speaking, multilingual patient

Abstract

In the United States, the neuropsychological assessment of native-Greek speaking individuals commonly includes the use of translated instruments and interpretive services. This case presentation will consider the clinical implications of utilizing translated measures versus the clinical utility of culturally adapted instruments in the context of surgical language testing. Neuropsychological assessment is an essential component of the presurgical evaluations of craniotomy candidates. As such, the neuropsychological referral may include evaluating suitability for surgery, the localization and lateralization of pathology, determining surgical parameters and predicting surgical outcomes. Further, when surgical parameters threaten language functions, the neuropsychologist may be called to conduct intraoperative language testing. Due to the time limits of the surgical setting and increased risk of patient discomfort, brief and valid assessments are of critical importance. Yet, despite a growing body of literature illustrating the impacts of nonnative-speaker status and culture on neuropsychological instrument performance, intraoperative language assessments often rely on directly translated measures. Intraoperative language mapping was conducted to elucidate critical language areas in the vicinity of a left parietal neoplasm in a right handed, native-Greek speaking, multilingual (Greek, English, Spanish) man. Baseline preoperative language assessments and intraoperative assessments were conducted in both English and Greek by a bilingual clinician. The salient issues explored will include a. the effective applicability of current language measures across cultural contexts, b. the psychometric properties and equivalency of translated assessments, and c. the use of the existing normative data.

DGR-2
Cultural Neuropsychology: Bilingual English-Persian (Farsi) Language Assessment in the Surgical Context

Abstract

Neuropsychological assessment of bilingual English-Persian (Farsi) speaking patients has been largely understudied despite the growth of Iranian-American and other Persian speaking populations (e.g., certain populations in Afghanistan, Tajikistan, etc.). The current clinical practice has mainly relied on the use of interpretive services or referral to professionals who speak the Persian language and use language specific instruments to assess neurocognitive functioning. With regard to the latter, clinical and psychometric issues can arise with the translation of tests and/or use of language specific instruments developed in the patient's native country. The case of an early 60s, right-handed, Iranian-American male with 18 years of education, diagnosed with a left temporal-parietal tumor and seizures will be presented to identify potential challenges in neuropsychological assessment and diagnosis. Data from the patient's pre-surgical, intra-operative language mapping, 6-month post-surgical, and 1.5-years post-surgical neuropsychological tests administered in the Persian and English language will also be presented. This discussion will highlight the following educational topics related to the assessment of bilinguals: 1) impact of socio-demographic factors, acculturation, and language usage (L1 vs L2) on test results; 2) translation issues with regard to word frequency, word length, and item equivalence; and 3) appropriateness of tests and use of normative data in the United States and Iran. The need for further instrument development specific to bilinguals will also be discussed.

A-1
Gender Differences on Judgment of Line Orientation in Patients with Alzheimer's Disease: An Examination of Global Performance and Error Types

Abstract

Objective: This project investigated gender differences on the judgment of line orientation (JOLO) in patients with Alzheimer's disease (AD) by examining raw scores and error types. It was hypothesized that men with AD would score higher on the JOLO than women with AD. Methods: Archival data from 61 patients (26 men and 35 women) were analyzed. Patients were diagnosed with AD if they met DSM-IV-TR criteria based on interview and neuropsychological testing. JOLO raw scores were used. Error type analysis was conducted using a modified coding protocol based on the work of Ska and colleagues (1990). Errors fell into four categories: (a) Intraquadrant, (b) Vertical/Horizontal, (c) Interquadrant, and (d) Combination. Results: Groups did not vary in age or Dementia Rating Scale-2 (DRS) raw score. Overall, women scored lower on the JOLO (Mf = 15.3, SD = 5.4; Mm = 21.0, SD = 4.6; p < .001). A hierarchical multiple regression was conducted with years of education as Step 1, DRS raw score as Step 2, and gender as Step 3. Gender accounted for nearly 20% of the variance (p < .001). The number of men and women making each error type was not significantly different. Over 95% of patients made Intraquadrant errors, over 45% made Vertical/Horizontal errors, over 35% made Interquadrant errors, and over 20% made Combination errors (Table 1). Conclusions: As in the neurotypical population, men with AD perform better than women with AD on the JOLO. Gender was a more powerful predictor of performance on the JOLO than years of education and dementia severity. Intraquandrant errors were made by virtually all patients, and nearly half of patients misidentified a vertical or horizontal line.

Table 1.

Hierarchical regression for JOLO raw score

 Model 1 (B [SE]) Model 2 (B [SE]) Model 3 (B [SE]) 
Constant 17.719 (0.708), p < .001 17.719 (0.704), p < .001 20.788 (0.996), p < .001 
Education 0.637 (0.255), p = .015* 0.585 (0.257), p = .027* 0.273 (0.242), p = .265 
DRS — 0.102 (0.082), p = .218 0.133 (0.074), p = .076 
Gender — — −5.347 (1.345), p < .001* 
Model R2 .096 .120 .311 
ΔR2 — .024, p = .218 .191, p < .001* 
 Model 1 (B [SE]) Model 2 (B [SE]) Model 3 (B [SE]) 
Constant 17.719 (0.708), p < .001 17.719 (0.704), p < .001 20.788 (0.996), p < .001 
Education 0.637 (0.255), p = .015* 0.585 (0.257), p = .027* 0.273 (0.242), p = .265 
DRS — 0.102 (0.082), p = .218 0.133 (0.074), p = .076 
Gender — — −5.347 (1.345), p < .001* 
Model R2 .096 .120 .311 
ΔR2 — .024, p = .218 .191, p < .001* 

Note: DRS = Dementia Rating Scale-2.

A-2
Cognitive Behavioral Therapy (CBT) Appears to Improve Cognitive and Psychological Functioning

Abstract

Objective: There is ample evidence to support that cognitive behavioral therapy (CBT) can improve the quality of life and cognitive processing in individuals with mild or severe psychopathology. The current research was interested in evaluating its utility in individuals with mild cognitive impairment (MCI). Methods: In a sample of 28 elderly individuals diagnosed with MCI (ages ranged from 65 to 88), a neuropsychological battery was used to assess their cognitive and psychological functioning pre-and-post treatment. The treatment included 8 weekly meetings of CBT and spouse support. All individuals remained for the entire course of treatment, which addressed their stress, anxiety, everyday difficulties, and worries about their reduced cognitive skills (e.g., memory, concentration, vigilance, etc.). Twenty-eight matched individuals were used as control. Results: Data analyses showed that after 8 weeks, the CBT participants and their spouses were reporting better psychological functioning, better quality of life, and better cognitive acuity. The psychological and neuropsychological assessment confirmed their claims and showed improved memory, vigilance, and concentration. The control group did not present with the same improvements. Conclusions: These findings show that MCI's medical treatments can be enhanced with CBT, while it raises the scientific questions of CBT's utility in early stage dementias.

A-3
Normative Data for Mexican American on tasks of Executive and Physiometric Functions: The Texas Mexican American Normative Studies

Abstract

Objective: Over 50% of the increase in the U.S. population from 2000 to 2010 was due to growth in the Hispanic population, 70% of which is Mexican American. Yet, there are few normative references available for this rapidly aging segment of the population. The Texas Mexican American Normative Studies (TMANS) was undertaken to fill this gap by combining data across multiple studies conducted in Texas. Methods: For the current project, data were analyzed from 489 English- and Spanish-speaking Mexican Americans (332 women and 157 men) recruited as part of multiple Texas-based studies, including Project FRONTIER, the Texas Alzheimer's Research and Care Consortium (TARCC), and clinic-based studies from Baylor College of Medicine and the University of Texas Southwestern Medical Center. Approximately one third of the Mexican American sample was tested in Spanish (n = 125). Results: Normative tables were created for both English and Spanish-speakers on the following tests: Exit 25, CLOX, Trail-Making Test-A and B, and the Ravens Colored Matrices, along with the Brief Smell Identification Test and Grip Strength. The norms are stratified by age and language of administration. Tables presented in the body of the poster (see Table 1 for example). Conclusions: With the rapidly expanding, and aging, Mexican American U.S. population, neuropsychologists require adequate normative references for both clinic and research use. The TMANS was undertaken to fill this gap. The current references on measures of executive function and physiometric tests used in the evaluation of cognitive impairment will provide valuable information to neuropsychologists.

Table 1.

Trails A scores by age and language in Mexican American

Scaled scores Spanish
 
English
 
Age ≤ 58 (n = 52) Age > 59 (n = 38) Age ≤ 63 (n = 166) Age > 64 (n = 163) 
≥102 ≥150 ≥99 ≥150 
101  86–98 123–149 
95–100  83–85 100–122 
85–94  68–82 89–99 
82–83 124–149 59–67 76–88 
74–81 108–123 52–58 60–75 
70–73 96–107 48–51 54–59 
62–69 73–95 43–47 46–53 
53–61 69–72 39–42 41–45 
10 47–52 57–68 33–38 38–40 
11 43–46 52–56 30–32 32–37 
12 40–42 46–51 26–29 29–31 
13 37–39 41–45 24–25 26–28 
14 30–36 25–40 21–23 23–25 
15 ≤29 ≤24 ≤20 ≤22 
Scaled scores Spanish
 
English
 
Age ≤ 58 (n = 52) Age > 59 (n = 38) Age ≤ 63 (n = 166) Age > 64 (n = 163) 
≥102 ≥150 ≥99 ≥150 
101  86–98 123–149 
95–100  83–85 100–122 
85–94  68–82 89–99 
82–83 124–149 59–67 76–88 
74–81 108–123 52–58 60–75 
70–73 96–107 48–51 54–59 
62–69 73–95 43–47 46–53 
53–61 69–72 39–42 41–45 
10 47–52 57–68 33–38 38–40 
11 43–46 52–56 30–32 32–37 
12 40–42 46–51 26–29 29–31 
13 37–39 41–45 24–25 26–28 
14 30–36 25–40 21–23 23–25 
15 ≤29 ≤24 ≤20 ≤22 

A-4
Longitudinal Assessment of Neuropsychological Predictors for Driving Risk Prediction

Abstract

Objective: Prior studies have shown that measures of visuomotor speed, visual attention, and visuospatial skills have been linked to driving impairment in older adults, but most data are concurrent in nature. The present study examined whether cognitive impairment was prospectively related to performance on a driving screen measure (Useful Field of View, UFOV). Methods: Longitudinal assessment of 27 community dwelling older adults with no neurological history (average 69 years of age, average 16 years of education, 5 men) were administered a neuropsychological battery at Time 1 and then administered a driving screen as part of a driving study an average of 22 months later (range 15–30 months). Out of the battery of tests administered at Time 1, we focused on those most commonly linked to driving in prior research (Trail-Making Test [TMT] parts A and B, and Repeatable Battery for the Assessment of Neuropsychological Status Figure Copy, Line Orientation, and Coding subtests). Results: After controlling for age, slower TMT A (r = .55) and worse Figure Copy (r = − .40), Line Orientation (r = − .38), and Coding (r = − .48) at Time 1 were all significantly related to higher risk of driving impairment as judged by UFOV at Time 2. Conclusions: Results suggest that neuropsychological screeners may be useful in the detection of driving risk even in older adults without dementia diagnoses.

A-5
False Positive Rates of Effort Index versus Effort Scale in Repeatable Battery for the Assessment of Neuropsychological Status

Abstract

Objective: Embedded measures of effort have proven to be useful additions to malingering assessment. Silverberg and colleagues (2007) proposed an effort index (EI) for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which appeared to be both sensitive and reasonably specific to malingering in the context of neurorehabilitation outpatient assessment. Because the RBANS is often used for dementia screening, in which there are higher rates of generalized cognitive impairment, the EI may show lower specificity in older adult samples. Recently, Novitski and colleagues (2012) proposed a different Effort Scale (ES) for the RBANS, finding a much lower rate of false positive errors in individuals with dementia. Methods: The present study examined the false positive rates of both the EI and the ES in a sample of 79 older adults (59% women and 91% Caucasian) with mean age 68 (range 56–88) and on average a college education (10–25 years); none had dementia and all were active drivers who were participating in a larger driving study. Results: Using the cutoffs given for the EI, this sample had a 4% false positive rate. Using the cutoff given for the ES, this sample had a 1% false positive rate. The two scales did not identify the same individuals, and there were no remarkable demographic, medical, or other neuropsychological features of the false positives. Conclusions: Future studies should consider to evaluate the utility of embedded measures of effort on neuropsychological screening measures such as the RBANS.

A-6
Association of the DRD4 VNTR Polymorphism with Executive Functions

Abstract

Objective: The Dopamine Receptor 4 (DRD4) gene is one of several genes thought to be involved in cognition. One polymorphism, the 7-repeat form of the 48-bp variable number tandem repeat (VNTR) has been associated with ADHD. Our objective was to examine whether the DRD4 genotype influences cognition in healthy, cognitively normal older adults. Methods: Eighty-six community dwelling older adults (age >65) were given a battery of neuropsychological tests that included measures of verbal and design fluency, inhibition, list learning, and reaction time. Composite scores for executive functions and verbal and spatial reaction times were calculated. The sample was divided into carriers and non-carriers of the 7-repeat allele of the DRD4 VNTR. A general linear model was constructed using the DRD4 7-repeat status as a predictor variable. Results: The presence of the 7-repeat allele of DRD4 was associated with significantly lower scores on the executive function composite score (t = − 2.214, p = .029) and a less number of total items recalled on the learning trials of the CVLT-II (t = − 2.269, p = .028), but not with the number of items recalled after a 20-min delay. There was no significant association of the DRD4 genotype with reaction times. Conclusions: The 7-repeat allele of the DRD4 VNTR was associated with poorer executive functioning. There was no significant difference between carriers of the 7-repeat allele and non-carriers on delayed verbal memory or reaction times. This finding highlights the importance of understanding the role of genetics in cognition.

A-7
Reliable Change Index Scores for FAS Phonemic Word Fluency

Abstract

Objective: Reliable change index (RCI) scores for phonemic word fluency (PWF) were determined for participants in four age groups (50–59, 60–69, 70–79, and 80–89) who had repeat testing within 9–15 months of the baseline. RCI scores indicate how much an individual's PWF score must change to be significant at the 95% confidence level. Methods: Participants were older adults without dementia. There were 62 participants in their 50s, 185 in their 60s, 120 in their 70s, and 39 in their 80s. The mean age of the sample was 67.93, education = 14.95, MMSE = 29.05, and %women = 70.91%. For the PWF task, each participant was asked to generate words beginning with the letters F, A, and S (three 1-min trials). The mean PWF score for the total sample was 39.69 words and for the four age groups were 40.02, 40.49, 39.07, and 37.17, respectively. Results: The RCI for the total group was 11.60, indicating that an older adult's total PWF score must change by 12 or more points to be 95% confident that the change was not due to chance. RCI scores for the four age groups were 13.88, 11.31, 9.82, and 14.60, respectively. A minimum 14-point change on the PWF score is needed to reach statistical significance for persons 50–59, 12 for those 60–69, 10 for those 70–79, and 15 for those 80–89. Conclusions: A change of at least 14, 12, 10, and 15 points on PWF for the four age groups, respectively, is needed for a statistically reliable change for an individual older adult.

A-8
Subjective Cognitive Complaint Endorsement Rates Remain Stable with Age

Abstract

Objective: The report of a cognitive complaint is necessary for the diagnosis of mild cognitive impairment, but many older adults complain of cognitive changes. To better understand subjective complaint, we assessed endorsement rates of cognitive complaint among cognitively normal (CN) older adults. Methods: Participants were from the National Alzheimer's Coordinating Center and included 3819 CN individuals (71 ± 11 years, 67% women) with a subjective cognitive complaint. Age cohorts were created: (a) 60–69 (n = 2,066), (b) 70–79 (n = 2,571), and (c) 80–89 (n = 1,363) were generated. One hundred and twelve of these participants (76 ± 8 years, 63% women) completed a cognitive complaint survey of commonly administered cognitive complaint questions (e.g., do you have problems with your memory? do you think that your memory is worse than 2 years ago?). Results: χ2 analyses revealed no difference in endorsement rates of cognitive complaint across age cohorts (20% endorsement rate in 60–69, 18% in 70–79, and 20% in 80–89, χ2 = 4.3, p = .12). Specific questions assessing subjective complaint showed different endorsement rates across the cohorts with the 70–79 cohort evidencing greater endorsement on the questions “remembering familiar phone numbers” (χ2 = 6.3, p = .01) and “difficulty recognizing familiar people” (χ2 = 5.9, p = .02) than the 60–69 cohort. Conclusions: Findings suggest that the frequency of subjective cognitive complaints remains stable with age in CN adults. However, methods of assessing cognitive complaint may produce different endorsement rates with age, highlighting the need to understand the best ways to assess subjective cognitive complaint to distinguish between worried well complaints and complaints that may represent the earliest clinical signs of an underlying neurodegenerative process. Acknowledgements: AG013846, AG030962, IIRG-08-88733, AG034962, AG036697, AG016976.

A-9
Examining Age-Related Changes in Left Hemisphere Functional Cerebral Systems Before and After Exposure to Pre-Digestive Stress: Evidence in Support of the Capacity Model

Abstract

Objective: The current research examined age-related changes in left hemisphere function to provide further support for the capacity model (Holland, Carmona, & Harrison, 2012). We predicted that older women would evidence a diminished capacity to regulate left hemisphere functional cerebral systems proposed to regulate the ingestion, absorption, and pre-digestion of food concurrent with completing a left-lateralized cognitive task. Methods: Right-handed women ages 55–85 (n = 20) and 18–26 (n = 21) were administered the Controlled Oral Word Association Task (COWAT) before and after ingesting 44–48 g of carbohydrates. Electroencephalography readings were taken before and after each experimental manipulation to assess changes in left hemisphere activation in the frontal and temporal electrode sites. Results: A main effect for Age was found for low beta power, F(1, 24) = 5.17, p < .05, indicating increased low beta power in older women relative to younger women across conditions. An Age × Condition interaction—F(1, 24) = 2.73, p < .05—indicates a relative increase in low beta power in the post stress conditions for older women. A main effect for Age was also found for the number of rule violations made on the COWAT—F(1, 38) = 5.84, p < .05, indicating that older adults made more rule violations across both administrations of the COWAT. Conclusions: The results provide promising preliminary evidence in support of the capacity model. Older women evidenced increased low beta power in the post stress conditions. Moreover, older women showed a reduction in capacity to maintain performance on the COWAT relative to their younger counterparts.

A-10
Functional Impairment in MCI when Measured by a Performance-Based Instrument

Abstract

Objective: Older adults (OAs) with mild cognitive impairment (MCI) by definition do not have impairments in activities of daily living (ADLs). However, recent evidence suggests that OAs with MCI may have problems performing complex ADLs (IADLs). ADLs are frequently evaluated through self or collateral report, while observer rating scales are rarely used even though they may be the most accurate representation of ADLs. This investigation compared self-report, collateral-report, and performance-based measures of functional status. We hypothesized that OAs with MCI would have compromised IADLS on a performance-based measure of functional status. Methods: Twenty-nine normal OAs and 22 OAs with MCI ages 65–85 completed the study. Participants had reliable collaterals, were literate by self-report, were not demented, or had a history of a neurological disorder. Participants and collaterals first were interviewed with the Clinical Dementia Rating Scale by a trained examiner. Subsequently, participants and collaterals completed an ADL questionnaire. Participants were then administered the Direct Assessment of Functional Status (DAFS). Results were analyzed with MANOVA in SPSS 17.0. Results: As hypothesized, OAs with MCI had decreased IADLS on the DAFS. However, there were no IADL differences between groups on self- or collateral report. Additionally, BADLs for both groups were the same. Conclusions: Contrary to current definitions, decreased ability to perform IADLs is evident in MCI. Importantly, this clinical observation is only evident when a performance-based measure is used. Results suggest our conceptualization of MCI may need to be reconsidered. Further, ADLs may be more accurately assessed by performance-based measures instead of self-reports.

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A Case Study of Dyslexia Diagnosed in an Older Adult

Abstract

Objective: Since learning disabilities are typically diagnosed in childhood, they may not be fully considered when assessing older adults. This case study of a 62-year-old man illustrates the importance of considering learning disabilities as potential etiologic factors in older adults experiencing impaired functioning on tasks dependent on academic skills. Methods: The patient was referred due to failing a recently implemented professional certification examination multiple times. Educational history included poor reading comprehension and “special classes” during the early school years. Forgetfulness and depressed mood emerged ∼3 years ago shortly following his first examination failure and have worsened. A brain MRI and an EEG were normal. A neurological evaluation was normal and attributed the patient's memory problems to poor sleep and depression. Results: The most clinically salient test data revealed verbal memory, verbal intellectual functioning, and reading achievement in the borderline range. Confrontation naming was mildly impaired and letter fluency was moderately impaired. Conversely, perceptual reasoning, visual memory, non-verbal concept formation, mental flexibility, and math computation ranged from average to above average. Symptom validity testing was within normal limits. Conclusions: Overall, evaluation findings revealed deficits in cognitive and academic skills primarily mediated by the left hemisphere and that dyslexia was a major reason for the patient's inability to pass the certification examination. This case study underscores the importance of assessing for the presence of learning disabilities in older adults experiencing difficulty on tasks dependent on academic skills. This practice is likely to increase diagnostic accuracy and the implementation of appropriate interventions.

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Base Rates of Reliable Cognitive Decline on Wechsler Variables in an Elderly Clinical Sample

Abstract

Objective: To compare base rates of reliable cognitive decline (RCD) among clinically referred older adults on the Wechsler Adult Intelligence Scale (WAIS) Indexes and the Wechsler Logical Memory (LM) subtests. Methods: Patients (n = 237) seen for repeat assessments in a cognitive disorders clinic with MMSE scores >21 were divided into three cohorts defined by Wechsler retest combination: Patients administered the Wechsler 3rd (W33; n = 115) or 4th editions (W44; n = 54) twice and those given edition-3 and then edition-4 (W34; n = 68). Reliable change regression equations were generated for each retest combination using Wechsler test–retest standardization data and applied to the respective clinical cohorts, with RCD defined as predicted difference z-scores of <− 1.645. Results: Cohorts were comparable on demographics and baseline WAIS performance; however, modest baseline LM differences were noted. Incidence of RCD exceeded normative base-rate expectations on all Wechsler indexes (22.6%–32.2%) and memory scores (47.7%–64.1%). These compare favorably with the MMSE (52.3%) and DRS (64.6%). However, significant base-rate differences were noted between retest combinations for some variables. Generally, those given W34 showed the lowest rates of decline on WAIS measures but the highest rate of delayed memory decline. Conclusions: High rates of RCD were observed within and across Wechsler test editions for the WAIS and LM in our high-risk clinical sample. Although the three cohorts were highly comparable, differences were noted between retest combinations for several variables, suggesting that regression equations optimized on different normative samples may have differential sensitivities when applied in clinical samples.

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The Predictive Power of Openness on Memory Ability in Older Adults with Mild Cognitive Impairment

Abstract

Objective: While it appears that both cognitive status and personality traits, such as those within the 5-factor model, have an impact on cognitive performance in older adults, few studies have assessed their combined impact. The Openness trait has been associated with better memory performance in non-demented older adults, but this relationship has not been investigated in samples with memory impairments. Methods: Fifty-three community-dwelling adults ages 65–84 (31 cognitively intact; 22 Mild Cognitive Impairment as determined by the Clinical Dementia Rating Scale) completed measures of personality (NEO-FFI) and mood symptomatology (Geriatric Depression Scale: GDS), and underwent a multidomain neuropsychological examination (Repeatable Battery of Neuropsychological Status: RBANS). Results: As expected, demographic variables (age, years of education, gender, and estimated premorbid IQ) and the current GDS score explained a significant amount of variance of RBANS immediate memory (27.8%). After controlling for these variables, cognitive status (MCI or cognitively-intact) further explained a significant portion of variance in memory performance (8.5% additional and 36.3% total; p = .011). Finally, adding Openness to this hierarchical linear regression model explained a significant additional portion of variance (13.4% additional and 49.7% total; p = .001). Conclusions: Not surprisingly, cognitive status contributes to explaining the variance in memory performance among older adults. However, the trait Openness was significantly related to better memory performance above and beyond one's cognitive status and demographic variables, suggesting that a lifelong pattern of involvement in new cognitive activities may protect from memory decline. This study suggests that personality may be a powerful predictor of memory ability and clinically useful in this population.

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The Link Between B12 and Neuropsychological Functioning Among Non-Hispanic and Mexican American Adults and Elders

Abstract

Objective: Numerous studies have documented a link between low vitamin B and poorer cognition; however, little work has focused on underserved Mexican-American adults and elders. The present study examines the effect of vitamin B12 on cognition in a non-Hispanic white and Mexican-American sample. Methods: Data were analyzed from a sample of 477 non-Hispanic whites (n = 236) and Mexican Americans (n = 211) who were recruited as part of Project FRONTIER, an ongoing epidemiological study of health among rural-dwelling individuals. B12 status was classified as Unlikely Deficient (UD; B12 ≥ 350 pg/ml) or Likely/Possibly Deficient (L/P D; B12 = 0–350 pg/ml). Results: Among the non-Hispanic whites, UD B12 group status was significantly related to lower scores on CLOX1, whereas L/P D B12 was significantly related to higher scores on CLOX2. Among Mexican Americans, high B12 levels were significantly related to lower scores on executive functioning. Among the Mexican Americans, UD B12 levels were significantly related to higher scores on a measure of language functioning. Conclusions: B12 supplementation is a common recommendation; however, the results of this study suggest a complex role of B12 in cognitive aging. It is possible that B12 metabolism needs to be accounted for, but also that a simple assessment of B12 may provide inadequate information to assess the relationship and that other biological markers (e.g., homocysteine, folate, inflammation, and liver functioning) must be taken into account simultaneously.

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Normative Data for the Victoria Stroop Test in a Memory Clinic Population

Abstract

Objective: Normative data with older adults are lacking for the Victoria Stroop Test (VST; Bayard, Erkes, & Moroni, 2011; Strauss, Sherman, & Spreen, 2006; Spreen & Strauss, 1998; Troyer, Leach, & Strauss, 2006). This study generated norms for a memory clinic population. Additionally, we examined performance on the VST in relation to age and diagnostic groups. Methods: A convenience sample of 277 consecutive patients referred to the East Central Florida Memory Disorder Clinic (ECFMDC) for brief neuropsychological evaluation was used. Participants were predominantly Caucasian (94.5%), with 55% women and 45% men. Mean education was 14 years. Participant ages ranged from 44 to 95 (M = 76). Correlation coefficients for the VST subtests were generated in relation to age. A MANOVA was conducted for VST subtests across diagnostic groups, including AD, other dementias, Mild Cognitive Impairment, psychiatric disorders, and no cognitive impairment (NCI). Results: A positive correlation was found between age and VST scores, with the exception of interference (p < .001). Results of the MANOVA showed that scores for the VST differed across diagnoses. Mean scores for time to complete VST subtests were significantly higher for the AD group than the NCI group (Dots: M = 8.10 s, SD = 1.95 s; Word: M = 13.71 s, SD = 3.17 s; Color/Word: 36.46 s, SD = 7.87 s; Interference: M = 1.69 s, SD = 0.98 s; Errors: M = 2.32, SD = 0.61). Conclusions: The VST is a useful measure for the memory clinic population despite the effect of age on test performance since it differentiates between individuals with and without cognitive impairments due to significant differences in their completion time and errors produced.

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Preliminary Look: Comparison of the Effort Index and Effort Scale on the RBANS

Abstract

Objective: Two embedded measures have been developed in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). This study sought to determine sensitivity and specificity of the Effort Index (EI) and Effort Scale (ES) in coached simulating (CS) and naïve simulating (NS) groups compared with individuals diagnosed with dementia (DS) using preliminary data from an ongoing study. Methods: The RBANS was administered to a CS (n = 18) and an NS (n = 13) group of graduate students and a DS (N = 9) from a skilled nursing facility. The Medical Symptom Validity Test (MSVT) was given in order to determine effort. Participants were excluded in the DS, if MSVT showed poor effort or normal memory for the CS and NS. Results: Predictive statistics revealed a receiver operating characteristic (ROC) area under the curve (AUC) of 0.88 for the comparison of NS with the DS on the EI, while an AUC of 0.93 on the ES. When looking at CS compared with the DS, the ROC analysis revealed an AUC of 0.91 on the EI and an AUC of 0.84 on the ES. Sensitivity on the EI and ES were 0.78, while the specificity ranged from 0.85 to 0.87 on the EI and 0.79 to 1.0 on the ES. Conclusions: This preliminary study suggests that the EI and ES may lead to unacceptably high false positives among those with verified dementia. Sensitivity and specificity were generally high for both measures of effort for simulator and dementia groups. The major limitation of this study is the very limited sample size.

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Utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in Differentiating Between Types of Dementia

Abstract

Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a frequently used screener in the assessment of memory functioning. Retention rates (RRs) on the RBANS have been used to distinguish dementia from no dementia (ND; Schoenberg et al., 2008) and amnestic mild cognitive impairment from Alzheimer's disease (AD; Clark, Hobson, & O'Bryant, 2010). The purpose of this study was to investigate the RR differences in AD, Vascular Dementia (VD), and ND groups. Methods: Thirty-eight archived cases from a local inpatient geriatric unit were reviewed. Inclusion criteria included RBANS raw scores and diagnosis of AD, VD, or ND. Results: There was a statistically significant difference between groups for Story Retention, F(2, 24) = 5.2, p = .01, and Figure Retention, F(2, 34) = 5.33, p = .01. No significant difference was found between groups for List Retention, F(2, 32) = 1.63, p = .21. Post hoc comparisons indicated that subjects in the ND group performed significantly better than subjects in both the AD and VD groups. However, the AD group did not differ significantly from the VD group. Conclusions: These findings suggest that RR is able to distinguish ND from VD and AD, but not AD from VD. Current results indicate that the RR may be able to differentiate dementia diagnosis from cognitive impairment without the presence of dementia, but further research should focus on larger sample sizes to determine if the RR can separate by type of dementia.

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Comparison of the Reliable Digit Span and Age-Corrected Scaled Score on the WISC-IV as a Measure of Effort in Children

Abstract

Objective: This study aimed to investigate the specificity of Reliable Digit Span (RDS) and Age-Corrected Scaled Scores (ACSSs) on Digit Span in the WISC-IV on psychoeducational evaluations. Methods: The sample included 129 archived psychoeducational evaluations from private and community mental health practices. Inclusion criteria were a diagnosis of Reading Disorder (RD), Mathematics Disorder (MD), Disorder of Written Expression (DWE), and/or Attention Deficit-Hyperactivity Disorder (ADHD) and a WISC-IV protocol. Cutoff scores proposed by Kirkwood and colleagues (2011) for the RDS and ACSS were used. Results: Specificity for the entire sample on the ACSS was 80.6% and on the RDS was 68.2%. Among participants diagnosed with RD, the specificity of ACSS was 78.5% and RDS was 62.5%. Specificity of 63.2% and 73.7% on RDS and ACSS, respectively, was seen in participants diagnosed with MD. A specificity of 72.7% on ACSS and 60.6% on RDS in individuals diagnosed with DWE. Specificity was 83.1% on ACSS and 71.2% on RDS in participants diagnosed with ADHD. Overall, specificity for ACSS was 70%, and RDS was 55.1% for individuals with a full-scale IQ of 85 or less. Conclusions: This study suggests that RDS and ACSS may have specificity concerns when used as an embedded symptom validity measure for children with learning disorders and ADHD, especially for children with a full-scale IQ of ≤85. However, specificity was greater across all groups with the use of the ACSS. A caveat regarding these data is that the children were not screened for poor effort.

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Predicting Academic Achievement: Does Working Memory Mediate Global Ability?

Abstract

Objective: The purpose of this study was to examine the potential that specific aspects of memory mediate the effects of global ability on academic achievement. In particular, the study tests three models, using verbal recall, visual recall, or working memory as mediators. It was hypothesized that verbal recall and working memory would mediate the effects of ability on achievement. Methods: The participants were 295 consecutive referrals to a tertiary care center in the southeastern USA, ranging in age from 6.00 to 16.75 years. The children were administered a combination of neuropsychological measures: The Children's Memory Scale (Cohen, 1997) measuring verbal memory, visual memory, and working memory; the third or fourth edition of the Wechsler scales (Wechsler, 1991, 2003) measuring global ability; and the third or fourth edition of the Wide Range Achievement Test (Wilkinson, 1993) measuring academic skills. Participants were predominantly men (66.10%) and predominantly Caucasian (77.29%). Referrals were generally for learning or behavioral problems; 55.93% met criteria for ADHD; 50.16% met criteria for learning disability; other participants had a history of seizure disorder (37.29%); traumatic brain injury (7.12%); or other neurological condition (3.56%). Results: The results support the partial mediation of ability by working memory, as well as the contribution of verbal recall to the variance accounted for by global ability. Visual recall did not add to the variance explained by global ability. Conclusions: These results suggest that closer examination of specific aspects of memory, such as working memory and verbal recall, may increase the specificity and utility of comprehensive assessments of children.

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Evaluating the Differential Boost Model for the Extra Time Accommodation

Abstract

Objective: The most requested accommodation for students at the post-secondary level is extended time. There are two main perspectives, the maximum potential thesis, that learning disabled (LD) students will benefit significantly from the use of accommodations while non-LD students will not benefit with accommodations. The differential boost perspective hypothesizes that all students, whether they have a learning disorder or not, will improve in their scores with extra time. There is a third possibility that, for students who do not need extra time, the provision of extra time might be deleterious to test performance. Methods: Thirty-two undergraduate juniors and seniors at a small liberal arts college served as subjects. All students who participated in the study indicated that they were not using extra time as an accommodation. Students were administered both the standard and the extended time versions of the Nelson Denny and the TOVA. Results: Twelve students (37%) did not require extra time. Group 1 included nine students who scored worse on the reading comprehension with extended test time (mean 208, SD = 14.3266), and Group 2 included five students who improved (mean 181.8, SD = 9.09398). The third group included the six students who scored the same on the NDRT on timed and extended time 201.667, SD = 21.9241. There was a significant effect of test time on reading comprehension scores at the p < .05 level for the three conditions—F(4.360, 2), p = .030. Data indicated TOVA findings for D' Prime. Conclusions: Extra time benefited individuals, with or without an LD, who read poorly regardless processing speed deficiency. Some individual performance deteriorated when provided extra time.

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Achievement and Learning Children with ADHD, RD, ADHD plus RD, and Without Diagnosis

Abstract

Objective: This study explored differences in performance on measures of achievement and learning in children with ADHD, RD, ADHD + RD, and without diagnosis. Methods: Participants consisted of a mixed normal and clinical sample of 99 individuals aged 6–16 (M = 9.53, SD = 2.57) who took the WRAT-3 and 138 individuals aged 6–16 (M = 9.30, SD = 2.51) who took the WRAML. Differences among groups in scaled scores of the Reading, Spelling, and Arithmetic subtests of the WRAT-3 and the Design Memory and Verbal Learning subtests of the WRAML were evaluated. Results: ANOVA results revealed significant differences in Reading, F(3, 95) = 39.13, p < .001; Spelling, F(3, 95) = 34.52, p < .001; Arithmetic, F(3, 95) = 18.29, p < .001; and Verbal Learning, F(3, 134) = 4.92, p = .003. Follow-up analyses revealed significant differences in: Reading between ADHD and RD, p < .001, and all diagnostic groups and No Diagnosis, p < .001; Spelling between ADHD and RD, p = .004, and all groups and No Diagnosis, p < .001; Arithmetic between all groups and No Diagnosis, p < .001; and Verbal Learning between ADHD and No Diagnosis, p < .001, and ADHD + RD and No Diagnosis, p = .005. Conclusions: Results indicated that those with ADHD and ADHD + RD were impaired on Verbal Learning but not Design Memory, which suggests a possible auditory component to the learning difficulties associated with ADHD. This pattern of results suggested that deficits in verbal learning ability in ADHD and ADHD + RD were likely due to increased attentional demands and hyperactive behavior rather than reading ability. Since Arithmetic is partially a verbally mediated task, this may explain why those with ADHD and ADHD + RD were also impaired on this measure.

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An Examination of the Cognitive Correlates of Mathematical Abilities

Abstract

Objective: Although it has been hypothesized that visual-spatial and processing speed skills are required for performing mathematical computations, there is a dearth of literature regarding cognitive correlates of math skills. This study examined relationships between these cognitive skills and math abilities in youths. Methods: Participants were 233 youths selected from a clinical sample, ages 6–16 (M = 9.77, SD = 2.75); 64% were men and 86% were right-handed. Perceptual reasoning measures included WISC-IV Block Design (BD), Matrix Reasoning (MR), and Perceptual Reasoning Index (PRI). Processing speed measures included WISC-IV Coding (CD), Symbol Search (SS), and Processing Speed Index (PSI). Math abilities were assessed using WJ-III Achievement Math Calculation Skills (Calculation) and Math Reasoning (Reasoning). Results: Pearson's correlations assessed relationships between perceptual reasoning, processing speed, and math abilities (controlling for verbal abilities). Correlations were significant at p < .001. The PRI correlated with Calculation (.46) and Reasoning (.53); BD and MR scores correlated with Calculation (.23 and .46, respectively) and Reasoning (.31 and .54, respectively). The PSI correlated with Calculation (.37) and Reasoning (.33); SS and CD correlated with Calculation (.50 and .39, respectively) and Reasoning (.47 and .28, respectively). Conclusions: Visual-spatial measures and processing speed measures were significantly correlated with math abilities, indicating that these cognitive processes are vital for performing math skills. Treatment, therefore, should focus on improving these broader cognitive skills and not solely on specific calculation skills.

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Atypical Landau–Kleffner Syndrome (LKS) Versus a Developmental Language Disorder with Language Regressions and Continuously Abnormal EEG: A Case Study

Abstract

Objective: Neuropsychologists and other medical professionals often deal with cases that involve diagnostic uncertainty. Within such juxtaposition lays the issue of when a diagnostic “zebra” might be better conceptualized as a “horse.” The differential diagnosis of a 5-year adopted old boy referred by an outside neurologist with Landau–Kleffner Syndrome (i.e., a rare acquired epileptic aphasia believed to occur in only 0.2% of all childhood epilepsies; Kramer et al., 1998) will be considered. Methods: A case study methodology with serial neuropsychological evaluations was employed. This included initial inpatient evaluation requested by the Attending Neurologist, as well as three outpatient evaluations performed annually. The patient had a history of language regressions and language delays within the context of a continuously abnormal EEG; albeit without electrical status epilepticus in slow wave sleep (ESES). Potentially important prenatal factors included in utero exposure to alcohol. Results: Relative to an average Full-Scale IQ with average verbal comprehension abilities, the patient demonstrated consistent deficits in language skills that put him at high risk for the development of a Reading Disorder. These included marked problems in both reading fluency and reading comprehension. Conclusions: Neurologically, the absence of ESES would normally rule-out a diagnosis of Landau–Kleffner Syndrome (LKS). From a neuropsychological perspective, the boy's functional language difficulties could be accounted for by nothing more esoteric than a Reading Disorder. Differential diagnosis would therefore appear to best reside with the parsimony of the “horse,” rather than the broadening of LKS. The patient's history of continuously abnormal EEG puts him at continued risk for development of epilepsy in the future.

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Neurochemical Composition Correlated with Variance in Attention and Hyperactivity/Impulsivity Symptoms: A Multivoxel Spectroscopy Study

Abstract

Objective: Attention Deficit Hyperactivity Disorder (ADHD) involves widespread dysfunction in the brain areas associated with attention and cognition. Proton magnetic resonance spectroscopy (1H-MRS) was used to detect neuronal or glial metabolite abnormalities that may contribute to developmentally inappropriate attention and impulsivity. Methods: 1H-MRS (four brain regions) was performed on 133 healthy children and adolescents (ages 5–17; 67 boys and 66 girls). Guardians of the children completed DuPaul ADHD Rating Scale IV Home edition, which assesses the frequency of inattention (IA) and hyperactive/impulsive (HI) symptoms. Results: Across all subjects, higher IA scores were associated with higher N-acetyl-aspartate (NAA) in anterior cingulate cortex (ACC, r = .23, p = .01) and higher total creatine in frontal white matter (tCr FWM, r = .21, p = .01) and ACC (r = .18, p = .03). These associations were mostly driven by women highlighting gender differences in brain organization. IA was correlated with higher Glutamate in the ACC of women only (r = .19, p = .05) and lower FWM Choline (Cho, r = − .30, p = .01) in men only. Higher HI scores were correlated with higher tCr FWM, ACC NAA and tCr ACC in women. Fourteen of these children with a formal diagnosis of ADHD/ADD also showed higher NAA (+8.2%, p = .03) in the ACC than age/sex matched controls. Conclusions: The elevated NAA in children with ADHD/ADD and the association between higher neuronal metabolites and IA suggest altered neuronal organization (e.g., increased density) and less efficient pathways in brain regions involved in executive function in children with attention/hyperactivity problems. These neurometabolite differences may contribute to the symptoms in ADHD/ADD and hence may be useful for diagnosis and treatment monitoring.

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Neurocognitive Differences among Learning Disabilities

Abstract

Objective: High comorbidity occurs between Attention Deficit Hyperactivity Disorder (ADHD) and learning disabilities (LDs), including Developmental Coordination Disorder (DCD) and Reading Disability (RD). Evidence suggests increased neurocognitive impairment in ADHD when comorbid diagnoses exist. Few direct comparisons between intellectual profiles of singularly and multiply affected children are available, particularly for the Wechsler Intelligence Scale Fourth Edition (WISC-IV), even though it is often used to evaluate children and profile differences may provide insight into impaired and spared abilities. This study addressed these matters by comparing WISC-IV profiles of children with ADHD and LD. Methods: Participants included 246 children with ADHD-Inattentive (n = 87), ADHD-Combined (n = 73), ADHD-DCD (n = 40), and ADHD, RD, and/or Writing Disorder (n = 46). Children were 10.1 years old and 72% men with an IQ of 101.3. Diagnoses were established through comprehensive evaluation including interviews with care-givers. Results: Results indicated a significant group by Index score interaction. This interaction was caused by the ADHD-RD group performing significantly poorer (p < .05) than the other groups on Verbal Comprehension (VC) and Perceptual Reasoning (PR) and generally evidencing a flat profile. In contrast, the ADHD-DCD group demonstrated a sloping profile with VC being the highest score followed by PR and Working Memory, with Processing Speed being the lowest score. Conclusions: Findings indicate differences in intellectual profiles of children with ADHD and LD. The presence of LD in ADHD produces unique intellectual profiles that are consistent with expected patterns, providing support for distinguishing between these disorders. The extent to which these profiles are predictive of academic, social, and behavioral disturbances awaits further investigation.

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Differences in Attention Parameters in Youth with ADHD, Depression, and Comorbid ADHD and Depression

Abstract

Objective: Attentional problems are common in youth with ADHD and depression, but few studies have investigated the influence of Depressive Disorders (DDs) on attentional performance in ADHD. There are conflicting findings about whether differences exist between ADHD, DDs and ADHD + DD on neuropsychological attentional performance (Favre et al., 2009; Gunther et al., 2011). The current study examined attentional differences in children with ADHD (n = 303), DDs (n = 158), and comorbid ADHD + DDs (n = 29). Methods: A total of 435 participants were included in this study, aged 4–17 (M = 9.7, SD = 3.1), 30.1% women, 57.5% Caucasian, and 86% right-handed, with an education range of 0–11 years (M = 3.9, SD = 2.8). Participants completed the Conners' Continuous Performance (CPT) Test II, subtests of the WISC-IV, subtests of the WRAML-2, and the Trail-Making Test. Results: CPT ADHD Percentage was significantly related to ADHD Inattentive (r = .22, p = .005) and ADHD Combined (r = .27, p = .001), but not to ADHD + DD, DD alone, or ADHD Hyperactive. WRAML-2 attentional scores were related to ADHD + DD but not to other diagnoses (r = − .17, p = .027). Other tests were not significantly related. Conclusions: The CPT is more sensitive for identifying children with inattentive symptoms of ADHD as opposed to attentional difficulties that are associated with depressed mood or hyperactive symptoms of ADHD. Caution should be taken when using this test to assess for ADHD in children. Tasks requiring visual and auditory rote information may be more difficult for children with comorbid ADHD + DD and should be considered when intervening.

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The Utilization of Self-Management and Video Feedback to Address Social Skills Deficits in an Adolescent with Autistic Disorder: A Case Study

Abstract

Objective: Emotional intelligence (EI) is defined as the ability to perceive, appraise, and express emotions accurately and appropriately (Salovey & Mayer, 1990). Certain childhood diagnoses impact the development or presentation of EI, particularly autism spectrum disorders, due to impairments in reciprocal social interactions. These deficits are behavioral manifestations of the underlying neurobiological etiology impacting attention (Akshoomoff et al., 2002). Evidence suggests teaching self-management is successful in targeting behaviors, including communication (Boettcher, 2004). Additionally, video feedback has successfully targeted a number of social behaviors, including initiation of conversation (Bellini et al., 2007). Both of these techniques were used to determine if specific targeted behaviors could be improved. Methods: Data were collected on a 19-year-old man diagnosed with autistic disorder, who was medically stable with no comorbid intellectual disability. Pre- and post-measures were utilized. Self-management and video feedback were utilized weekly over 21 weeks to improve reciprocal conversations and behavioral self-monitoring. Neuropsychological data, de-identified history, and behavioral report will be organized and presented in a single-case summary. Evaluation procedures included administration, scoring and interpretation of comprehensive quantitative and qualitative measures. Results: Results of testing and observation indicated that he was successfully taught how to self-manage identified behaviors and able to utilize video review for self-management accuracy during conversations with a single partner on a variety of topics. Conclusions: Results corroborate findings in the literature regarding self-management and video feedback. Skills taught during the therapeutic interaction were effectively translated into real-world outcomes for this young man: increased number of friends, social activities, initiations, job opportunities, and utilization of community resources.

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Cross-Informant Variance on the Behavior Rating Inventory of Executive Function (BRIEF) Parent and Teacher Forms in Childhood Epilepsy

Abstract

Objective: Behavioral rating scales are commonly used to assess executive functioning in children and adolescents. Given the varying degrees of difficulties seen across settings, parent and teacher reports are often utilized in combination. This study examined the correspondence between parent and teacher ratings of executive functioning in a sample of clinically referred children and adolescents with epilepsy. Methods: Behavior Rating Inventory of Executive Functioning (BRIEF) variables were gathered from parents and teachers of 59 clinically referred children and adolescents (age range: 5–18, SD = 2.83). Intraclass correlations between BRIEF subscales and composite indices were calculated for parent and teacher forms to assess inter-rater agreement. Frequency of scale elevations (t-score ≤65) was determined. Results: Significant inter-rater relations were found on Shift (r = .51, p < .001) and Emotional Control (r = .39, p < .001) scales. The Behavior Regulation Index (r = .47, p < .001), Metacognition Index (r = .48, p < .001), and General Executive Composite (r = .30, p < .05) showed significant inter-rater relations. The most frequently elevated parent report scales were the Initiation (31%), Working Memory scales (53%), the General Executive Composite (38%), and Metacognition Index (40%). Similarly, the Initiation (35%), Working Memory (48%), Monitoring scales (38%), Metacognition Index (38%), and General Executive Composite (36%) were frequently elevated on teacher report forms. Conclusions: While there is some agreement on specific BRIEF subscales, there is also evidence of cross-informant variance. This likely reflects the fact different settings (e.g., home vs. school) place different demands on executive functions. Thus, the findings highlight the importance of obtaining information from different raters to capture the complete range of executive dysfunction in children with epilepsy.

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Development of Factitious Disorder after Mild Traumatic Brain Injury in an Adolescent Woman

Abstract

Objective: Prognosis after multiple concussions is often unclear until well after the injury, with lingering symptoms most commonly reported by adolescent women (Blume et al., 2012; Kirkwood et al., 2006; Pinto et al., 2012;). Mild traumatic brain injuries (mTBIs) generally result in full recovery, though pre-morbid functioning, prior history of concussion, family dynamics, expectations, and motivation influence the course (Kirkwood et al., 2008). S's case illustrates that the differential diagnosis process amidst persistent symptoms after multiple mTBIs and complicating factors including family dynamics and suboptimal effort. Methods: S was referred for neuropsychological evaluation because of ongoing academic challenges 18 months after sustaining a head-to-head collision followed 10 min later by a ball-to-head (left temporal) blow. Based on hospital admission, Glascow Coma Scale of 13, S's TBIs were mild (Teasdale & Jennett, 1974). Neuroimaging was negative. Results: S exhibited difficulties with attention, working memory, problem-solving, impulsivity, and word-finding. General intellectual functioning and academic achievement were average. Suspiciously low performance on memory and effort measures and inconsistency on testing and between tests and observed behavior suggested some invalid results. On personality testing, S reported mild depression and moderate anxiety characterized by somatization. Integrating test data with clinical history yielded diagnoses of factitious and adjustment disorders. Conclusions: S's complex presentation illustrates the differential roles of development, adjustment, and family dynamics as factors affecting recovery after mTBI in an adolescent woman. Objective data elucidated suboptimal effort. While S experienced a genuine concussion from two mTBIs, her sick role persisted beyond the physiological effects of mTBI, consistent with a factitious disorder.

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Peabody Picture Vocabulary Test (PPVT) and Autism Diagnostic Observation Schedule (ADOS) as Predictors of Word-Learning Abilities of Children with Autism

Abstract

Objective: To investigate how core social deficits in children with Autism Spectrum Disorders (ASDs) relate to anomalous or delayed language, we compared social-communication skills as measured by subsections of the Autism Diagnostic Observation Schedule (ADOS), patterns of lexical knowledge from the Peabody Picture Vocabulary Test (PPVT-IV), and children's implementation of word-learning strategies. Methods: As part of a larger study, 16 2–7-year-old children with ASD were given the ADOS, PPVT-IV, and a word-mapping task. Performance on Gestures, Pointing and Joint Attention sections of the ADOS, and accuracy for concrete versus abstract words on the PPVT-IV were compared with the ability to receptively pair novel objects cued by gaze, point, touch, or manipulation with labels. Results: Analysis using a mixed-effects binomial model identified increased learning in conditions of gestural support over gaze. On the PPVT-IV, comprehension of verbs and attributes, but not nouns, was positively correlated with word-learning performance (ps = .05, verbs and attributes; p = .75, nouns). PPVT-IV age equivalency was also correlated with performance (p < .01). Neither total ADOS scores nor specific subscales were predictive of word learning (ps > .50). Conclusions: Comprehension of abstract, but not concrete, words corresponds to improved word-learning strategies, such as using another's gaze to infer communicative intent, for children with ASD. There was no evidence of a relationship between gestural communication or joint attention abilities and word mapping, suggesting that the expression of these skills may not lead to their application in language acquisition.

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A Non-verbal Stroop Task Assessment of Inhibition among Children with Autism

Abstract

Objective: The color-word Stroop task is often used to assess inhibitory processing. However, the task is language-and-reading-related which may make the task inappropriate for certain populations including individuals with Autism Spectrum Disorder (Adams and Jarrold, 2009). Therefore, the present study was conducted to examine the effectiveness of a non-verbal Stroop task for examining inhibitory processing among individuals with autism. Methods: A sample of 42 autistic participants was compared with a matched control group. Groups were matched on age, gender, location, community size, ethnicity, and years of education for both the mother and father. Participant age ranged from 3 to 17. All participants completed the Non-verbal Stroop Card Sorting Task in which two decks of cards (i.e., one set of color congruent cards and one set of color incongruent cards) were sorted by target color. Sorting times and number of errors were recorded for each deck. Results: Both the control group—t(41) = 2.55, p < .02—and the autism spectrum disorder group—t(41) = 2.64, p < .02—showed significant Stroop interference. Furthermore, autistic spectrum disorder group was significantly slower and made more errors than the control group. This difference persisted after controlling for naming speed. Conclusions: The results suggest that Stroop interference among individuals with autism spectrum disorder is not due to deficits in language or reading ability but may be limited to impaired inhibitory processing.

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A Case Study of a 7-Year-Old Sustaining Neonatal Stroke: Emergence of Neurocognitive Deficit

Abstract

Objective: Perinatal stroke is a cerebrovascular event near birth usually observed in full-term infants (Lynch & Nelson, 2001). Regarding stroke in adults, it is well documented that damage in the right hemisphere reveals the presence of hemispatial neglect on neuropsychological tests of visual-spatial processing, such as clock drawings (Robertson & Lamb, 1991). Studies examining the visual-spatial processing abilities of children with early unilateral brain injury report a similar pattern of deficit, but children tend to compensate for such deficits seen on complex figure drawings (Akshoomoff et al., 2002). Methods: We present a case of a 7-year-old woman, who sustained a right parietal lobe hemorrhage and a small hemorrhage of the right temporal region just following birth. We compare neuropsychological test findings from her initial evaluation (6 years) with her current evaluation (7 years). Results: Measures of overall cognitive functioning were mildly impaired across evaluations and domains, with verbal abilities relatively better preserved compared with perceptual skills. Within this context, significant visual-perceptual dysfunction was apparent, especially during the second evaluation. Interestingly, the reproduction of a clock drawing much resembled the hemispatial neglect described in adult patients. Conclusions: These results are consistent with research indicating that early brain insult results in poorer outcomes with evidence of more global deficits the earlier the injury occurs (Anderson et al., 2010). This case also stresses the importance of continued follow-up of these children, as early brain injury is often associated with more pronounced cognitive deficits as the child ages (Banich, Levine, & Huttenlocher, 1990).

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Parent and Referring Professional Satisfaction with Neuropsychological Evaluations at an Academic Medical Center

Abstract

Objective: This study aimed to determine parent and referring professional satisfaction with pediatric neuropsychological evaluations. A priori hypotheses predicted high levels of satisfaction across raters and no significant differences between the overall satisfaction of parents and professionals. Methods: A clinical sample was obtained at a large academic medical center and included patients with a range of diagnoses and neurocognitive concerns. Following a neuropsychological evaluation and report, parents and referring professionals were asked to rate the extent to which the report captured the child's strengths and weaknesses, how much the results sounded like the patient, and the helpfulness of the report using a 4-point Likert scale (1 = Not at all, 4 = Yes, very much). Data were returned for 190 of 1,088 patients, for a return rate of 18%. Mean ratings were calculated for each questions as well as questionnaire totals. A paired sample t-test including the 19 patients with multiple respondents was conducted to assess differences between raters. Results: The results indicated high mean levels of satisfaction as parents' mean ratings on each question ranged from 3.0 to 3.5 while professionals' mean ratings ranged from 3.49 to 3.57. On a paired sample t-test comparing ratings for patients with multiple respondents, no significant difference was found between total ratings, t(18) = − .90, p = .38. Conclusions: The results of this study confirm a previous study's report of high parent satisfaction with pediatric neuropsychological evaluations and add that referring professionals report similarly high levels of satisfaction and that ratings do not significantly differ between respondents.

A-34
Neuropsychological and Functional Outcomes of Children Diagnosed With a Brain Tumor at Age 3 or Younger: A Review

Abstract

Objective: Twenty to 25% of malignant pediatric brain tumors occur in children under the age of 3. These children are living longer with more preserved neurocognitive profiles due to recent improvements in treatment methodologies; however, little is known regarding long-term prognosis and neurocognitive sequelae. The purpose of this literature review is to summarize the existing literature on the neurocognitive sequelae and functional outcomes of pediatric brain tumor diagnosed at age 3 or younger. Methods: Peer-reviewed, English-language journal articles available via PsycINFO and Medline (EBSCO) from 1999 to 2012 were obtained. Keywords included: pediatric brain tumor, neurocognitive late effects, neurocognitive outcome, functional outcome, and neuropsychological sequelae. Reference lists were also reviewed and additional articles were abstracted. Sixty-five studies were obtained with a manual search of each study's age range, resulting in 11 studies that met the inclusion criteria: diagnosis of brain tumor at 3 or younger and assessment of neuropsychological or functional outcomes. Results: Informal review of the 11 studies revealed that children who acquire brain tumors at a young age are at increased risk for long-term deficits including decreased cognitive, sensory, and motor abilities, poorer functional outcomes, and a greater risk for endocrinopathy. Conclusions: Few studies have examined the cognitive and functional outcomes of pediatric brain tumor survivors who were diagnosed at age 3 or younger. Although responses to treatment interventions and survival rates have been examined, little is known regarding long-term neurocognitive outcomes. Future studies should follow these children into adulthood and comprehensive neuropsychological evaluations should be integrated into the primary objectives of future protocols.

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Neuropsychological Profile of Early Correction of D-Transposition of the Great Arteries

Abstract

Objective: The purpose of this study is to examine neuropsychological profile of two youngsters who underwent early correction of D-Transposition of the Great Arteries (D-TGA). D-TGA is a congenital heart condition that presents in neonates, in which the aorta and pulmonary arteries are reversed. Forty infants per 100,000 live births are affected. This often results in periods of hypoxia that convey neurodevelopmental risk. Evidence suggests that early surgical correction of D-TGA diminishes the risk of negative neuropsychological sequelae. Methods: This case study examines two cases of children with D-TGA surgically corrected within the first week of life. Both a 4-year-old boy corrected at 4 days and a 7-year-old boy corrected at 18 h were referred for neuropsychological evaluation. Results: Results of the 4-year old revealed a profile of diminished cognitive functions with deficits in auditory, language, and articulation. Strengths included visual and episodic memory and sensorimotor functions. Results of the 7-year old revealed neurocognitive deficits in processing speed, short-term memory, and executive functioning. Conclusions: While emerging studies suggest that early surgical correction diminishes neurodevelopmental sequelae, clinicians should recognize that neuropsychological effects are not eliminated. Various cognitive abilities are likely to be adversely affected. This study demonstrates the value of neuropsychological assessment in elucidating cognitive profiles necessary to drive early intervention. The role of serial assessment will be addressed.

A-36
Associations Between Executive Dysfunction and Symptoms of Depression in an Outpatient Pediatric Sample with Cerebral Palsy

Abstract

Objective: Growing evidence suggests that depression is associated with impairments in executive control (Lissnyder et al., 2010). The present study aimed to examine the relationship between parent-reported levels of executive dysfunction and depressive symptoms in an outpatient pediatric sample of children diagnosed with cerebral palsy (CP). Methods: Sample included 72 participants, ages 6–15, taken from a database of children with CP who were previously referred for outpatient evaluations. Participants were selected for inclusion if their battery included a Wechsler intelligence measure, the Behavior Rating of Executive Function (BRIEF)-Parent Form, and the Behavior Assessment System for Children, Second Edition (BASC-2)-Parent Rating Scales. Scales from the BRIEF that represent specific areas of executive functioning were analyzed for associations with the Depression Scale of the BASC-2. Results: Pearson's product–moment correlation coefficient (r) was used to determine the relationship between BRIEF executive scales and the BASC-2 depression scale. There was a moderate correlation between reported global executive dysfunction and reported depressive symptoms (r = .48, n = 71, p < .0005), with higher levels of executive dysfunction associated with higher levels of depressive symptomatology. Further, executive difficulties in the specific areas of shifting and emotional control were strongly, positively correlated with levels of depressive symptoms (r = .630, n = 72, p < .0005, and r = .657, n = 72, p < .0005, respectively). Conclusions: Findings indicate that parent-reported levels of executive impairment in children with CP are strongly correlated with symptoms of depression. Further research is needed to determine whether executive dysfunction predicts the development of depressive symptoms, and if this relationship is dependent upon overall cognitive ability.

A-37
Ethnicity, Gender, and Risk of Maltreatment among Pediatric Cancer Patients Presenting for Neuropsychological Evaluation

Abstract

Objective: Children with chronic illnesses are at increased risk for neglect and physical and sexual abuse. Given that these children are increasingly likely to be referred for neuropsychological evaluation, pediatric neuropsychologists are uniquely positioned to assess maltreatment. The purpose of this poster is to ascertain the prevalence of maltreatment among children with cancer who presented for neuropsychological evaluation at a pediatric hospital. Methods: A retrospective chart review yielded 205 records for children who had received a neuropsychological evaluation between 2003 and 2012. Charts were reviewed for gender, ethnicity, and type of cancer. Children were placed in one of five categories based on level of exposure to abuse or neglect. Results: Of the 205 children, 16% (33) experienced or witnessed abuse or neglect, two times the reported rate of victimization of medically fragile children in the state of California (8.1%). History of maltreatment was independent of type of cancer (χ2 = 0.577, p < .05) and gender (χ2 = 0.043, p < .05). Among those with history of maltreatment, 75% identified as an ethnic minority. Caucasian children were less likely to be maltreated than Hispanic (Relative Risk [RR] = 0.587) or African-American children (RR = 0.377), and Hispanic children were less likely to be maltreated than African-American children (RR = 0.641). Analyses of abuse subtypes indicated that 21% of children had witnessed domestic violence, 18% experienced physical abuse, 12% experienced neglect, and 6% experienced sexual abuse. Conclusions: Care should be taken to formally assess for history of maltreatment, including exposure to domestic violence, among children with cancer, particularly when the child is a member of an ethnic minority.

A-38
Motor Benefits Obtained after Pediatric Constraint-Induced Movement Therapy Retained 1-Year Post-Treatment in Young Children

Abstract

Objective: Previous research from this laboratory in adult chronic stroke patients has shown that the motor benefits of Constraint-Induced Movement (CI) therapy have been retained for at least 2 years post-treatment. This study evaluated whether similar retention rates are found in children following CI therapy. Methods: Thirteen children (5.1 ± 1.8 years) with unilateral motor deficits due to damage in the central nervous system were administered CI therapy. Motor functioning was measured using the Pediatric Motor Activity Log (PMAL) before and after treatment and at the 1-year follow-up time point. Retention was calculated as pretreatment PMAL score subtracted from the 1-year PMAL score and divided by the treatment change score. Results: At 1-year post-treatment, children retained, on average, 81% of the motor benefits obtained during CI therapy. Additionally the grade of motor impairment was significantly correlated with retention rates (r = − .493, p < .05). Children with severe motor impairment retained only 68% of the motor improvements gained after treatment while children with moderate motor impairment retained 86% of their treatment gains 1-year post-treatment. Importantly, grade of impairment severity was not correlated with magnitude of treatment gains immediately following CI therapy. Conclusions: Motor improvements children obtain following CI therapy are largely retained 1-year post-treatment. However, while grade of motor impairment does not hinder children's ability to benefit from CI therapy, it significantly influences how well children retain these benefits. Children with high levels of motor impairment would benefit by returning to treatment occasionally to help regain the initial motor improvement made in therapy.

A-39
A Case Study Assessing the Neuropsychological Sequelae Associated with Pediatric Exposure to Arsenic (As)

Abstract

Objective: A dearth of information associated with neuropsychological sequelae as a result of protracted pediatric exposure to arsenic (As) permeates the literature. Arsenic toxicity is correlated with central nervous system dysfunction and suspected degeneration of white and grey matter. However, specific clinical presentations continue to be refined. Methods: The present case study introduces a 6-year, 11-month boy following prolonged exposure to As (peak = 0.047 μg/L) and the subsequent cognitive, behavioral, and emotional disturbances within his neuropsychological profile. A brain single-photon emission computed tomography (SPECT) study revealed increased tracer activity in the right lateral prefrontal cortex, temporal lobe, left basal ganglia, and anterior cingulate gyrus as well as decreased tracer activity in the temporal lobe, inferior orbital prefrontal cortex, medial prefrontal cortex pole, and left internal and medial cerebellar. Results: Neuropsychological results indicated declines in cognitive functioning and academic difficulties, particularly in mathematics. The neuropsychological profile included dampened non-verbal abilities, significant weaknesses in processing speed, as well as deficits in visual perceptual skills and motor functioning. In addition, marked disturbances in emerging executive functioning, specifically sustained attention, working memory, organization of information, and novel problem-solving skills were noted. Weaknesses in inhibition and the ability to monitor one's own behavior as well as behavioral difficulties, such as hyperactivity and conduct problems, also emerged. The pronounced disruptions in cognitive, behavioral, and emotional functioning were likely exacerbated if not initiated by arsenic exposure. Conclusions: The presenting case study sheds light on the all encompassing nature of impairment following arsenic toxicity during development.

A-40
Self-Reported Mood Symptoms Have Minimal Effect on Memory and Visual Motor Integration in Outpatient and Inpatient Adolescent Samples

Abstract

Objective: Brooks and colleagues (2010) reported that children diagnosed with depression performed worse on a computerized cognitive test battery, particularly on measures of memory functioning. This study examined the association between self-reported depressive symptoms and memory and visual motor integration in adolescents in both outpatient and inpatient clinical samples. Methods: The following neuropsychological measures were used: the Wide Range Assessment of Memory and Learning (WRAML) and the Beery–Buktenica visual motor integration (VMI) test. Records from children and adolescents aged 7–17 with an IQ > 70 were examined. Data were collected at either an outpatient neuropsychology clinic (n = 70) or an inpatient psychiatric hospital setting (n = 84). Depressive symptoms were measured using the Children's Depression Inventory (CDI). Results: Individual regressions were run using the total sample, outpatient sample, and inpatient sample for CDI total score predicting WRAML and VMI performance. Generally, statistical associations were small and non-significant between self-reported depressive symptoms and domains within the previously mentioned measures. The variance predicted (R2 value) by CDI total score for WRAML performance was generally less than 2% and the variance predicted for VMI performance was generally less than 1% for all samples. Conclusions: Consistent with much of the adult literature, our results suggest that poor performance on memory and VMI tasks is minimally related to self-reported symptoms of depression.

A-41
Do Parent Reported Depression and Anxiety Symptoms Predict Memory Performance in School-Referred Children?

Abstract

Objective: Neuropsychologists often assess children with symptoms of depression and anxiety in the context of a neuropsychological assessment. The effects of mood on cognitive status have been examined previously, with studies finding a significant impact of mood on memory (Porter et al., 2003). Less research has been conducted on the effects of anxiety on memory (O'Jile et al., 2005), with some studies finding a relationship while others not finding this without the addition of comorbid depressive symptoms (Kizilbash et al., 2002). No previous studies have examined the impact of depression or anxiety symptoms on CVLT-C performance within a school-referred sample. This study aimed to examine the degree to which parent reported depression or anxiety symptoms would predict performance on the CVLT-C. Methods: Children referred for psychological assessment through their school were included in analyses (n = 103, M = 10.74). Separate multiple regression analyses were used to determine the amount of variance in the CVLT-C learning outcome measures individually predicted by BASC2 parent reported Depression and Anxiety. Results: Variance predicted by BASC2 parent reported Depression ranged from −0.001 (Trial 1) to 0.043 (Long-Delay Cued Recall) and by Anxiety ranged from 0.001 (Short-Delay Free Recall) to −0.010 (Trial 1, Short-Delay Cued Recall, Long-Delay Free Recall). Conclusions: We found that neither depression nor anxiety symptoms accounted for a significant portion of variance in the CVLT-C scores. Results suggest that memory deficits are likely representative of actual memory disturbance rather than phenomena associated with depressive or anxious symptomatology.

A-42
The Relationship Between Internalizing Symptoms, Intellectual Functioning, and Academic Achievement in School-Referred Children

Abstract

Objective: Previous research has found that internalizing disorders negatively influence cognitive functioning and academic performance (Lundy et al., 2010). Few studies have examined the relationship between internalizing symptoms and academic performance in non-clinical samples, and none has examined this relationship in a school-referred sample. The purpose of this study was to determine the relationship between internalizing symptoms and performance on intelligence and academic achievement measures in school-referred children. Impairment in these abilities may help explain why children with internalizing problems have academic difficulties. Methods: Children referred for psychological assessment through their school were classified into high (T ≥ 60) and low (T ≤ 55) symptom groups based on their BASC2 Parent and Teacher ratings (n = 130). High and low Depression, Anxiety, Somatization, and overall Internalizing Problems groups were compared on their WISC-IV and WIAT-II performance using MANOVA. Correlations between BASC2 Internalizing scores and WISC-IV and WIAT-II scores were examined. Results: No significant differences were found between any groups on any of the WISC-IV Index or WIAT-II subtest scores. No significant correlations were found between any BASC2 scales and WISC-IV Index or WIAT-II subtest scores. Conclusions: These findings suggest that academic problems in children with internalizing symptoms are not a result of impaired intellectual functioning or academic skills. School difficulties may be due to other factors such as decreased interest or motivation. Additionally, the level of symptoms in our population may not have been severe enough to affect performance.

A-43
Prenatal, Perinatal, and Neonatal Complications in a Sample with Autism Spectrum Disorders

Abstract

Objective: To collect information about prenatal, perinatal, and neonatal history of participants with Autism Spectrum Disorders (ASD) and compare incidences with the general population. Methods: Information was collected from 147 parents of children with ASD. Autism-Spectrum Quotient (AQ) cutoff scores confirmed the parent-reported diagnosis of ASD, resulting in 146 participants. Twenty-three pre-, peri-, and neonatal factors were examined using a nationwide online survey. Incidences were compared with those reported in the 2010 National Vital Statistics Report. Frequencies were compared with this national population using binomial probability (p < .05) with Bonferonni correction. Total AQ score and factors were correlated using Spearman's rank correlation (p < .05). Results: Several factors had significantly different proportions in the ASD sample compared with the general population. When compared with the general population, the ASD group was found to have a higher incidence of preeclampsia, induced labor, placenta previa, and presence of sacral dimple. Lower incidence of threatened miscarriage, vaginal bleeding, placental abruption, infection of cervix, c-section, and jaundice existed. Placental abruption was significantly correlated with Total AQ score (r = .182, p = .028). Conclusions: The results corroborate previous findings of differences in incidences of pregnancy, delivery, and neonatal complications in the ASD sample. The rate of c-section in the ASD sample was lower than that of the general population, yet the rate of complications was higher. Though further research is needed to interpret this finding, preventative c-sections may be helpful in reducing complications associated with ASD.

A-44
Adaptive and Executive Functioning Deficits in Children with Fetal Alcohol Spectrum Disorders

Abstract

Objective: Children with Fetal Alcohol Spectrum Disorders (FASDs) are known to have significant adaptive function deficits. Adaptive function skills are typically highly correlated with intellectual skills, but children with FASD may have other significant contributing factors to deficits in adaptive functioning such as executive dysfunction. The current study hypothesized that IQ and adaptive functioning would not be significantly correlated in children with FASD, but there would be a significant negative correlation between executive and adaptive function scores. Children with clinically significant executive dysfunction were hypothesized to have greater adaptive deficits across domains than children with subclinical executive function scores. Methods: Participants included 27 children evaluated within a multi-disciplinary FASD clinic using the 4-Digit Diagnostic Code (Astley, 2004). Children were 41% girls (mean age = 9.7 years) and 82% were in adoptive/foster homes. A comprehensive neuropsychological battery was administered, including Wechsler Intelligence Scale for Children-IV, Behavior Rating Inventory of Executive Function (parent rating), and Vineland Adaptive Behavior Scales-Second Edition (parent/caregiver rating). Results: Full-Scale IQ and Vineland Adaptive Behavior Composite (VABC) were not significantly correlated—r(24) = − .24, p = .23, but the BRIEF Global Executive Composite and VABC were negatively correlated—r(15) = − .61, p < .01. Children with clinically significant executive function ratings had lower VABC scores—F(1, 15) = 6.24, p = .02; however, on specific domains only socialization differed significantly between groups—F(1, 15) = 6.28, p = .02. Conclusions: Children with FASD have adaptive function deficits that are associated with executive dysfunction but not general intelligence. Socialization was most impacted by executive dysfunction. Results could be used to target adaptive interventions.

A-45
Learning Style Clusters as a Predictor of Academic Achievement in Twice-Exceptional Children and Adolescents

Abstract

Objective: Previous literature (McDonald, 2011) suggests seven clusters of learning styles in twice-exceptional (2e) youth. This study explored the relationship between learning style clusters in 2e youth and academic achievement. Hypotheses included: (a) the seven clusters would predict academic achievement and (b) cluster 5, consisting of 2e youth with significantly higher working memory abilities, would perform better on academic achievement. Methods: The sample included 95 participants (67 men and 28 women) between the ages of 6 and 16 (M = 10.29, SD = 2.94). Ethnic background included: 86.3% White, 8.4% African American, 3.2% Latino, 1.1% Middle Eastern, and 1.1% Other. Wechsler Intelligence Scale for Children Index standard scores of ≥120, and the presence of a learning disability, behavioral, or social-emotional difficulties determined 2e. The Wide Range Achievement Test assessed academic achievement. Analyses were controlled for age, gender, and ethnicity. Results: Hierarchical regression analyses revealed seven clusters significantly predicted performance on Reading, R2 change = .115, F(1, 79) = 10.34, p = .001; Spelling, R2 change = .105, F(1, 80) = 9.509, p = .0015; and Math, R2 change = .091, F(1, 80) = 8.048, p = .003. MANOVAs revealed that youth in cluster 5 scored significantly higher on combined academic achievement than youth in the six remaining twice-exceptional learning style clusters, F(3, 77) = 6.78, p < .0005; Wilks' λ = .79; partial η2 = .21. Conclusions: Results supported the hypotheses. Findings suggest learning styles in 2e youth may impact academic functioning. Clinical implications and suggestions for future research in this area will be discussed.

A-46
Use of the Rey–Osterrieth Complex Figure with Deaf Children and Adolescents: Normative Data and Psychometric Characteristics

Abstract

Objective: The Rey–Osterrieth Complex Figure (ROCF) measures visuoconstructive skills, visual memory, and executive functions. The purpose of this study was to collect preliminary normative data and evaluate psychometric properties of the ROCF when used with deaf youth. Methods: The ROCF copy and memory trials were administered following standard instructions and included the recognition trial. The test was administered to 74 deaf youth between the ages of 6 and 21 by a psychologist versed in American Sign Language and deaf culture. Binaural sensorineural hearing loss ranged from severe to very profound and primary mode of communication was ASL. Twenty-one individuals were readministered the ROCF a second time within a period of 2 years. The ROCF protocols were scored using the 36-point scoring system and compared with normative data provided by Meyers and Meyers (1995). Results: Data were analyzed to provide means and standard deviations for each age group. Scores for each of the four trials generally increased with age. Higher scores were obtained for the recognition trial compared with the copy and memory trials. However, these performances varied as a function of the age language was first acquired, but not gender, type of educational instruction, or parent hearing status. Last, scores for each trial were fairly stable across the two test administrations as evidenced by moderate to moderately-high test–retest reliability coefficients. Conclusions: The ROFC performance of deaf youth is fairly comparable with that of hearing youth and is reliable over time. Results are discussed in light of unique cultural and linguistic factors.

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Visual Search Performance of Deaf Youth on a Cancelation Test

Abstract

Objective: To assess the visual search strategies of deaf youth when completing a non-verbal cancelation test. Methods: The Attention Sustained (AS) subtest from the Leiter International Performance Scale–Revised can be used to assess attention, concentration, and visual-spatial scanning abilities. The AS subtest is comprised of four parts that vary in the target–distractor ratio and type of organization (structured vs. random). The AS was administered to 47 deaf children and adolescents (51% women and 49% men). Binaural sensorineural hearing loss ranged from moderate to very profound. The primary mode of communication was a signed language (e.g., American Sign Language), but a subset of the sample had some degree of aural/oral ability. The number of hits, errors of omission, and errors of commission were calculated for each quadrant. Results: Quadrants 1, 2, 3, and 4 were compared across the four parts. Significantly more targets were identified in the first quadrant of all four parts for youth with either early exposure to American Sign Language, early exposure to formal education, or early audiological habilitation. No differences were identified for errors of omission or commission. When compared with the performance of the normative hearing sample, deaf youth identified significantly fewer targets on part 4 (random order), quadrants 1, 2, and 4. Conclusions: Deaf youth with early exposure to language and/or education appear to develop visual search strategies similar to hearing youth, but tend to identify fewer targets. These findings are discussed in relation to the development of a native language, processing speed, and reading ability.

A-48
Neuropsychological Findings in Pediatric Opsoclonus–Myoclonus Syndrome: A Case Study

Abstract

Objective: Opsoclonus–Myoclonus Syndrome (OMS) is a rare autoimmune condition characterized by involuntary muscle jerks, cerebellar ataxia, and involuntary eye movements in addition to language and cognitive dysfunction, behavioral/mood disruption, and sleep disturbances. Half of all cases present as a paraneoplastic syndrome and the majority of children demonstrate persistent neurocognitive sequelae. Limited data exist regarding the nature and course of neuropsychological impairments in OMS. This study presents neuropsychological data of an 18-year-old woman diagnosed with opsoclonus myoclonus ataxia status post-excision of a stage II neuroblastoma/adrenal tumor. Methods: The patient presented with ataxia at 18 months. Abdominal CT scan at 28 months revealed left adrenal tumor. Subsequent resection indicated stage IIB neuroblastoma. Treatments included adrenocorticotropic hormone and immunoglobulin G. The patient presented with a relapsing and remitting course of OMS-related symptoms. Social and academic deficits were noted as well as anxiety, behavioral/emotional dysregulation, and daily living skill deficits. Symptoms of ataxia resolved with no evidence of tumor recurrence at 15 years of age. No current medications. Results: Findings revealed global deficits in cognitive, motor, and language skills, with general intellectual functioning and overall daily living/adaptive skills within the range of Mild Mental Retardation. Relative strengths were noted in verbal reasoning and rote verbal memory. Conclusions: Although the literature in neuropsychological and behavioral profiles of OMS is still emerging, current findings support previous data identifying global cognitive impairment. Beyond deficits in intellectual functioning alone, findings suggest multiple neuropsychological deficits, but relative strengths in basic verbal memory and learning with important implications for intervention.

A-49
A Comparison of Expressive and Receptive Vocabulary Skills in Deaf Children

Abstract

Objective: This project examines the relationship between expressive and receptive vocabulary skills in deaf children. It is expected that there is a positive correlation between standard scores on measures of receptive and expressive vocabulary and that the mean score for receptive vocabulary will be higher than expressive vocabulary. Methods: As part of the NSF-funded Science of Learning Center on Visual Language and Visual Learning, 85 deaf children were administered the Picture Vocabulary test from the Woodcock Johnson Test III-Tests of Achievement (WJPVT) and the Peabody Picture Vocabulary Subtest, 4th Edition (PPVT-IV) as part of a larger battery. The children ranged from ages 3–5 and were recruited through their school. The WJPVT is an expressive vocabulary tests completed in the child's dominant language. The PPVT-IV is a test of receptive vocabulary, which was presented to the children in spoken English. Results: There is a statistically significant correlation between the standard scores on the WJPVT-III and the PPVT-IV, r = .401 (one-tailed <.01). There was also a statistically significant difference in mean standard score on the WJPVT (M = 100.98, SE = 1.32) and the PPVT (M = 75.59, SE = 1.92)—t(84) = 13.737, p = .0001. Conclusions: Expressive and receptive vocabulary skills provide the foundation for literacy skills. Receptive vocabulary typically develops at twice the speed as expressive vocabulary, but these results indicate that this is not happening in deaf children. Further, the receptive and expressive vocabulary skills are positively correlated and signify a strong link between receptive and expressive language skills in deaf children.

A-50
Differences in Attention Deficits in Adults with Attention Deficit/Hyperactivity Disorder or Fetal Alcohol Spectrum Disorder

Abstract

Objective: Prior research revealed that Attention Deficit/Hyperactivity Disorder (ADHD) populations experience problems with sustained attention (vigilance), whereas Fetal Alcohol Spectrum Disorder (FASD) populations struggle with shifting attention, though research with adults is not readily available. Distinguishing the nature of attention problems between ADHD and FASD will facilitate differential diagnosis. The following study compares performance between adults with ADHD with adults with FASD on Conner's Continuous Performance Test, 2nd Edition (CPT-II), a computerized measure of attention. Methods: Eighteen adults (mean age = 26.64; SD = 9.3) were diagnosed with FASD through an outpatient multi-disciplinary clinic. All subjects were diagnosed according to the 4-digit code by a physician specializing in FASD. Subjects were compared with 34 adults diagnosed with ADHD who completed an assessment at a university community clinic (mean age = 26.74; SD = 8.5). All subjects underwent a standardized cognitive testing battery completed by a PhD Level Psychologist. Standard scores derived from the CPT-II were compared between groups. Results: A MANOVA controlling for FSIQ identified statistically significant weaknesses in the FASD group on standard scores sensitive to sluggishness, erraticness, and within respondent variability (p < .05). A pattern of weakness in vigilance in the ADHD group emerged but did not achieve statistical significance. Conclusions: Compared with adults with ADHD, adults with FASD may present with a sluggish, erratic, and variable response pattern indicative of poor attentional capacity. These results may aid in delineating attentional profiles between ADHD and FASD. Future studies should evaluate vigilance in adults with ADHD compared with adults with FASD.

A-51
Visual Attention as a Predictor of Digit Symbol Substitution in Older Adults

Abstract

Objective: Few studies have found the effects of cognition, visual attention, education, and psychomotor processing speed on age-related decline in Digit Symbol Substitution measures (Joy, Kaplan, & Fein, 2004). Useful Field of View (UFOV) measures the visual and selective attention required to identify visual stimuli in a variety of tasks (Owsely et al., 1991). This study investigated the predictive value of UFOV after controlling for education, cognition, and psychomotor speed. Methods: Archival data were used from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. The participants (n = 1,187; 284 men and 903 women) completed a variety of cognitive measures and questionnaires that includes: Digit Symbol Substitution, Digit Symbol Copy, and UFOV. Results: Digit Symbol Substitution performance was significantly correlated with education (r = .276, p < .001), MMSE total score (r = .374, p < .001), UFOV (r = − .457, p < .001), and Digit Symbol Copy (r = − .683, p < .001). Using hierarchical regression, after controlling for education, cognition, psychomotor speed, and the interaction between UFOV and psychomotor speed, UFOV significantly explained an additional 37.3% of the variance for Digit Symbol Substitution (p < .001). Conclusions: The results suggest that UFOV is a significant unique predictor of Digit Symbol Substitution performance in older adults (β = − 0.225, p < .001). The individuals with the second lowest performance on visual attention showed a more blunted effect of psychomotor processing speed on Digit Symbol Substitution than the other performance groups on UFOV. This study provides evidence that performance of Digit Symbol Substitution is more than just psychomotor speed as it is also influenced by visual and selective attention.

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Exploratory Factor Analysis of the Connor's Continuous Performance Test-II in a Clinical Versus Non-Clinical Population

Abstract

Objective: This study aims to compare components of the factorial structure of the CPT-II in a clinical versus non-clinical population. Methods: The clinical group consisted of 51 participants, suffering from either anxiety or depression, with a mean age of 31.84 (SD = 12.68). The group of participants was 49% men. The participants' mean education was 13.51 (SD = 2.76; 66.7%). The non-clinical group had 44 participants with a mean age of 31.84 years (SD = 15.91) and were 36.4% men. The mean education was 15.90 (SD = 2.23). Results: Using an exploratory factor analysis, a three-factor model was found to be a good fit for the CPT-II when used in both populations. Independent t-tests were then used to determine differences between clinical and non-clinical groups. The study found a statistically significant difference between the groups on Factor 1, t(90) = 2.745, p = .007, which contained Hit Rate Standard Error (erraticness), Variability (variability in individual's standard errors), and Response Style (individual response style). Factor 1 explained 39.98% of the variance of the model. The other factors were non-significant. Conclusions: Individuals that suffer from anxiety and depression may be erratic, cautious, not respond as often, or be unable to sustain their performances. Previous studies have related the individual blocks of the CPT-II to various clinical. However, the blocks were not individually symptom specific. In order to evaluate differences between the disorders and CPT-II performance, future research should focus on how erratic and cautious responding and variability in responding throughout assessment impact performance.

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P300 Analysis in Mild Traumatic Brain Injuries

Abstract

Objective: Thatcher's Severity Index was created to provide an “objective and quantitative” measure of severity within mild traumatic brain injuries (mTBIs). This index was used to categorize the severity among mTBIs to study the relation between severity and evoked response potential of P300. It is hypothesized as index increases, amplitude decreases, and latency elongates. Methods: P300 data and Thatcher's Severity Index were analyzed for 31 (13 women and 18 men) patients from a private practice with a history of mTBIs (age; M = 42.19, SD = 14.40). Selection was based on a probability threshold of 70% in NeuroGuide's normative database. Database discriminated mTBI patients from the age-normed control group to provide a TBI Discriminant Score. P300 was obtained from an auditory “oddball paradigm.” Index was correlated with amplitude and latency at the Pz and Cz sites. Results: Data pointed to significant negative correlation between severity index and latency at Cz—r(31) = − .356, p < .05—and Pz—r(31) = − .405, p < .05—sites. No significant findings were found with amplitude. Conclusions: Analysis suggests the presence of subpopulations within current mTBI population. Significant finding of decreased latency could indicate a subpopulation that were not affected or improved after their injury. Remaining individuals could possibly be the subpopulation that is reflected in other studies; individuals whose P300 latency increased post-injury. The two possible groups were not studied separately to see what common factors defined each group. Findings point to complexities in defining mTBI populations.

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Gender and Performance Differences in the Stroop Test among Arab Children: A Cross Cultural Study

Abstract

Objective: The Stroop Test is one of the most commonly used neuropsychological tests to measure attentional interference and inhibition. However, there are few studies in the scientific literature that include participants that are not from a Western or Hispanic culture. The purpose of the current study was to evaluate gender differences in the Stroop Test among Arab children and to compare their performance with children from another culture. Methods: Participants were 49 children from Hebron, Palestine, 19 were boys and 30 were girls that volunteered (with permission of Department of Education). The mean age was 13 years old. A translated version (Arabic) of the Stroop Test was administered in single sessions by a trained research assistant. The results were compared with the norms of the Spanish version of the Stroop Test (Armengol, 2002). Results: t test showed there was a significant gender difference among Palestinian children, with girls significantly outperforming boys in the third part of the test and in attentional interference. In addition, there were significant differences in the performance of Spanish and Palestinian children. Palestinian children performed significantly slower in the first part (word reading) and the second part of test (color naming). However, there were no significant differences between groups for the third part of the test (color naming without reading the word). Conclusions: These findings provide further evidence for the possibility of cultural factors affecting neuropsychological test performance. In contrast with the Spanish children performance, gender difference was found among Palestinian children. It was suggested that gender differences were due to cultural differences.

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The Effects of Depression and Anxiety on Visual Spatial Working Memory

Abstract

Objective: Baddeley and Hitch (1974) have suggested that working memory is a multicomponent model consisting of a phonological loop, visuo-spatial sketchpad, and a central executive. The demarcation of separate constituents of working memory raises the question of whether each component is differentially impacted by various negative emotions. Methods: Twenty-eight patients with depression were recruited from Stanford University Medical Center. General anxiety and depression were measured using the Mood and Anxiety Symptom Questionnaire. The differential effects of depression and anxiety on visuo spatial working memory and verbal working memory were assessed using the spatial span and the digit span tasks of the WMS-III, respectively. Linear regression analyses were conducted. General depression and anxiety scores were the independent variables, and the standardized scores on the spatial span and digit span were the dependent variables. Results: Results indicated that together general depression and anxiety significantly accounted for 37.8% of the variance on spatial span, F(2,24) = 7.28, p < .004. Furthermore, both general depression and anxiety significantly contributed to the model once the other had been accounted for. Similar results were not found for digit span, with general depression and anxiety only accounting for 2% of the variance on digit span total F(2,24) = 0.24, ns. Conclusions: Lavric (2003) propose that visuo spatial working memory is selectively disrupted by anxiety, while verbal working memory remains unimpeded. Keller (2000) revealed that depression and anxiety were associated with hemispheric asymmetries. This suggests that there may be competing the overlap of attention between the visuospatial regions and anxiety and depression, but not so for verbal working memory.

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Correlates of the CAARS Infrequency Index in Adult Referrals for ADHD/LD

Abstract

Objective: We recently developed an Infrequency Index for the Conners Adult Attention-Deficit/Hyperactivity Rating Scale (CAARS CII), which is based on items endorsed infrequently by large samples of university students, some of whom had diagnoses of Attention-Deficit/Hyperactivity Disorder (ADHD), as well as a sample of clinic referrals for ADHD. The present study assessed the utility of the CII by examining correlates of high scores on the scale within a clinical sample. Methods: Data were taken from 90 sequential cases in a university clinic, who were referred for assessment of ADHD or learning disorder. As part of a large battery, which varied slightly by case, depending on need, we examined whether the CII was related to other self-report validity indices (such as those on the MMPI-2 RF), other self-report psychological variables, performance on a measure of non-credible responding (the Word Memory Test; WMT), and performance on a cognitive measure commonly used in ADHD assessment (Test of Variables of Attention; TOVA). Results: Consistent with predictions, high scores on the CII were related to high scores on MMPI-2 RF validity scales, as well as high levels of current anxiety, current depression, and childhood ADHD symptomatology. High scores on the CII were also related to non-credible performance on the WMT and worse performance on the TOVA (omissions, commissions, d′, but not speed). Conclusions: Results suggest that the CII may be useful in detecting not only overreported ADHD symptomatology, but also non-credible performance on cognitive measures in adult ADHD assessment.

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The Utility of Verbal Memory, Executive Functioning and Depression in Predicting Health and Safety Knowledge in Older Adults

Abstract

Objective: Previous research has shown independent relationships between executive functioning, memory, depressive symptoms and knowledge of health and safety in older adults (Baird, Podell, Lovell, & McGinty, 2001). However, there have been limited studies to explore the interaction effects of executive functioning, memory impairment and mood-related symptoms on skills of independent living. The objective of this study was to determine the relationship between performance on the Hopkins Verbal Learning Test-Revised (HVLT-R; Brandt & Benedict, 2001), the Wisconsin Card Sorting Test (WCST; Berg, 1948; Grant & Berg, 1948), the Geriatric Depression Scale (GDS; Brink, Yesavage, Lum, et al., 1982), and the Independent Living Scale (ILS; Loeb, 1996) Health and Safety subtest. Methods: Participants were older adults seen at a private neuropsychology practice. Multiple regression analyses were used to evaluate the amount of variance accounted for by the HVLT-R, WCST, and GDS on the ILS Health and Safety subtest. Results: Multiple regression analyses revealed that poorer scores on the HVLT-R and GDS uniquely predicted knowledge of health and safety on the ILS. Depressive symptoms on the GDS moderated the relationship between the HVLT-R and the ILS health and safety score. There was no relationship between the WCST, GDS, and the ILS. Conclusions: Both immediate verbal memory capacity and depression predicted inadequate health and safety knowledge; verbal memory was moderated by depression. However, overall executive functioning did not predict knowledge of health and safety skills. Further research is needed to better inform the impact of neurocognitive and psychosocial variables on functioning.

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Dense Amnesia Following Endoscopic Third Ventriculostomy

Abstract

Objective: To promote awareness and knowledge of potentially devastating outcomes of endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus (OH) as it relates to the limbic structures vital to memory. The classic relationship of limbic structures (thalamus, fornix, mammillary bodies) to intact memory functioning is well established. Published complications of ETV include transient short-term memory loss, behavioral and emotional changes, eating disorders, and one case of permanent amnesia related to fornix column disruption. Methods: We present a 36-year-old woman who underwent EVT for OH secondary to pineal gland tumor and subsequent suboccipital craniotomy for tumor excision 3 days later with no reported surgical complications. Comprehensive neuropsychological evaluation was completed 2 and 16 months post-surgery. Cognitive and behavioral data clearly suggest dense anterograde amnesia. Retrograde amnesia is present, with islands of intact recollections following a temporal gradient. Magnetic resonance and diffusion tensor images are presented demonstrating a lesion of the left anteromedial thalamus, which receives input from the mammillothalamic tracts, vital to memory. Results: Neuropsychological performance was characterized by low-average overall intelligence (WASI), intact attention, visuospatial, and executive functioning. In contrast, verbal fluency and verbal and non-verbal memory were severely impaired and visual disruption (diplopia) impacted tasks of visual-motor integration and tracking (Trails, Coding, Stroop). Mood was variable with flat and anxious affect. Orientation was impaired to time and place. Conclusions: The present case builds on previous evidence indicating the consideration of severe memory impairment as a possible devastating complication of EVT. Education and behavioral interventions were provided to the family.

graphic

A-59
Don't I Know You? Executive Function Deficits Result in Misidentification of Strangers

Abstract

Objective: Research on facial recognition has highlighted the fusiform gyrus as a neural substrate for this ability, as seen in studies evaluating normal face perception and prosopagnosia. Further studies have investigated neuroanatomical differences between recognition of known and unknown faces, with one study identifying an important role for the prefrontal cortex in facial recognition due to the contribution of monitoring and decision functions. This case study investigates the neuropsychological profile of an adolescent complaining of over-recognizing unfamiliar faces following diffuse axonal injury (DAI). Methods: The patient is a 19-year-old woman who suffered DAI as a result of a head trauma sustained in a motor vehicle accident, with neuroimaging showing small punctuate hyperdensities in the left parietal lobe, right frontal lobe, and gray–white junction. While some neurocognitive symptoms have improved over time (attention; balance), one ongoing complaint is the “over-recognition of faces,” in that the patient will insist a stranger is someone she knows, even when this person has different physical features than the identified individual. We administered standard neurocognitive testing and specialized measures of face perception, famous face identification, and face memory to evaluate the patient's complaints. Results: Findings from standard neuropsychological testing and specialized face processing measures were grossly normal. Weaknesses were seen, however, on aspects of executive control tasks, including planning and organization problems, and difficulty discriminating targets from foils on memory measures. Conclusions: These findings suggest that executive abilities, rather than limitations in face perception or identification, may contribute to false facial recognition and should be considered in light of such symptom presentation.

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Validation of New Visual-Spatial Memory Test

Abstract

Objective: The present study examined a new measure of visual-spatial memory that emulates the Morris Water Test (the Poreh Non-verbal Memory Test [PNMT]), a test that utilizes stimuli that is not amenable to verbal mediation and requires multi-trial learning. Methods: Thirty-five subjects with known alcohol abuse history and 30 normal controls were administered the PNMT as well as the RAVLT and ROCF. The subjects were recruited from the general community via a newspaper advertisement. Participants completed a consent form followed by the aforementioned tests, in a counterbalanced manner. The mean age was 44.20 years (SD = 12.21), mean educational level was 13.66 years (SD = 2.06), and mean alcohol dependence was 11.43 years (SD = 10.67). Results: The study found that the PNMT 30-min delay correlated with the ROCF 30-min delay (r = − .447, p < .000) and the RAVLT 30 delay (r = − .413, p < .000). The RAVLT and the PNMT learning curve also had the same logarithmic characteristics. Additional analyses showed that within the PNMT, subjects with a history of alcohol abuse exhibit a more robust learning curve. Unlike the ROCF (r = .307, p = .006) or the RAVLT (r = .266, p = .015), the PNMT (r = .03, p = .406) did not correlate with years of education but did correlate with age (r = .339, p = .03). Conclusions: The current study provides preliminary validity data for the PNMT. However, additional research is needed to assess whether the PNMT can better distinguish between patients with lateralized temporal lobectomy as this should be the gold standard for the validation of such verbal as opposed to non-verbal memory tests.

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A New, Computer Administered Test of Verbal Memory

Abstract

Objective: We report on a new, brief test of auditory-verbal recognition memory, with both an immediate and delayed component, that is suitably difficult for clinical use in a normal population and contains intended indices of effort. Methods: The test consists of a combination of 27 high- and low-frequency target words, presented via computer and read out loud by participants. There are two sets of recognition trials, immediate and after a delay with interference. Subjects select from three choices. In the delay condition, one foil is novel, while the other was seen in the immediate condition. Data from 66 of 100 volunteers at the Honolulu VAMC, including the self-reported history of mTBI and disability status, were correlated with performance. Results: Data from valid trials showed a remarkably normal distribution in both the immediate (mean 19.97 [3.53]) and delay (mean 19.63 [3.89]) conditions. Pearson's correlation between trials (n = 59) is .67. For subjects for whom all data (n = 49) were available, linear regression on the number of head injuries on performance was not significant in the immediate condition, B = − 0.76 t(47) = − 1.67, p = .10, but their performance was significantly poorer in the delay condition, B = − 0.1.63 t(47) = − 3.31, p < .01. Conclusions: This test appears thus far to demonstrate good reliability, and the data suggest that it may be sensitive to a history of mTBI, although possible confounds remain to be examined. We are currently working on a replication, which will also permit examination of the effort indices.

graphicVA correct scatterplot by TBI

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ACTH level and Reduced Performance on Logical Memory Task

Abstract

Objective: Studies have found major depressive disorder to be associated with increased hypothalamic–pituitary–adrenocortical (HPA) axis functioning, leading to increased adrenocorticotropic hormone (ACTH). Although evidence suggests increased HPA activation is associated with decreased performance on memory tasks, few studies have examined the role of ACTH in neuropsychological assessment performance. The purpose of this study is to determine the effects of ACTH level on verbal memory in depression. Methods: Depressed subjects (n = 54) were recruited at Stanford University Medical Center for a study examining the HPA axis and cognition in major depression. Subjects completed neuropsychological assessments, psychological diagnostic interviews and blood sampling to measure plasma ACTH. As part of the neuropsychological assessment battery, Wechsler Memory Scale–Third Edition (WMS-III) was administered. Hamilton Depression Rating Scale was administered to assess for depressive symptomatology. Stepwise linear regression was conducted with age and depression severity entered at Step 1 and ACTH level at Step 2. Logical memory was the dependent variable. Results: Our results indicate significant effects of ACTH on logical memory performance. After controlling for age and depression severity, ACTH account for an additional 8.5% (p < .04) of the variance on LM Immediate Memory and for an additional 8.1% (p < .05) of the variance on LM Delayed Memory. In both cases, greater ACTH level was associated with decreased memory performance. Conclusions: The findings suggest that ACTH is a significant predictor of verbal memory performance in depression. Importantly, these findings replicate our previous work which found similar relationships between verbal memory and ACTH in unmedicated depressed patients and healthy controls.

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Composite Cardiovascular Risk Scores and Neuropsychological Test Performance: A Meta-Analytic Review

Abstract

Objective: A recent trend in the research involving cardiovascular risk and neuropsychological test performance has been to link elevations in composite cardiovascular risk scores, such as the Framingham Stroke Risk Profile, to future cognitive decline. While the link between individual vascular risk factors and neuropsychological test performance has been well established over the years, the study of the combination of these factors through composite risk is more recent and, as such, requires further analysis. Methods: This meta-analysis quantitatively summarized the strength of the association between composite cardiovascular risk scores and neuropsychological test performance. Articles that employed either a composite cardiovascular risk score or two or more risk factors from the risk score in combination with neuropsychological tests were included. Two hundred and two effect sizes were obtained from 28 studies employing 42,537 participants. Results: Composite cardiovascular risk scores were significantly associated (r = − .16) with neuropsychological test performance. Hypertension and diabetes were significant moderators to this relationship. Division of these effects into cognitive domains significantly improved the homogeneity of the sample; however, no significant differences were found among the five cognitive domains that were assessed. The above association was found in global cognitive function, executive function, attention, and memory, but not for visuospatial function. Conclusions: These results suggest that composite cardiovascular risk scores can be useful indicators of future cognition. Implications of these findings may be carried to the development of a dementia risk score using similar risk factors and earlier lifestyle changes to reduce cerebrovascular disease and cognitive decline.

A-64
Measuring Cerebellar Ataxia in Chronic Alcoholic Subjects More Precisely Using the International Cooperative Ataxia Rating Scale (ICARS)

Abstract

Objective: Alcoholism is the most common cause of cerebellar dysfunction, yet estimates of the incidence of alcoholic cerebellar degeneration (ACD) vary greatly. This study set out to characterize the frequency and pattern of ACD in an alcoholic group using the International Cooperative Ataxia Rating Scale (ICARS). Methods: We compared the performance of 49 alcoholics and 29 controls and examined the relative contributions of demographic and alcohol consumption variables to ICARS scores. Results: The alcoholic group demonstrated significantly poorer performance on all of the ICARS subscales when compared with the control group. Within the alcoholic group, performance was more impaired on the speech scale than on all of the other scales, except the lower limb component of the kinetic scale, and less impaired on the oculomotor scale compared with all other scales. Years of heavy drinking and lifetime alcohol consumption correlated with total ICARS scores; however, maximum daily consumption was actually negatively correlated with ICARS scores. Of the alcohol history variables, years of heavy drinking was the best predictor of total ICARS scores, making a 19% unique contribution, followed by the period of abstinence from alcohol, which uniquely contributed 7% of the variance. Conclusions: ACD may affect up to two thirds of chronic alcoholics. Assessing the number of years an individual has been drinking beyond a certain threshold can give a good indication of the likelihood of ACD.

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Habitual Prospective Memory Predicts Electronically Monitored Antiretroviral Non-Adherence in HIV Infection

Abstract

Objective: HIV-associated deficits in prospective memory (PM) are known to increase risk of non-adherence to combination antiretroviral therapy (cART). The current study extends that literature by evaluating the construct of “habitual” PM, which is hypothesized to better reflect real-world situations in which an intention recurs at regular intervals (e.g., chronic medication taking behavior). Methods: Participants included 98 HIV-infected persons prescribed cART who completed a comprehensive medical exam, psychiatric interviews, neurocognitive assessment, and a 30-day observation of adherence to a sentinel ART as measured by Medication Event Monitoring System caps. Non-adherence was operationalized as < 90% prescribed ART doses taken. The Adherent (n = 43) and Non-Adherent participants (n = 56) did not differ in demographics, premorbid verbal IQ, comorbid mood or substance use disorders, or general neurocognitive functioning (ps > .10). All subjects completed a habitual PM task in which they were instructed to press the space bar one time per 1-min trial of a computerized Stroop paradigm (but not within the first 20 s). Results: Individuals in the cART Non-Adherent group had significantly higher rates of omission errors on the habitual PM task than the Adherent group (p = .02, Hedges g = 0.43). The effect of habitual PM did not vary according to the ongoing strategic load of the Stroop paradigm and no between-group effects were observed for early responding or errors of commission (ps > .10). Conclusions: Findings indicate that impairment in the cognitive ability to execute a future intention at regular intervals (i.e., habitual PM) is associated with a moderate risk of non-adherence to ART in persons living with HIV infection.

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Memory-based Adherence Strategies for Antiretroviral Medication Management in HIV: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness

Abstract

Objective: “Forgetting” is the most commonly endorsed reason for missing an antiretroviral (ART) dose among HIV-infected individuals, but we know little about the prevalence, predictors, and effectiveness of the mnemonic strategies to support ART adherence that are commonly recommended by clinical neuropsychologists. Methods: The frequency and perceived effectiveness of 28 self-reported memory-based medication strategies was assessed with the Prospective Memory for Medications Questionnaire in 233 HIV-infected individuals. Thirty-day ART adherence was measured via the Medication Event Monitoring System. Results: HIV individuals employed multiple (8.7 ± 5.6) strategies with the most common being internal (e.g., “read medication instructions more than once”). More frequent overall strategy use was uniquely associated with increased affective distress, dependence in everyday functioning, and non-ART pill burden (ps < .01), as well as poorer 30-day ART adherence (r = − .15, p = .02), but not neurocognitive deficits or perceived effectiveness of strategy use (ps > .10). Individuals who used strategies frequently but perceived them as minimally effective had more affective, physical, and functional distress (ps < .01). Conclusions: HIV-infected individuals employ multiple, primarily internally based mnemonic strategies for ART management, which were most common among individuals with comorbid non-adherence risk factors (i.e., higher pill burden, affective, and functional distress). More frequent strategy use was associated with worse ART adherence and was not related to perceived effectiveness. Primary reliance on internally based mnemonic strategies may reflect a meta-functional deficit (i.e., limited cognitive insight into adherence behavior) and is insufficient to support optimal ART adherence in vulnerable populations. Future ART adherence research examining the benefits of awareness training on mobile technology reminder interventions may be warranted.

A-67
The Role of Processing Speed in Multiple Sclerosis During the Controlled Oral Word Association Test

Abstract

Objective: People with multiple sclerosis (MS) consistently generate fewer words than controls on the Controlled Oral Word Association Test (COWAT). Some studies suggest that this difference may be partially due to oral motor slowing; it is also believed that slowed processing speed negatively impacts MS patients' performance on this task. This study examined the disparate roles of oral motor slowing and processing speed deficits during the COWAT. Methods: Participants with MS (n = 37) and controls (n = 23) were recruited through advertisement in the local Multiple Sclerosis Society newsletter and by word of mouth. Audio of the testing was recorded using Audacity, and time to say words and between-word pauses were parsed using a semi-automated segmenting feature in Praat (see image). Results: Averaged over COWAT trials (F, A, and S), MS participants required more between-word time than controls to generate six words—t(58) = 2.57, p < .05. There was no difference between groups in total time to pronounce these words. In the MS group, greater between-word time was associated with lower total COWAT scores (r = − .76, p < .001) and worse performance on the Paced Auditory Serial Addition Test (r = − .38, p < .05). Conclusions: MS participants spent more total time in between-word processing than controls. This between-word time was associated with an objective measure of processing speed and total COWAT score. In contrast, no evidence was found for the influence of oral motor slowing on test performance. Future studies should investigate the roles of oral motor slowing and processing speed difficulties in MS subtypes where oral motor slowing is more common.

graphicPraat Program: Word/Pause Example

A-68
Neuropsychiatric Features in Progressive Supranuclear Palsy

Abstract

Objective: Progressive supranuclear palsy (PSP) is a rare neurological disorder that typically presents with motor disturbances including postural instability and falls, axial parkinsonism, and slowing of vertical saccades (Litvan et al., 1996). PSP patients also display psychiatric disturbances, but, they have been less studied (Litvan et al., 1996). This study examined the neuropsychiatric features present in patients with PSP as part of a multisite effort. Methods: One hundred and fifty-four patients diagnosed with PSP meeting the NINDS-SPSP criteria were examined across multiple sites in the USA. The Neuropsychiatric Inventory (NPI; Cummings et al., 1994) was used to evaluate for behavioral abnormalities. Caregivers were asked to rate affected behaviors on a 1–4 scale for frequency and a 1–3 scale for severity. Each domain was calculated by multiplying frequency and severity. Results: The mean NPI total score was 10.82 (SD = 9.2). Apathy was the most frequently occurring behavioral symptom (present in 62% of patients). Apathy severity was rated in the moderate-to-severe range in 43% of the patients. Depression was present in a majority of patients (59%) but was rated as moderate to severe in only 19%. Agitation (36%), Irritability (33%), Disinhibition (32%), and Anxiety (25%) were also present in a large number of patients. Delusions, hallucinations, and euphoria were infrequent and occurred in <14% of the sample. Conclusions: Consistent with previous studies (Aarsland, Litvan, & Larson, 2001; Litvan et al., 1996), the neuropsychiatric profile of PSP patients is dominated by apathy. As expected, these findings suggest that behavioral abnormalities in PSP follow a pattern associated with executive dysfunction.

A-69
Wernicke–Korsakoff Syndrome Resulting from Delusional Food Refusal: A Case Study

Abstract

Objective: Wernicke–Korsakoff Syndrome (WKS) is a neurological condition caused by thiamin deficiency, and typically characterized by eye movement abnormalities, truncal ataxia, delirium, severe anterograde amnesia, and retrograde amnesia. Most patients develop WKS as a result of malnutrition secondary to alcoholism; however, the syndrome may occur in other conditions as well. Cases of WKS in the context of gastrointestinal disease, anorexia nervosa, and schizophrenia have been reported. We present a case of a 35-year-old African-American man who developed WKS due to a somatic delusion and consequent food refusal. Methods: Extensive medical workups over a 10-year period revealed no medical causes for his physical symptoms, which included abdominal pain, nausea, and vomiting. Psychiatric history was positive only for depression. There was no history of significant alcohol use. One year prior to referral the patient began refusing to eat due to a belief that food would become “stuck” in his stomach and he would die. This delusion and associated behavior resulted in significant weight loss and malnutrition. Results: The patient was not oriented to person, time, or situation. Severe truncal ataxia and nystagmus were observed. An abbreviated neuropsychological battery was administered, with the most profound deficits on tasks of memory. The patient exhibited no appreciable learning curve on auditory word list and story learning tasks. Recall for both verbal and visual stimuli was absent and recognition was near chance level. Conclusions: Findings are typical of WKS. This patient, however, developed WKS due to specific delusional beliefs resulting in food refusal, a less common presentation.

A-70
Recall Speed on the Auditory-Verbal Learning Test in Multiple Sclerosis: Associations with Fatigue, Processing Speed, and Working Memory

Abstract

Objective: People with multiple sclerosis (MS) commonly demonstrate problems with list learning and delayed list recall. They also have processing speed deficits compared with controls. No studies have examined the relationship between processing speed and list recall speed in MS. We examined differences in list recall speed between patients with MS and controls, as well as the clinical correlates of recall speed in MS. Methods: Participants with MS (n = 40) and controls (n = 25) were recruited through advertisement in the Multiple Sclerosis Society newsletter and by word-of-mouth. List learning and memory was tested using the Auditory Verbal Learning Test (AVLT). Audio of testing sessions was recorded using Audacity, and timing of words and between-word pauses was parsed using a semi-automated segmenting feature in Praat. Results: During AVLT trials 1–5, MS patients took longer between-word pauses than controls—t(63) = 2.03, p < .05. In the MS group, longer pauses during list recall were associated with fatigue (r = .37, p < .05) and slowed processing speed (r = − .40, p < .05). MS participants also demonstrated longer pauses compared with controls during the long delay—t(44.74) = 2.84, p < .01. Longer pauses at delayed recall were associated with cognitive fatigue (r = .32, p < .05) and working memory difficulties (r = − .33, p < .05). Conclusions: MS participants required more time to recall words than controls during list learning trials and at the long delay. Longer between-word pauses were associated with more self-reported fatigue. Additionally, longer pauses were associated with worse performance on separate measures of processing speed and working memory. Findings support research suggesting that processing speed difficulties may negatively impact performance on list learning tests in MS.

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Evaluating the Relationship Between the PIC-II and Vineland in Children with Fetal Alcohol Spectrum Disorder

Abstract

Objective: Children with Fetal Alcohol Spectrum Disorder (FASD) present with a wide range of neurobehavioral difficulties including adaptive skills deficits and personality problems. From a clinical perspective, it is important to know how these two constructs correlate in order to guide efficacious interventions. The purpose of the current study was to investigate the relationship between the Personality Inventory for Children–Second Edition (PIC-II) and Vineland Adaptive Behavior Scales (VABS), in children with FASD. Methods: This sample consisted of 102 children diagnosed with FASD by a physician specializing in neurodevelopmental disorders (mean age = 10.33, SD = 3.24). All participants were administered the PIC-II and VABS as part of a comprehensive neuropsychological evaluation. Results: Pearson's correlations among the PIC-II and Vineland ranged from .019 (p > .05) to .513 (p < .01). There was a high level of correlation among many of the constructs of interest in this study, including 10 correlations that were significant at the .01 level and 7 that were significant at the .05 level. There was a high degree of overlap among variables such as socialization adaptive skills when compared with antisocial behaviors, communication ability in comparison with academic achievement, and daily living skills when compared with maladaptive behaviors. Conclusions: In order to more fully understand adaptive skill deficits, it is important for researchers and clinicians to investigate personality problems. Understanding real-world functional impairment (adaptive skills deficits) from a psychiatric (personality problems) viewpoint is imperative in order for clinicians to guide treatment.

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Serial Neuropsychological Assessment of Juvenile Neuronal Ceroid Lipofuscinosis (Batten Disease): A Pediatric Case Study

Abstract

Objective: Juvenile Neuronal Ceroid Lipofuscinosis (JNCL) or “Batten Disease” is a neuropsychiatric disorder characterized by progressive visual loss, visual and motor impairments, and seizures. While the condition is rare, the progression of JCNL is always fatal, often resulting in death in late teens or early 20s. Specific manifestations of impaired cognitive abilities have been documented; however, little evidence exists examining the progression of neurocognitive symptoms. Serial assessments across 12 months are presented to establish a progression of JNCL symptoms within an individual's neurocognitive functioning. Methods: The current case report presents results from a series of neuropsychological assessments involving a 7-year-old girl diagnosed with confirmed JNCL who is also being followed by an interdisciplinary team including neuro-ophthalmology, rheumatology, and neuropsychology. The patient was referred to a neuropsychologist within an academic medical center to assess overall neurocognitive functioning. A timeline of symptoms and results of diagnostic and neuroimaging procedures are presented. Results: Evaluation of the patient revealed several weaknesses within her cognitive functioning. Most notably, attention/concentration and impulse control were significantly below expected levels for age and gender. However, later testing revealed some improvements within her sustained focus, as well as very limited overall cognitive decline over the 12-month span. Conclusions: Discussion in this case focuses on the role of neuropsychologists in longitudinal monitoring of symptoms associated with JNCL. The need to monitor individuals with JNCL over time given the progressive decline of neurocognitive functioning and co-occurring attention and behavior issues that directly impact home and school functioning will also be discussed.

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Does Substance Abuse Confound Neuropsychological Screening in HIV?

Abstract

Objective: The purpose of the present study was to determine whether the use of substances interferes with neuropsychological screening for HIV associated neurocognitive disorders. Methods: Data were obtained from 221 HIV+ patients seeking medical treatment. Participants: 57% men and 93.2% were African American. Mean (SD) descriptive values: 37.18 (11.49) years of age, 11.57 (2.21) years of education, 42.38 (66.13) months with HIV diagnosis, 355.46 (312.77) T-cell count. Psychological screening was conducted using the M.I.N.I. International Neuropsychiatric Interview. Neuropsychological screening was conducted using the Modified HIV Dementia Scale (MHDS) and the Montreal Cognitive Assessment (MoCA). Results: Of the sample, 49.3% reported current use of cigarets, 30.8% reported use of illicit substances within the past year, and 33.8% reported consumption of excessive amounts of alcohol. After controlling for education with partial correlation, history of substance abuse use treatment was not associated with MHDS (r = − .10; p = ns) or MoCA (r = .01; p = ns) scores. The presence of current substance use was not associated with MHDS (r = − .08; p = ns) or MoCA (r = − .02; p = ns) scores. Current tobacco use was not associated with MHDS (r = − .08; p = ns) or MoCA (r = − .06; p = ns) scores. Conclusions: Use of tobacco and abuse of substances may not be independently associated with significantly more impairments on neuropsychological screening measures. These factors may be part of a lifestyle that places individuals at risk for lower education, which may ultimately affect neurocognition.

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Planning Moderates Success of Mental Imagery Strategy for Prospective Memory in HIV Infection

Abstract

Objective: Mental imagery (MI) holds promise to rehabilitate HIV-associated prospective memory (PM) impairment, but little is known about its cognitive mechanism of action. The present study tested the hypothesis that visual planning abilities moderate the effectiveness of MI for PM in this population. Methods: Participants included 166 HIV-infected individuals who completed a comprehensive neurocognitive assessment. All participants were given a PM intention whereby they were asked to perform a medication management task when shown the grooved pegboard test. Participants were randomized into either: (a) an MI arm in which they were asked to repeat the instructions and visualize the similarities between the cue (i.e., pegboard) and the intention (i.e., pillbox) stimuli or (b) a control arm in which they repeated the instructions. Results: Logistic regression analyses revealed no effect of MI on PM task completion (p > .10) but a significant effect of Tower of London total moves score (ToL; p < .001) and its interaction with MI (p = .04). Individuals in the MI condition with intact ToL performance were three times more likely to complete the PM task (OR = 3.1 [95% CI = 1.6,6.3]; p < .002), even when covarying for factors on which the PM completion groups differed (e.g., education). MI did not interact with other aspects of executive functions (e.g., switching) or working memory in predicting PM task completion (ps > .10). Conclusions: Findings suggest that the cognitive architecture of mental imagery strategies for improving PM rely upon intact planning abilities in HIV+ individuals and may inform clinicians' decisions to implement such strategies across patients with differing cognitive strengths.

A-75
Neurocognitive Profile of a Child with Schizencephaly: A Case Report

Abstract

Objective: Schizencephaly is a rare neuronal migration disorder marked by cerebral clefts and associated brain defects. Seizures are common. Neuropsychological outcomes literature is limited to several adult cases identifying cognitive impairment, dyslexia, motor issues, and psychiatric disturbances. This case study extends limited knowledge regarding sequelae of shizencephaly with a pediatric neurocognitive profile. Methods: At 3 months of age, neuroimaging revealed a midline anterior schizencephalic cleft between the frontal lobes, agenesis of the corpus callosum, and absence of the septum pellucidum. At 4 months, hydrocephalus was treated with a complex ventriculoperitoneal and posterior fossa to peritoneal shunt, which failed and required revision. At 6 years, minor EEG abnormalities noted with no marked epileptogenic activity. At 8 years, comprehensive neuropsychological evaluation was completed. Results: Neuropsychological assessment revealed borderline Full-Scale IQ, deficits in fluid reasoning, working memory, sustained auditory attention, dual-tasking, spatial and verbal information encoding, visual-spatial, and sensorimotor skills. Relative strengths noted in quantitative reasoning, all basic areas of academic achievement, inhibitory control, and problem-solving. Externalizing, internalizing, and adaptive concerns in home and school settings were reported. Conclusions: Neurocognitive profiles typically reflect anatomical characteristics of the cleft and amount of affected cortical matter. In this case study, despite the cleft location, strengths in frontal functions were contrasted by adaptive deficits in behavioral regulation. This underscores the importance of pediatric neuropsychological assessment for the identification of individual strengths and weaknesses. Utilization of diffusion tensor imaging may be helpful in explaining a pattern of deficits by analyzing neuronal pathways versus isolated areas of insult.

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Affect Identification and Interpersonal Skills: An In-depth Evaluation of Social Cognition in Schizophrenia

Abstract

Objective: The primary purpose of this study was to evaluate individuals with schizophrenia on a number of increasingly complex social cognitive tasks across multiple subdomains of social cognition. Unique contributions of these subdomains to one another were systematically examined, with contributions evaluated including those of basic visual and auditory perception on affect perception, of affect perception on perception and interpretation of complex social situations, and of perception and interpretation of complex social situations on theory of mind. Methods: Participants included adults who were diagnosed with schizophrenia (n = 50). Path analysis was used to compare the goodness of fit of various models depicting the various hypothesized relationships between the social cognitive variables. Results: While it was hypothesized that the simplest, most parsimonious model would be the best fit for the data, it was found that a slightly more complex model, which included paths reflecting the predictive relationships of auditory perception and visual perception to auditory/visual affect identification, was found to be the best fit. Conclusions: The present study identified relationships between the variables as expected, with performance on more simple cognitive variables predicting performance on increasingly more complex social cognitive variables. Performance on measures of basic auditory and visual perception tasks was also found to predict performance on auditory/visual affect identification tasks. The findings of the present study warrant further exploration of social cognition in schizophrenia, particularly in the evaluation of the efficacy of treatment strategies which target more basic social cognitive processes that contribute to higher-order social cognitive processes in a bottom-up fashion.

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Test–Retest Stability of the Wide Range Achievement Test, Third edition, Reading-Recognition Subtest in HIV+ Participants

Abstract

Objective: The Wide Range Achievement Test, Third Edition, Reading-Recognition subtest (WRAT-3 RR) is an established measure of premorbid ability, yet its long term stability is not well documented. We examined test–retest stability of the WRAT-3 RR over time in a sample of HIV+ adults. Methods: Participants (n = 87) were derived from the Manhattan HIV Brain Bank, a longitudinal study of advanced HIV infection. Participants completed a comprehensive neuropsychological battery, including the WRAT-3 RR. Results of two evaluations, separated by at least 12 months (M = 59.2 months [36.3]), were used to assess stability across clinical, medical, and demographic factors. Results: Average change in WRAT-3 RR standard scores was 4.7 points (range = 0–13 points). Correlational analyses indicated that the overall stability of the WRAT-3 RR was high (r = .94, p < .001). Reliability coefficients remained robust across all clinical, medical, and demographic subgroups (rs = .87–.96). Importantly, the stability for participants whose overall cognitive status declined over time was .96 (p < .001). Coefficients for participants with interval increases and decreases in CD4 count were 0.91 and 0.94, respectively (ps < .001). Similarly, estimates remained high (≥.91, all ps < .001), regardless of interval change in cocaine toxicity. Finally, coefficients were above 0.90 for all racial/ethnic groups (all ps < .001). Conclusions: Overall, this study demonstrated that across HIV+ subgroups, there is little change in WRAT-3 Reading score from baseline to follow up assessments, even with lengthy inter-test intervals. These findings support the test–retest stability of WRAT-3 Reading scores in an advanced HIV+ sample.

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Effects of Antiviral Therapy for Hepatitis C on Executive Functions

Abstract

Objective: Limited data suggest that antiviral (ANT) therapy for chronic hepatitis C virus (HCV) infection likely hampers aspects of cognition during treatment. The degree to which ANT therapy for HCV impacts executive functions has not been carefully investigated. The purpose of this longitudinal study, therefore, was to determine whether individuals receiving ANT therapy for HCV (ANT+) evidence decline on executive function measures compared with individuals with HCV not undergoing ANT therapy (ANT−). Methods: 29 ANT− and 30 ANT+ were recruited through Oregon hepatology clinics. Groups did not significantly differ in terms of age, education, estimated baseline intellectual functioning, gender, or ethnicity. Participants completed the Neuropsychological Assessment Battery (NAB) Executive Functions Module at baseline, and then ∼3 months after initiating treatment (ANT+) or after baseline (ANT−). Results: A repeated measures general linear model (GLM), with the NAB Executive Functions Index as a within subjects factor and group as a between subjects factor, revealed a significant effect for time (p = .016) and the interaction of time and group (p = .049); the ANT− group improved over time consistent with practice effects, but the ANT+ group did not benefit from experience. GLMs with individual subtests as within subjects factors revealed a significant interaction of time and group (p = .022) on Judgment; the ANT- group improved over time while the ANT+ group's performance declined. Conclusions: Although it is unclear whether effects persist following treatment termination, these data suggest executive functions, particularly judgment and everyday problem-solving, are adversely affected during ANT therapy for HCV.

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Dercums Disease (Adiposis Dolorosa): Neuropsychological Features of a Rare Metabolic/Autoimmune Disorder

Abstract

Objective: Dercum's Disease (adiposis dolorosa) is a rare condition resulting in painful unencapsulated lipomas in subcutaneous fat and associated multiple organ system involvement (Endocrine, GI, Infectious Disease, Hematologic, Urologic, Pulmonary, Rheumatologic, Psychiatric, and Neurologic). The etiology of Dercum's Disease is unknown, although metabolic/autoimmune components have been hypothesized. Psychiatric/neurological symptoms may include anxiety, depression, sleep distubances, headaches, dizziness, chronic pain, peripheral neuropathy, deafness, and dimming/blurring of vision. Neuropsychological symptoms have not been extensively reported in the literature but may include attention/concentration problems, difficulty expressing thoughts, impaired memory, and confusion (Herbst & Asare-Bediako, 2007; Kosseifi, Anaya, Dronovalli, & Leicht, 2010). Methods: The present case involves a 52-year-old, left-handed Caucasian man diagnosed with Dercum's Disease, referred for neuropsychological evaluation for complaints of difficulty concentrating, short-term memory loss, difficulty with spelling, reading and writing, and sensory and psychomotor complaints. Results: Neuropsychological testing revealed minimal-to-mild neuropsychological deficits in the areas of attention, processing speed, executive functioning, and primary sensory and psychomotor functioning. The patient demonstrated average intellectual functioning and average/high average general memory skills. The patient's anxiety surrounding the unpredictability of Dercum's Disease, chronic pain, and depressive symptomatology contributed to the further derailment of his cognitive functioning. Conclusions: Neuropsychological testing proved to be of significant diagnostic importance in differentiating the patient's complaints and facilitating the development of a comprehensive neurobiopsychosocial treatment plan. This case underscores the need to integrate neuropsychological test findings with the effects of disease burden, chronic pain, and affective disturbances in the diagnosis and treatment of Dercum's Disease.

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Influence of Depression and Anxiety on Measures of Intelligence in Patients with Multiple Sclerosis

Abstract

Objective: To assess the association of depression and anxiety on measures of intelligence in patients with multiple sclerosis (MS). Previous studies by this group have found no significant association between measures of auditory learning over trials and mood. Methods: 30 patients with MS (men = 7) seen in the University of South Florida (USF) Health Neuropsychology Clinic for evaluation of cognitive impairment through a routine battery of neuropsychological tests. Patients for the study were screened based on the availability of necessary measures, specifically the Wechsler Abbreviated Scale of Intelligence or the Wechsler Adult Intelligence Scale, Beck Depression Inventory II and State-Trait Anxiety Inventory. This study is an analysis of collected data in the USF Neuropsychology Database. Results: A significant negative association was found between state anxiety and measures of intelligence (p = .014, β = − .452). No significant association was found for depression or trait anxiety and intelligence. Conclusions: The results indicate that state anxiety does have a significant impact on measures of full-scale IQ in patients with MS, while depression and trait anxiety do not influence performance. This finding is important when interpreting test scores of patients with MS in a clinical setting and assessing the influence of mood on neurocognitive performance in this population.

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Self-Reported Fatigue During a Cognitively Demanding Task: What Does it Represent?

Abstract

Objective: Multiple sclerosis (MS)-related fatigue has been conceptualized as being both physical and cognitive in nature. However, the definition, experience, and consequences of cognitive fatigue remain fairly elusive. The present investigation sought to examine pre-existing factors that could contribute to self-reported cognitive fatigue during a cognitively demanding task. Methods: Eighteen (18) individuals with MS (mean age = 46.5 [SD = 9.83] and mean education = 16.4 [SD = 2.52]) completed a comprehensive baseline evaluation prior to completing a cognitively demanding task (N-back) while undergoing functional MRI. Half of the individuals reported experiencing significant fatigue (>5 of 10) during the task. Independent sample t-tests were conducted to compare the fatigued and non-fatigued groups on baseline measures of cognition, emotional functioning, and indices of physical and cognitive fatigue. Results: Fatigued individuals reported greater trait anxiety (p = .033), vegetative symptoms of depression (p = .014), and cognitive fatigue (p = .006) prior to completing the task. There were no differences between the groups with regard to cognition (memory, attention, language, processing speed, executive functioning), mood or evaluative symptoms of depression, or physical fatigue. Conclusions: Certain pre-existing emotional factors may contribute to reports of cognitive fatigue during cognitively demanding tasks that are independent of objective cognitive performance.

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Acute Disseminated Encephalomyelitis (ADEM): A Case Study

Abstract

Objective: Acute Disseminated Encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the CNS. Although similar to Multiple Sclerosis (MS), ADEM is frequently monophasic, diagnosed in children, and preceded by infection. Diagnostic features of ADEM are not well defined. To date, criteria include polysymptomatic presentation, mental status change, symptoms of encephalopathy, and indistinct lesions on MRI (Young et al., 2008). Deficits are similar to MS, but less severe and include impairments in attention, executive functioning, motor, visual-spatial abilities, and behavioral or emotional dysfunction (Hann et al., 2003). Limited empirical evidence is available regarding adult onset ADEM. Methods: This case describes a right-handed, 49-year-old woman referred for a neuropsychological evaluation secondary to persistent cognitive and emotional changes 1 year post onset of infection-ADEM. Initial symptoms included vertigo, apraxia, dysarthria, and confusion which progressed to lasting difficulties in gait, speech, attention, processing speed, word-finding, multitasking, short-term memory, and emotional regulation. Neuropsychological data, de-identified history, neuroimaging, and neurologist report will be organized and presented in a single-case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed significant weaknesses in dual attention, verbal fluency, naming, memory (variable), and emotional regulation. With regard to mood, there was evidence of moderate depression and anxiety. Conclusions: The patient presented with deficits consistent with the effects of ADEM on neurocognitive function. Neuropsychological assessment can be extremely helpful in clarifying the exact nature and extent of difficulties, thereby guiding intervention.

A-83
Carbon Monoxide Poisoning: A Case Study

Abstract

Objective: Evidence suggests that carbon monoxide (CO) exposure frequently results in neuropathic changes and cognitive impairments. Identified lesions and perfusion defects are documented in the cerebral white matter, basal ganglia, frontal lobe, corpus callosum, mesial temporal lobe, thalamus, and hippocampus (Parkinson et al., 2002; Ruth-Sahd et al., 2011). However, neuropsychological testing has demonstrated greater sensitivity to CO poisoning than neuroimaging with deficits displayed across memory, attention, processing, visuospatial, executive functioning, motor, and emotional regulation measures. Methods: This case describes a 52-year-old man referred for neuropsychological evaluation following multiple simultaneous respiratory infections. The patient, secondary to high levels of anxiety, chain-smoking cigarets during his sickness. Ultimately, his respiratory infections became severe enough that his throat began to close thereby trapping the CO from smoking in his lungs. This resulted in loss-of-consciousness with CO poisoning/anoxia. Two years post event, the patient reported persistent difficulty with word-finding, processing speed, short-term memory, irritability, and emotional incontinence. Neuropsychological data, de-identified history, and neurologist report will be organized and presented in a single-case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed significant weaknesses in attention, processing speed, cognitive flexibility, ability to self-regulate, non-verbal memory, verbal learning, and verbal memory. There was also evidence of moderate anxiety and depression. Conclusions: The patient presented with deficits consistent with the effects of CO poisoning on neurocognitive function. Neuropsychological assessment can be extremely helpful in clarifying the exact nature and extent of difficulties, thereby guiding intervention.

A-84
Epilepsy and Neuropsychology of Lipoid Proteinosis

Abstract

Objective: Lipoid proteinosis, or Ubach–Wiethe, is an autosomal recessive disease which is caused by reduced expression of the extracellular matrix protein 1 gene, ECM1, on chromosome 1q21. It is a disease of abnormal deposition of glycoprotein in various tisses internal organs and the skin of human beings. Major symptoms of the disease may include hoarseness of the voice, scarring of the skin, hearing deficits, and beading of the papules around the eyelids. Neurologically, it presents with bilateral calcifications in the medial temporal regions, which can lead to epilepsy and neuropsychological and neuropsychiatric abnormalities. It is a rare disease with ∼500 cases reported world-wide. Methods: Here, we present a rare case of a 37-year-old Saudi man who was diagnosed with epileptic seizures at age 15, as well as memory deficits, behavioral and personality changes such as low self-esteem, easy irritability and depressed mood. His symptoms have affected his work, social life, and interpersonal relationships. On physical examination, he was found to have a life-long history of lipoid proteinosis with hyperkeratoic dermatosis over the face, hands, and knees. He was also found to have hoarseness and bilateral ear cholesteatoma. Neuroimaging (MRI) was positve for bilateral symmetrical calcification of the amygdala. EEG findings revealed complex partial seizures. He was given a full battery of neuropsychological tests. Results: Testing showed deficits in general memory, working memory, perceptual organization, and processing speed. His scores on BDI fell within moderate depression range. Conclusions: A 37-year-old Saudi man with a case of lipoid proteinosis, a rare systemic disorder, who presented with physical, neurological, and neuroimaging manifestations of the disease . Neuropsychological assessment showed deficits in working memory, general memory, processing speed, and perceptual organizational skills. His intellectual functioning abilities fell within average range. Assessment of mood revealed a moderate level of depression. Our testing findings support many of the previous neuropsychological report findings.

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CADASIL: Neuropsychological Cognitive Function Decline, A 1-Year Follow-up Study

Abstract

Objective: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant inherited angiopathy that was found to be caused by mutations in the NOTCH3 gene on chromosome 19. It is a rare hereditary brain disease with different psychiatric, neurobehavioral, and cognitive deficits leading to dementia. In this case study, we present a 52-year-old highly educated medical doctor, who was afflicted by the disease at age 45. Despite his illness, he was able to carry out his professional responsibilities until a year ago, when he started to complain of forgetfulness and very mild right side weakness. MRI of his brain was carried out, along with other laboratory investigations. He was found to have very small lacunar infarcts, which also affected his speech. The diagnosis of CADASIL was established by mutational screening of the NOTCH3 gene. Methods: Because of his memory problems, he was administered a battery of neuropsychological tests at baseline, the results of which showed moderate cognitive deficits. A year later, he quit his job due to severe memory deficits, which led to the assessment of his cognitive abilities using the same neusopsychological instruments and psychological questionnaires. Results: The results of the retesting showed significant decline in the patient in his executive functions (initiation, set shifting, organization and planning, processing speed, declarative memory, working memory, and verbal fluency). Conclusions: This is the first case in the Arabic world of a patient who was inflicted with CADASIL, a rare autosomal disease, who has undergone a comprehensive neuropsychological evaluation initially at baseline and again 1 year later. Our findings showed a significant decline in this highly educated medical doctor. His deficits were seen in the functions of the frontal lobe, working memory, processing speed, speech, and language. This case highlights CADASILs occurrence at an early age. It has a very ominous progressive prognosis.

A-86
The Cognitive Sequelae of Meningioma and Pre-Surgical Decision Making with Longitudinal Neuropsychological Data

Abstract

Objective: Meningiomas account for 34% of all primary brain tumors; however, there is a paucity of literature on their cognitive sequelae. Referral for repeat neuropsychological evaluation was made to evaluate change since testing ∼2.5 years prior. The subject was a 68-year-old Caucasian woman with a stable right parasagittal meningioma and perceived cognitive deterioration. Past neuropsychological evaluation was interpreted as being “… minimally abnormal due to reduced executive functions and weakness in visual memory.” Prior medical and family histories were non-contributory. Mild anxiety and depression corresponded with the meningioma diagnosis. More recent personality changes included amotivation. Neuroimaging revealed a parasagittal meningioma with a diameter of 2 cm which was stable for 3 years. Methods: After a review of background documents, including neuroimaging and raw data from the past neuropsychological evaluation, a follow-up neuropsychological evaluation was completed. Results: NP data revealed a severe deficit in visuospatial construction superimposed on a superior intellectual ability. Relative inefficiencies in visuoperception and executive functions likely represented a departure from baseline. Effort was good. Depression and anxiety were elevated. Conclusions: Test results revealed a pattern suggestive of right frontal-parietal dysfunction which was consistent with the site of the meningioma. When compared with her past evaluation, results indicated a mild decline in executive functions and a severe decline in visuospatial ability. Given the size and location of the meningioma, cognitive dysfunction was most likely secondary to decompression. From a neuropsychological standpoint, the removal of the meningioma was recommended. Neurosurgery was scheduled and pre-surgical testing is pending.

graphic

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Relationship of the Wechsler Test of Adult Reading to the Wechsler Adult Intelligence Scale Fourth Edition in a Clinical Sample

Abstract

Objective: The Wechsler Test of Adult Reading (WTAR) was designed to provide an estimate of premorbid cognitive functioning. The objective of this study was to examine the relationship between the WTAR-predicted Full-Scale IQ (PredFSIQ), and Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV) FSIQ and index scores; General Ability (GAI), Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), Processing Speed (PSI), in a clinical sample. Methods: Data from 70 consecutive patients seen for an outpatient neuropsychological evaluation were included. Diagnoses included general memory complaints/mild cognitive impairment (31%), mixed neurological (31%), TBI/mTBI (27%), and psychiatric (10%). The sample had an equivalent number of men (n = 32) and women (n = 38) with a mean age of 48 ± 11 years, mean education of 14 ± 2 years. Correlational analyses and paired t-tests were used to compare scores from the WTAR and WAIS-IV. Results: Significant correlations were obtained in four of six comparisons as follows: PredFSIQ-FSIQ = 0.30; PredFSIQ-GAI = 0.36; PredFSIQ-VCI = 0.45, and PredFSIQ-WMI = 0.28. T-tests showed significant differences between scores on WTAR and FSIQ, GAI, VCI, and WMI but not PRI and PSI. Conclusions: The predicted FSIQ derived from the WTAR is modestly correlated with four of the six WAIS-IV index scores with the strongest being with VCI. This is not surprising given the strong verbal requirements for both tests. Since processing speed is effected in a range of neuropsychological conditions the lack of correlation between PredFSIQ and PSI was not unexpected.

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Validation of the Brief Cognitive Status Exam Inhibition Task

Abstract

Objective: The Brief Cognitive Status Exam (BCSE) is a new measure of global cognitive functioning. The Inhibition task on the BCSE requires individuals to inhibit an over-learned response (i.e., naming two shapes) and provide a novel response (i.e., naming the opposite shape). The purpose of the present study was to examine the validity of the Inhibition task. Methods: A mixed clinical sample of 80 veterans with a mean age of 58.4 years (SD = 11.4) and mean education of 13.3 years (SD = 2.4) was administered the BCSE as part of a neuropsychological evaluation. Convergent and divergent validity of Inhibition scores (time, omissions, commissions) were examined using Spearman's ρ, and discriminant validity was examined by comparing Inhibition scores across three clinical groups, dementia (n = 19), cognitive disorder (n = 36), and no cognitive impairment (n = 25). Results: Inhibition scores correlated strongest with Stroop Color-Word (ρs ranged from 0.41 to 0.54). Inhibition time correlated moderately with other measures of executive functioning (ρs ranged from 0.31 to 0.45), as well as auditory attention span (ρ = 0.42) and confrontation naming (ρ = 0.37). Inhibition scores were not related to verbal or visual memory, novel problem-solving, or mood. Inhibition time and error scores were unable to differentiate among clinical groups. Conclusions: The BCSE Inhibition task exhibited adequate convergent and divergent validity and may be a useful adjunct to the Stroop test for patients with a reading disability. Given its high ceiling and poor discriminative ability, the Inhibition task may not be sufficient as a stand-alone measure of inhibitory control.

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Exploratory Factor Analysis of the Wechsler Adult Intelligence Scale, 4th Edition in a Neurology Clinic Sample

Abstract

Objective: The present study investigated the factor structure of the Wechsler Adult Intelligence Scale, Fourth Edition in a neurology clinic sample. Methods: Two exploratory factor analyses were conducted to examine the structure of WAIS-IV scores of 300 patients (47% women) referred for an outpatient neuropsychological evaluation. Data were collected through a chart review of patients seen from 2009 to 2012. The sample attained an average of 13.5 years of education (SD = 2.9) and ranged from 17 to 83 years of age (mean = 46). A principal axis analysis with promax rotation assessed the structure of the 10 core subtests of the WAIS-IV. A secondary analysis was conducted wherein the number of factors to be extracted was set to 4. The resulting structure was hypothesized to produce factor loadings similar to the conceptual design of the WAIS-IV. Results: Two factors emerged in the principal analysis. Subtests from the Verbal Comprehension and Working Memory Indices loaded on the first factor, accounting for 51.6% of total variance. The second factor contained subtests from the Perceptual Reasoning and Processing Speed Indices, accounting for 11.9% of total variance. In the secondary analysis, four factors matched the conceptual design of the WAIS-IV. However, processing speed and working memory factors accounted for only 8.9% and 6.7% of total variance, respectively. Conclusions: Two factors emerged in a manner consistent with the verbal and perceptual distinctions between the VCI/WMI and PRI/PSI subtests. Differences between neurological subgroups were also considered. Future research with homogenous samples should explore factor contributions within diagnostic subgroups.

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The Use of Functional Near Inferred Spectroscopy (fNIRS) to Detect Deceptive Responding: A Pilot Study

Abstract

Objective: The objective of this study is to validate the use of Functional Near-Infrared Spectroscopy (fNIRS) as a method for detecting intentionally inaccurate responding through imaging differentials in activation in the prefrontal cortex. Previously, fMRI studies have found differential activation for accurate responding and feigned memory problems in the areas of the prefrontal cortex associated with executive functioning and working memory (Browndyke et al., 2008). Methods: Subjects were 15 healthy controls (6 men and 9 women; 22–57 years old). A memory task, similar to the VSVT, was developed for this study; four-digit numbers were used. There were four conditions: accurate responding, false responding, feigning a memory problem, and a “game” condition in which the subject was asked to pick the larger of the two numbers presented but while not dropping below 75% accuracy in the correct selection. This was a block design with three experimental blocks per condition intermixed with visual fixation blocks. NIRS data were collected using a 16-channel fNIR100 system. The system includes 4 light sources and 10 photodetectors. Results: The results of this study demonstrated differential activation among the four conditions with the true responding showing little activation and the “game” condition showing the highest levels of cortical activation. Conclusions: These findings support the use of fNIRS as a non-invasive technique for imaging the prefrontal cerebral cortex. These data also suggest that different cortical processes are involved when subjects respond accurately and feign memory problems, and this can be imaged using NIRS technique.

B-1
Changes in Grey Matter Volume Produced by Constraint-Induced Aphasia Therapy II

Abstract

Objective: Determine whether structural neuroplastic changes occur in grey matter volume following the administration of Constraint-Induced Aphasia Therapy II (CIAT II), a new form of treatment for chronic post-stroke aphasia. CIAT II is an enhanced version of an earlier form of CI aphasia therapy (CIAT I) and was found in a preliminary study to produce functional treatment changes more than 10 times as large as those obtained by CIAT I. CIAT II is modeled after the procedures of CI Movement Therapy (CIMT), used to improve motor deficits following stroke. Past research from this laboratory indicates that CIMT produces structural brain changes and that this neuroplastic reorganization is correlated with the magnitude of the treatment effect. Because CIAT II is an analog of CIMT, we anticipated that similar neuroplastic reorganization would follow CIAT II. Methods: Four patients (70.8 ± 9.6 years) with chronic stroke and moderate expressive aphasia were included. Two were men. Longitudinal voxel-based morphometry was used to compare changes in patient MRI scans before and following treatment. Results: Whole-brain analysis revealed grey matter gains in bilateral frontotemporal areas subserving language function. Changes fell short of significance in this small pilot sample (max tobs = 4.16, tcrit = 5.29). Conclusions: Although results did not reach statistical significance, the pattern of grey matter change in regions subserving language function suggests that CIAT II remodels the language-associated cortex in a manner analogous to that found in motor cortex following CIMT for hemiparesis. Further research in larger patient samples is warranted.

B-2
Adolescent with Bilateral Intracranial Frontal Empyema with Resultant Expressive Aphasia and Executive Functioning Deficits

Abstract

Objective: We present a case of a 15-year-old man who sustained bilateral frontal subdural empyemas and abscess formation following acute sinusitis. Intracranial empyema in pediatric patients is rare with little published data. Bilateral frontal localization is even more rare. The findings will be discussed in relation to research associating frontal lobe damage with aphasia and executive functioning. Methods: The patient's clinical course, neuroimaging, and neuropsychological test results are described. Comparisons are made with prototypical bilateral frontal lobe damage. The patient's acute clinical presentation was consistent with expected symptoms including seizures, fever, altered consciousness, and motor deficits (Legrand et al., 2009). Neurological deficits were consistent with frontal lobe lesions including executive dysfunction and expressive aphasia (Duncan, 2000). Results: Acute testing 4 weeks post-admission revealed severely impaired initiation and expressive language and gross motor deficits. Neuropsychological evaluation 13 weeks post-admission was consistent with classic frontal brain injury, including deficits in initiation, planning, and word finding. Testing revealed mildly impaired IQ, expressive aphasia, but intact receptive language. Executive deficits included poor cognitive flexibility, impaired working memory, and impulsivity as evidenced by significant impairment on the Wisconsin Card Sorting Test and numerous rule violations on the Delis–Kaplan Executive Functioning System Tower Test. Fine motor dexterity was impaired bilaterally. In contrast, verbal learning and memory were relatively intact. Conclusions: This case represents an unambiguous example of a rare bilateral subdural empyema. Neurocognitive deficits were consistent with classic frontal injuries with relatively preserved posterior functions. This case helps elucidate the neurocognitive profile of this rare condition.

B-3
Verbal Fluency Discrepancy Used to Make Differential Diagnosis Between Alzheimers Disease and Vascular Dementia

Abstract

Objective: We investigated the difference in scaled scores between verbal fluency measures and made diagnostic comparisons for Alzheimer's disease (AD), vascular dementia (VAD), and MCI. We compared scaled score performances on category fluency and phonemic fluency across diagnoses. Methods: The sample consisted of 181 persons with AD, 51 with VAD, and 39 with MCI, following consensus diagnosis criteria. They were evaluated as outpatients and administered a standard battery including the assessment of phonemic fluency (i.e., COWAT) and category fluency. Results: ANCOVA, controlling for education, gender, age, and severity of impairment, revealed significant differences between verbal fluency scaled score differences for MCI and dementia (F = 4.48, p = .01). Multiple comparisons indicated differences between verbal fluency difference scores for AD and VAD (p < .001). Category fluency scaled score comparisons revealed significant differences for all three diagnostic groups (p < .01). Phonemic fluency scaled score differences were not significant between dementia groups, although there was a significant difference between the dementia groups and MCI. Conclusions: Performance on phonemic fluency tasks did not vary between dementia groups, only dementia versus MCI; thus, phonemic fluency performance provides little diagnostic differentiation between dementia groups. A significant difference between category fluency across all diagnoses (AD performing significantly worse) implies that category fluency differentiates AD and VAD. Additionally, persons with AD demonstrated a discrepancy in verbal fluency scaled scores (FAS > category), while VAD and MCI showed no significant difference between verbal fluency scaled scores.

B-4
A Pediatric Case Study Involving Ewings Sarcoma: Chemotherapy (Ifosfamide)-Induced Encephalopathy

Abstract

Objective: Cancer and its treatment may significantly impact a child's developing brain. Literature on single traumatic events including oncology treatment (Brown & Madan-Swain, 1993), related encephalopathy (Marlow et al., 2005), and neurotoxicity (Vutskits et al., 2008) suggest the potential for negative cognitive and behavioral impacts. Methods: Data were collected on a girl (12-year-old) who was referred for neuropsychological evaluation due to a complex medical history including Ewings sarcoma, Ifosfamide-induced Encephalopathy and related Methylene Blue Toxicity (age 7), Cardiomyopathy, and brief cyanotic events. The evaluation consisted of records review, clinical interview, and neuropsychological testing including: WISC-IV, CMS, WCST, TMT, D-KEFS, WIAT-II, EVT, RCF, CDI, CBCL, YSR, SCARED, BRIEF, GPB, and TOMM. Results: Intelligence testing revealed low-average ability (GAI = 87). She performed average or above in reading, visual scanning and sequencing, verbal fluency, expressive vocabulary, and visual-motor integration. She exhibited impaired visual and verbal memory, attention, processing speed, executive functioning, and mathematics. Emotional dysregulation was also evident. Conclusions: Aligning with the literature on chemotherapy, this case exhibited impairments in attention, processing speed, and memory. Directly following cancer treatment, she was diagnosed with cardiomyopathy, encephalopathy, and related Methylene Blue Toxicity. Multiple cyanotic events may have further resulted in poor attention and processing. Cognitive impairments frequently increase frustration, which induces emotional dysregulation in children. Subsequent diagnoses included ADHD-NOS, Cognitive Disorder-NOS, Mood Disorder due to Medical Condition with Mixed Features, and ODD. This case will help demonstrate the utility of neuropsychological assessment in clarifying cognitive dysfunction in complex cancer patients and guiding appropriate intervention.

B-5
Self-Endorsement of ADHD Symptomology and Performance on Cognitive Baseline Measures of Concussion: Are They Related?

Abstract

Objective: The present experiment aimed to determine if there was a relationship between self-reported symptoms common to ADHD and performance on baseline measures of concussion. Previous studies suggested that those who endorsed higher rates of ADHD symptoms would have poorer performance on Concussion Resolution Index (CRI) and Standardized Assessment of Concussion (SAC). Methods: Two hundred and eigty-eight NCAA DII student athletes (men = 162 and women = 126; mean age = 20.5 years) completed the baseline measures for the university's mandatory concussion management program. Participants voluntarily completed the Conners' Adult ADHD Rating Scale–Self Report: Short Form (CAARS). Results: Correlation of the CRI factors (Simple Reaction Time, Complex Reaction Time, and Processing Speed) with the CAARS domains (Inattention/Memory, Hyperactivity, Impulsivity, Self-Concept, and ADHD Index) yielded no significant outcomes. Correlation of the SAC domains (Orientation, Immediate Memory, Concentration, Delayed Memory, and total score) with the CAARS domains evidenced a positive correlation only between reported symptoms of hyperactivity and Immediate Memory scores—r(288) = .119, p < .05. About 32.3% of the sample (men = 30 and women = 63) endorsed item totals in the “slightly above average” range or higher for the Hyperactivity domain, while only 8.7% (men = 9; women = 16) scored in this range or higher on the ADHD Index. Conclusions: No strong relationship between self-reported severity of ADHD symptoms and performance on cognitive baseline measures of concussion was uncovered. This suggests that the measures utilized during baseline testing are not influenced by reported ADHD symptoms.

B-6
Use of Vibrotactile Detection Tests in Detecting Concussion and Post-Traumatic Stress Disorder

Abstract

Objective: Differentiating between Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury proves challenging since many symptoms between these conditions overlap. This project studied whether a novel, vibrotactile device that detects brain injury can also differentiate among control subjects, concussed subjects, and those diagnosed with PTSD. Methods: Twenty healthy control subjects, eight subjects diagnosed with concussion, and seven subjects diagnosed with PTSD participated. Concussion subjects were primarily student athletes; PTSD subjects were both combat veterans and victims of domestic abuse. The basic task required that participants report whether the pattern of two successive stimulations presented via vibrating disks on the forehead was the same or different. Three blocks of 36 or 64 trials included either stimulation of three points or stimulation of two disks at a frequency that creates the illusion of a three-point stimulation in normal subjects. Testing sessions lasted ∼25 min. Results: The groups differed significantly both regarding total percent correct (F = 8.130, p = .001, hp2 = .344) and total completion time (F = 5.551, p = .009, hp2 = .264). Post hoc Bonferroni tests revealed that the PTSD (p < .01) and concussed subjects (p < .01) differed significantly from the control subjects, but did not differ from one another (p = .387). Conclusions: Performance differences between the control and concussed groups were predicted based on previous research (Mortimer et al., 2011). Unexpected was the finding that the PTSD group also differed from controls but not from the concussed group. The differing genesis of PTSD among those subjects may have contributed to this finding.

B-7
Predictors of Neurobehavioral Symptoms in a Mixed Polytrauma Sample: Preliminary Findings

Abstract

Objective: Given the high prevalence of comorbid conditions found in polytrauma settings, effective screening measures are needed. Several screening tools are commonly used in polytrauma clinics within the Department of Veterans Affairs. The purpose of the study was to investigate the use of three screening measures (i.e., Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI], and Posttraumatic Stress Disorder Checklist [PCL]) to predict scores on the Neurobehavioral Symptom Inventory (NSI). Research suggests that the presence of mental health conditions, such as PTSD, share a significant amount of variance with postconcussive symptoms. The investigators hypothesized that the PCL would be the best predictor of scores on the NSI. Methods: A sample of 71 veterans was used for this study. All subjects were administered the screening measures as part of an evaluation in an outpatient Level 3 polytrauma clinic. Stepwise linear regression analysis was conducted with BDI-II, BAI, and PCL scores (independent variables) on a calculated NSI total score (dependent variable). Results: Regression analysis revealed that BAI and PCL total scores were best predictors of NSI total scores, F(2,68) = 71.08, p < .001. Surprisingly, the BAI total score accounted for ∼61% of the variance (adjusted R2 = .61). The PCL accounted for only 6% of the variance in the model. Conclusions: This study suggests that the need for screening of mental health concerns when assessing neurobehavioral symptoms in a polytrauma setting. BAI scores were the best predictors of NSI total scores and may inflate item scores on the NSI.

B-8
A Comparison of the NSI and PCL-M in TBI Only, TBI and PTSD in PTSD Only Patients

Abstract

Objective: Compare responses of active duty military patients with mild traumatic brain injury (TBI) versus those with TBI and post-traumatic stress disorder (PTSD) versus those with only PTSD; on the Neurobehavioral Symptom Inventory (NSI) and the Post-traumatic stress checklist-military version. Methods: Data from 69 consecutive referrals; Mild TBI (n = 25): mean age of 25.84, with 12.08 years of education. TBI and PTSD (n = 15): mean age of 28.53 with 12.87 years of education. PTSD (n = 29): mean age of 29.28 with 12.39 years of education. Results: An ANOVA showed differences on the PCL-M (F = 26.45, df = 2, p < .001) and the NSI (F = 17.11, df = 2, p < .001). TBI only showed a mean NSI score of 19.72 and a PCL-M mean score of 30.32; TBI and PTSD showed a mean NSI score of 39.67 and a PCL-M mean score of 52.07 PTSD showed a mean NSI score of 38.41 and PCL-M mean score of 53.31. Data indicate 16 of 17 items on the PCL-M could differentiate between TBI and PTSD; with TBI most often reporting symptom severity of 2 or less; while PTSD scored 3+. Forteen of 22 NSI items were different between TBI and PTSD, with general severity ratings for TBI of 2 or less, while PTSD scored 3+. Conclusions: Data indicate that the scores on the NSI and PCL-M are lower with TBI only; however, with PTSD both NSI and PCL-M are elevated. Results indicate that it may be severity of the items and not specific items that help differentiate TBI from PTSD.

B-9
Acute Symptom Reporting Does Not Predict Chronic Symptom Reporting Within the First 3 Years Following Moderate–Severe Traumatic Brain Injury in U.S. Military Service Members

Abstract

Objective: The purpose of this study was to examine the relation between acute and chronic symptom reporting within the first 3 years following moderate-to-severe traumatic brain injury (TBI). Methods: Participants were 37 U.S. military service members who were evaluated at Walter Reed Army Medical Center following a TBI (mean age = 28.0 years; 59.5% blast, 91.9% men). Participants completed the Neurobehavioral Symptom Inventory within 2 months of injury (M = 20.3 days, SD = 14.1) and follow-up telephone interviews at either 12 (n = 17), 24 (n = 20), and/or 36 (n = 20) months post-injury. Results: At baseline, more than half of the sample reported symptoms consistent with DSM-IV symptom criteria for post-concussional disorder. When compared with baseline, the number of participants that were symptomatic remained similar at 24-month follow-up (55.0%; baseline = 50.0%), but declined at 12-month follow-up (23.5%; baseline = 70.6%), and 36-month follow-up (40.0%; baseline = 65.0%). The progressive course of recovery from baseline to follow-up was characterized by much variability. Although some participants did improve from baseline to follow-up (12 months = 47.1%; 24 months = 10.0%; 36 months = 35.0%), a substantial minority remained symptomatic from baseline to follow-up (12 months = 23.5%; 24 months = 40%; 36 months = 30%), or first reported to be symptomatic more than 2 years post-injury (24 months = 15%; 36 months = 10%). Using regression analyses, symptom reporting at baseline was not a significant predictor of symptom reporting at 12-month, 24-month, or 36-month post-injury (p > .05). Conclusions: As expected, a large proportion of service members remained symptomatic 1–3 years following moderate-to-severe TBI. Unexpectedly, however, acute symptom reporting within the first 2-month post-injury was neither consistently associated with, nor predictive of, symptom reporting in the chronic phase of the recovery trajectory.

B-10
Six-Week Outcome Following Uncomplicated Versus Complicated Mild Traumatic Brain Injury: Neuropsychological and Diffusion Tensor Imaging Findings

Abstract

Objective: To compare short-term outcome following uncomplicated versus complicated mild traumatic brain injury (MTBI). Methods: Participants were 127 patients (60 Uncomplicated MTBI, 20 Complicated MTBI, and 47 Trauma Controls) recruited from a Level 1 Trauma Center in Vancouver, Canada (mean age = 33.7 years; education = 14.6 years; 72.4% men and 84.3% Caucasian). Participants completed 3T MRI with diffusion tensor imaging (DTI) and a neuropsychological evaluation at 6–8 weeks post-injury (M = 46.8, SD = 6.2, range = 31–66 days). Results: Univariate ANOVAs revealed no significant differences among the three groups across a battery of neuropsychological tests. Both groups of patients with MTBIs reported significantly more post-concussion symptoms than the trauma control subjects (Cohen's d for the total scores = 0.67 and 1.06; DSM-IV postconcussional disorder: 10.3% trauma control, 30% uncomplicated MTBI, and 45% complicated MTBI). Univariate ANOVAs revealed no significant differences among the three groups on measures of fractional anisotropy (FA) or mean diffusivity (MD) in the genu, body, or splenium of the corpus callosum. Using a cutoff score of 2 SDs from the mean for the six DTI measures (three FA and three MD) in the trauma control group, having one or more low DTI scores occurred in 6.4%, 18.3%, and 20% of the trauma control, uncomplicated MTBI, and complicated MTBI groups, respectively. Conclusions: Patients with MTBIs reported greater post-concussion symptoms than trauma controls and a minority of patients with MTBIs showed evidence of microstructural changes in the corpus callosum. Contrary to expectations, patients with complicated MTBIs did not show evidence of worse outcome than patients with uncomplicated MTBIs.

B-11
Health-related Quality of Life 4 Years Following Mild Traumatic Brain Injury in U.S. Military Service Members: Influence of Acute Symptom Reporting

Abstract

Objective: To examine the influence of acute symptom reporting on long-term health-related quality of life (HRQOL) following mild traumatic brain injury (MTBI) in U.S. military service members. Methods: Participants were 122 service members who sustained an MTBI and were evaluated at the Walter Reed Army Medical Center (mean age = 26.7 years; 76.2% blast and 96.7% men). Participants completed the Neurobehavioral Symptom Inventory (NBSI) and the PTSD-checklist (PCLC) within 2 months of injury, and follow-up telephone interviews at 8-month (n = 47), 12-month (n = 61), 24-month (n = 34), 36-month (n = 31), or 48-month (n = 22) post-injury. Two groups were formed using the NBSI/PCLC: (a) Symptomatic: DSM-IV symptom criteria for Post-concussional Disorder (PCD) or Post-traumatic Stress Disorder (PTSD) or (b) Asymptomatic: no DSM-IV criteria for PCD and PTSD. Results: There were no significant differences (all p > .05) between Symptomatic and Asymptomatic groups in all five follow-up cohorts for satisfaction with life, health status, seizures, frequency/severity of bodily pain, alcohol consumption, military status, return to work/duty, suicidal/homicidal thoughts, mental health treatment, and help with daily activities. On the remaining variables, some group differences were noted for a handful of cohorts, but no consistent patterns emerged (e.g., a greater proportion of the symptomatic group were married [12 and 36 months], had a higher number/severity of headaches [12, 36, and 48 months], and were taking medications [24 and 48 months]). Conclusions: Symptom reporting within the first 2-month post-injury was not predictive of long-term HRQOL and should not be relied on to identify individuals “at risk” for poor outcome. Long-term follow-up for all MTBIs, regardless of the presence/absence of acute symptom, should be the rule not the exception.

B-12
Impact of Pain on the Neuropsychological Profile of Veterans with a History of Mild Traumatic Brain Injury

Abstract

Objective: The current study investigates the impact of pain on the neurocognitive profile of Veterans who have sustained a mild traumatic brain injury (mTBI). Methods: Subjects are OEF/OIF Veterans who were administered a neuropsychological test battery including Delis–Kaplan Executive Function System subtests (D-KEFS), California Verbal Learning Test (CVLT-II), Wechsler Adult Intelligence Scale Processing Speed Index (WAIS-IV PSI), Miller Forensic Assessment of Symptoms Test (MFAST), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and the Clinician Administered Post Traumatic Stress Disorder Scale (CAPS). Veterans were asked, if they had pain the last 30 days, the degree to which pain interfered with their life, and the location of pain. Veterans were divided into two groups, those who endorsed pain (n = 308), and those that did not (n = 113). Results: Pain group evidenced significantly decreased performance on D-KEFS: Color Naming (p = .04), Word Reading (p = .02), Inhibition (p < .0001), Inhibition/Switching (p < .001), Letter Switching (p < .001), Number + Letter Switching (p < .001), Number + Letter Sequencing (p < .0001), Motor Speed (p < .001); CVLT-II: Long Delay Free Recall (p = .04); WAIS IV: PSI (p < .0001); and significantly higher scores on MFAST (p < .0001); BDI-II (p < .0001); BAI (p < .0001); and CAPS (p < .0001). Performance on the aforementioned neuropsychological measures was significantly associated with degree of pain interference. Head pain was the most frequently reported location of pain and evidenced the greatest level of impact on performance. Conclusions: Results suggest that pain significantly impacts the neurocognitive profile of veterans with mTBI in the domains of processing speed, motor and executive functioning, verbal memory, and emotional well-being.

B-13
Reliability and Validity of the Naming Test from the Neuropsychological Assessment Battery (NAB) in Patients with Acquired Brain Injury

Abstract

Objective: Confrontation naming is commonly assessed in patients with acquired brain injury (ABI). To date, there is limited independent validation of the Naming Test from the NAB in patients with ABI. Methods: Thirty-six individuals (69.4% men) with stroke (38.9%) or moderate-to-severe traumatic brain injury (61.1%) admitted to a residential post-acute brain injury rehabilitation program were each administered a comprehensive neuropsychological evaluation including the NAB (forms 1 and 2; counterbalanced) and the Boston Naming Test (BNT). Alternate forms reliability and convergent and discriminant validity were assessed using Pearson's correlation coefficients. Results: Forms 1 and 2 of the NAB were found to be highly equivalent (r = .75; paired t-test [t = 0.502, p > .05]). Neither form of the NAB was significantly correlated with age or education level. The NAB correlated significantly with the BNT (Form 1: r = .85; Form 2: r = .75) as well as the delayed recall trial of a word-list learning test (Form 1: r = .39; Form 2: r = .35). In contrast, the BNT was significantly correlated with level of education (r = .47, p < .01) as well as neuropsychological tests that assess visuospatial skills and verbal working memory. Conclusions: The current study provides independent validation of the Naming Test from the NAB in patients with ABI. The correlation coefficients discovered are consistent with those provided from the NAB standardization data. Future work is needed to better delineate potential differences in the underlying constructs related to the NAB Naming Test and the BNT.

B-14
Not Just Attitude: Personality Changes and Other Long-Term Effects of TBI

Abstract

Objective: The immediate and intermediate neuropsychological sequelae of traumatic brain injury (TBI) have been well documented; however, very few studies have examined the very long-term effects of TBI (i.e., >10 years post-injury). A literature review was conducted to examine the current status of the field with regard to the very long-term effects of TBI. Changes in neuropsychological, psychological, social, and occupational functioning were targeted. A case study of a male TBI subject 34 years post-injury illustrates key findings. Methods: A literature review was conducted using five authoritative information search engines (e.g., PubMed, ProQuest). Search terms included long-term, very long-term, TBI, cognitive, neuropsychological, and behavioral. Outcome data were reviewed. Results: Studies reviewed indicated persisting changes in all domains. Behavioral changes included increased behavioral problems (e.g., impulsivity, aggressiveness, violence) and impairments in work, educational, and social functioning. Neuropsychological impairments included processing speed, reaction time, finger tapping, memory, and executive functioning. Long-term TBI patients described increased psychiatric symptoms, including depression, anxiety, loneliness, irritability, reduced emotional control, and impaired interpersonal functioning. Conclusions: The available literature supports the case study's subjective experiences, as well as the researchers' clinical experiences with older veterans at the San Francisco VA Medical Center. However, the TBI literature has been dominated by more acute neurological and neuropsychological changes. Longer-term psychosocial sequelae are often perceived as characterological issues independent of the injury. Future research could benefit TBI patients and their caregivers by providing recommendations for effective coping with lingering psychosocial changes.

B-15
“Sandbagging” Baseline Concussion Testing on ImPACT is More Difficult than It Appears

Abstract

Objective: Claims and beliefs that athletes intentionally malinger (or “sandbag”) on baseline assessments have not been systematically or prospectively evaluated. We sought to identify the utility of ImPACT, Medical Symptom Validity Test (MSVT), and Balance Error Scoring System (BESS) in detecting naïve versus “coached” malingering and identify patterns in performance on these measures. Methods: Sixty participants were assigned to one of three groups, using revised scripts (Mittenberg, 1993) to guide performance: Optimal effort, Naïve malingerers, Coached malingerers, and completed ImPACT, MSVT, and BESS. Performance below 90% was considered malingering for MSVT; ImPACT automatically “flagged” cases as “invalid.” Results: All participants in the optimal effort group provided valid test results. However, the MSVT identified more participants in the Naïve (90%) and Coached (90%) groups than ImPACT (70% and 65%, respectively). For those participants not “flagged” by ImPACT, mean performance remained 1–3 SD below normative data. MANOVA revealed a significant effect of malingering group on all ImPACT Composite and Symptom scores (p < .001) and BESS scores (p < .034). Post hoc tests revealed that naïve malingerers were unable to distinguish themselves from coached malingerers on Verbal and Visual Memory and Symptom Scores. Coached malingerers performed similar to controls on Impulse Control and were not significantly different from malingerers or controls on Reaction Time or the BESS. Conclusions: Intentional “sandbagging,” naïve or coached, can be readily detected on ImPACT. Relative to naïve malingerers, exposure to “coaching” resulted in some improvement performance, but few of these improvements were statistically significant.

B-16
Examining the Length of Time Between Consecutive Mild Traumatic Brain Injuries as a Predictor of Long-Term Subjective Symptoms

Abstract

Objective: Although second-impact syndrome has been found to be particularly catastrophic, the impact of multiple head injuries over a longer span of time is still not well understood. The aim of the present study is to investigate how the time between two consecutive mild traumatic brain injuries (TBIs) affects subjective cognitive, psychological, and neurological symptoms many years post-injury. Methods: One hundred and thirty-five community-dwelling adults (56% men, mean age = 40.10, mean time since last injury = 10.20) with two confirmed mild TBIs were assessed at an urban medical center. The Beck Depression Inventory, Somatic, Cognitive, and Affective Dimensions of Symptom Checklist (SCL), and Structured Health Interview (SHI; neurological dimension) were administered. A series of hierarchical regression analyses were completed. Covariates were age, years of education, and time since injury. Results: Time between TBIs ranged from 0 to 46 years (mean = 12.24 [11.07]). Hierarchical regression analysis suggests that the duration of time between two mild TBIs does not predict the presence and severity of subjective cognitive, neurological, and psychological complaints. However, within this group greater age predicts increased cognitive—SCL; F(3,192) = , p < .05—and neurological—SHI; F(3,95) = 2.682, p < .05—complaints. Conclusions: The presence and severity of subjective cognitive, neurological, and psychological symptoms reported in individuals with recurring mild TBI was not found to be influenced by the amount of time between consecutive head injuries at long-term follow-up. However, greater age did account for increased symptom reporting in this population.

B-17
Emotional Distress and Post-Concussive Symptom (PCS) Endorsement among Military Personnel

Abstract

Objective: To elucidate the impact of an emotional overly on the endorsement of Post-Concussive Symptom (PCS) among military personnel. Methods: Sixty-seven military personal (64% men; mean [SD] age of 37 [12]; 61% ≥college or formal degree; 76% sergeant or higher; mean [SD] time in service was 158 [110] months; 67% ≥1 deployment; 19% non-concussion, 46% grade 1 concussion, 34% grade 2 or 3 concussion) voluntarily completed a self-report measure of PCS, the Neurobehavioral Symptom Inventory (NSI). The sample was divided into two cohorts: A self-reported “Depressed and/or Combat Stress” (DEPANX; n = 20) and a non-Behavioral Health Diagnosis group (NOBH; n = 47). There was no difference between cohorts regarding age, sex, rank, time in service, number of deployments (all p > .05), but the DEPANX group reported experiencing a greater number and severity of alleged concussions than the NOBH group (ps ≤ .012). Personnel with history of neurological disease including dementia, LD/ADHD, or severe TBI were excluded. Results: The DEPANX cohort universally scored higher than the NOBH cohort across NSI Total (36.7 [17.4] vs. 11.9 [14.1]), Affective (12.9 [4.9] vs. 4.1 [4.7]), Cognitive (7.1 [4.4] vs. 2.3 [3.4]), Somatosensory (10.2 [7.8] vs. 3.4 [4.6]), and Vestibular (3.5 [2.2] vs. 1.3 [2.2]) scales (all ps ≤ .001). Conclusions: Depressed and/or anxious military personnel with a history of concussion(s) are likely to endorse higher rates of post-concussive symptoms than those without current emotional distress irrespective of age, sex, rank, time in service, or number of deployments. However, this relationship may be moderated by the number and severity of concussions reported. Limitations and implications will be discussed.

B-18
Using the Automated Neuropsychological Assessment Metrics in Return to Duty Decisions in the Combat Zone

Abstract

Objective: The Automated Neuropsychological Assessment Metrics (ANAM) is used by the military to screen for cognitive decline following a concussion. This study examined ANAM in return to duty (RTD) decisions in the combat zone. Methods: One hundred and ninety-seven concussed service members who were assessed acutely and followed until RTD (or determination not to RTD) were included. Post-concussion ANAM consistent with predeployment testing (i.e., Reliable Change Indices, RCIs; not significantly different than predeployment scores) was one requirement for RTD. This study assessed the role of concussion severity, fatigue, headache, mood, loss of consciousness (LOC) and combat stress in performance on ANAM. Results: Correlations were observed between the total number of impaired RCI scores and days to RTD, fatigue, headache, concussion severity, and ANAM mood scores (i.e., <.01). One-way ANOVAs were used to analyze the subtests and total number of impaired RCI scores with the presence or the absence of combat stress and LOC as group variables. For LOC, results indicated non-significant group differences on all ANAM subtests, however, group difference was significant for the total number of impaired RCI scores (p = .035). For stress symptoms, significant differences were observed on four subtests and total number of impaired RCIs (all p < .01). Conclusions: ANAM appears to be sensitive to physiological states so it is difficult to parse out the effects of concussion on testing. However, results suggest that severity of concussion and LOC affect ANAM performance. Further research is necessary to provide administration guidelines in the context of sleep deprivation, headache pain, and so on, in order to best utilize the ANAM for concussion screening.

B-19
One-month Test–Retest Reliability of ImPACT

Abstract

Objective: Past research by Broglio and colleagues (2007) documented relatively low test–retest reliability data for three computer-based neurocognitive tests: ImPACT, Headminder's CRI, and CogState's Concussion Sentinel. However, their methodology has been criticized for administering three complete test batteries in one test session, and their test–retest data for ImPACT were lower than those documented at 1 (Elbin et al., 2010) and 2 years (Schatz, 2009). We sought to document the test–retest reliability of ImPACT, when administered independent of other measures, over a time frame of 1 month. Methods: Participants were 26 college-age students recruited from a university human subjects pool. Varsity athletes were excluded, as were students with previous exposure to the ImPACT test, or diagnosis of a previous concussion. One participant was excluded due to test scores outside of the range of age-adjusted norms. Participants completed the ImPACT test as a baseline and returned 4 weeks later for a second administration (analogous to a post-concussion test). Results: Repeated-measures ANOVA, with Bonferroni correction, revealed a significant practice effect for Motor Speed composite score (p < .001), with no significant differences noted for the other measures. Intraclass correlation coefficients (ICCs) were as follows: Verbal Memory (ICC = .788), Visual Memory (ICC = .597), Motor Speed (ICC = .876), Reaction Time (ICC = .767), and the Symptom Scale (ICC = .810). Conclusions: Administration of ImPACT, independent of other neurocognitive test batteries, yielded considerably higher test-reliability coefficients than Broglio and colleagues (2007). The current results support the assertion that the ImPACT test demonstrates reliability across a 1-month “clinically relevant” time interval.

B-20
Predictors of Cognitive Decline in Service Members with Deployment-Related TBI

Abstract

Objective: Rates of TBI following deployment in the OEF/OIF conflicts range from 20% to 66%. Previous research shows that Service Members with TBI show greater cognitive performance declines than those without TBI. The potential confounding effects of PTSD, emotional distress, and sleep disturbance on cognitive functioning are not well understood. This study examined factors predictive of cognitive change in Military Personnel assessed for possible TBI. Methods: Sample included 70 Military personnel referred to a combat support hospital for TBI evaluation during their deployment in Iraq who underwent computerized neurocognitive testing and psychological and physical health questionnaires. Fifty-one participants had confirmed mild TBI (mTBI) within 3 days. Stepwise regression was used to determine factors most predictive of change in cognitive performance from baseline. Predictors included TBI, PTSD symptomatology, general emotional distress, sleep disturbance, number of deployments, and number of previous TBIs. Results: Analyses revealed that recent mTBI was the strongest predictor of cognitive change from baseline accounting for 18% of the variance, followed by PTSD symptomatology (R2 change = 7%), and sleepiness levels (R2 change = 4%). Other predictors did not account for additional variance. Conclusions: Confirmed recent mTBI was the strongest predictor of cognitive decline in Service Members suffering injuries during deployment. PTSD symptoms and sleepiness contributed to cognitive decline, but to a lesser degree. Chronic insomnia has been speculated to cause impairment but was not a significant predictor. While PTSD is believed by some to drive persistent problems following more chronic mTBI, its role in acute mTBI was limited.

B-21
Influence of Resilience on Depression in Patients with Traumatic Brain Injury: A Preliminary Study

Abstract

Objective: A growing body of literature indicates that resilience, the ability to “bounce back” from adversity, may play an important role in the mental health among individuals who acquire a traumatic injury. Among individuals with spinal cord injury, Catalano, Wilson, Chan, and Chiu (2011) found resilience mediated the effect of depression, and White, Driver, and Warren (2010) reported resilience to be inversely associated with depression. The purpose of the present study was to examine the influence of resilience on depressive symptoms among individuals who acquired a traumatic brain injury (TBI). Methods: The sample consisted of 34 inpatients of an acute rehabilitation facility who acquired a TBI (25 men and 9 women; mean age = 41.47, SD = 17.08). Depressive symptoms were measured by the Personal Health Questionnaire–9 (PHQ9; Spitzer, Kroenke, & Williams, 1999); Resilience by the Connor-Davidson Resilience Scale (Connor & Davidson, 2003); and intensity of pain was assessed on a scale of 1 (“no pain”) to 10. A hierarchical multiple regression analysis (HMR) was conducted with Age, Pain (rating), and Resilience (total score) entered as predictors in a step-wise sequence; criterion variable was PHQ9 scores. Results: The HMR revealed that Age, Pain, and Resilience collectively accounted for 45% of the variance of depressive symptomology (adjusted R2 = .45, F(3,30) = 10.09, p < .0005), with Resilience being the only significant predictor (β = − .67; t = − 4.71, p < .0005). Conclusions: Findings suggest assessing an individual's resilience may help in the identification of inpatient individuals who are at greater risk of depression post TBI.

B-22
Comparison of Cognitive Performance between Blast- and Non-blast-induced Mild Traumatic Brain Injuries in the Acute Deployed Setting

Abstract

Objective: Military service members deployed to combat theaters in Iraq and Afghanistan are at risk of sustaining mild traumatic brain injuries (mTBI) from blast (e.g., improvised explosive devices) as well as non-blast (e.g., motor vehicle accidents, falls) causes. Despite the high incidence of mTBI in deployed personnel, questions remain about the effects of blast-related versus non-blast-related mTBI on acute and long-term cognitive sequelae. Methods: This is a retrospective review of military personnel who were referred for evaluation in theater for suspected mTBI and underwent neurocognitive screening. Diagnosis of mTBI was made by semi-structured clinical interview. Only individuals in which mechanism of injury could be determined (blast vs. non-blast) and who were within 4 weeks of injury were included. Two hundered and six individuals were included in the final sample: 187 with blast mTBI and 19 with non-blast mTBI. Results: There were no differences between blast-related and non-blast-related mTBI groups on age or time since injury. Analysis of variance revealed significantly lower scores on the RBANS Immediate Memory Index for the blast group (p < .01). No significant group differences were observed on other RBANS subscale scores or total performance score. Conclusions: Study results reveal that blast-related mTBI was associated with diminished scores on tasks of verbal learning, with no group differences observed on other neurocognitive domains assessed. In contrast to previous research suggesting that blast-related mTBI does not differ from other mechanisms of injury with respect to cognitive performance, our findings indicate that some group differences may be apparent, at least in the acute injury stage.

B-23
Predictors of Outcome After Treatment for Mild Traumatic Brain Injury

Abstract

Objective: To determine factors affecting the outcome of comprehensive outpatient rehabilitation of individuals who sustained a mild traumatic brain injury (mTBI). Methods: Data were retrieved from a 5-year series of referrals. Fifty non-consecutive participants met criteria for mTBI (i.e., LOC < 30 min, GCS > 12). Patients and therapy staff completed the Mayo-Portland Adaptability Inventory, Fourth Edition (MPAI-4; Malec, 2005) at the beginning and at the end of treatment. Participants were also administered the Trail-Making Test at the start of treatment. Results: Participants generally rated poorer adaptability than staff at the beginning of treatment and also at discharge. Regression analyses revealed that, after controlling for baseline ratings, prior psychiatric and concussion history, and Trail-Making performance, accounted for additional unique variance in participant rated MPAI-4 Total Score at discharge; F(4, 45) = 6.11, p < .01, adjusted R2 = .29. Prior psychiatric history was associated with worse participant rated MPAI-4 Adjustment scores at treatment discharge (SRC = 0.57, t = 4.88, p < .01). Better Trail-Making Part B performance at treatment initial predicted better participant rated MPAI-4 Ability score at treatment discharge (SRC = − 0.27, t = 1.98, p = .05). Conclusions: Premorbid and baseline factors should be taken into account during comprehensive treatment for mTBI, as they can influence long-term outcomes. Adaptability ratings from both staff and participants can be useful in gaining different perspectives and assessing factors impacting recovery.

B-24
Personality Factors and Post-Concussion Symptom Reporting at Baseline in Collegiate Athletes

Abstract

Objective: The purpose of the present study was to determine what influence personality factors have on baseline symptom reporting in a sample of collegiate athletes. Methods: Participants included 435 college athletes (76% men) who enrolled in a concussion management program at a large university. The average age of athletes completing baseline testing was 18.46 years (SD = 0.92), and the majority of the sample was Caucasian (76%). Prior to participating in varsity athletics, athletes underwent neuropsychological testing, including completion of the Post-Concussion Symptoms Scale (PCSS) and the NEO-Five Factor Inventory (NEO-FFI). Results: An exploratory factor analysis was conducted on the PCSS. Factors were extracted using principal components analysis with Varimax rotation, and factor values >0.4 were retained. Four distinct symptom clusters emerged: Physical/Sensory (eight items), Sleep/Fatigue (five items), Affective (four items), and Somatic (two items). The NEO-FFI scales were then used to predict PCSS symptom clusters and the PCSS Total Score. The Neuroticism scale significantly predicted the PCSS Total Score, b = 0.34, t(429) = 6.78, p < .001, as well as the following symptom clusters: Physical/Sensory, b = 0.22, t(432) = 4.53, p < .001; Sleep/Fatigue, b = 0.23, t(432) = 4.80, p < .001; and Affective, b = 0.39, t(432) = 8.41, p < .001. The Agreeableness scale significantly predicted the PCSS Total Score, b = − 0.12, t(429) = − 2.32, p < .05, and the Sleep/Fatigue symptom cluster, b = − 0.14, t(432) = − 2.85, p < .01. Conclusions: Overall, these results suggest that athletes high in neuroticism may have a tendency to report greater symptoms at baseline than those low in neuroticism, and athletes high on the Agreeableness scale may have a tendency to report fewer symptoms at baseline.

B-25
Driving Behaviors of Veterans with Traumatic Brain Injury and Post-Traumatic Stress Disorder

Abstract

Objective: Veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) reportedly have difficulties readjusting to civilian driving. However, the most common high-risk driving behaviors and situations remain undefined. This study addresses this absence in the literature by employing a novel self-report measure of driving habits in OIF/OEF veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Methods: Participants included 12 OIF/OEF veterans (11 men and 1 woman), aged 23–48 (M = 31.9 years) with a history of TBI and PTSD, recruited through the Philadelphia Veterans Affairs Medical Center (PVAMC). Participants were administered the Veteran Driving Questionnaire (VDQ), which includes 100 items rated on a 5-point Likert scale and generates three subscales—affective states, behaviors, and situations. Results: Scores for individual items on the VDQ were analyzed. Driving situations rated most anxiety provoking included being boxed in by other drivers; driving near/next to roadside debris; driving when lost; being approached quickly by another car; and driving in slow or stopped traffic. Driving behaviors endorsed most frequently included speeding, keeping a careful eye on other cars, wearing a seatbelt or helmet, and getting distracted by sights and sounds. Driving under the influence was the least endorsed item. Conclusions: Initial findings support previous research showing that specific situations are anxiety provoking for many combat veterans with TBI and PTSD. This study extends previous research by inquiring about a broader range of situations and specific behaviors that might be contributing to the high accident rate in this population.

B-26
Classification Accuracy of Neurocognitive Measures in Detecting Sport-Related Concussion

Abstract

Objective: Neurocognitive assessment contributes significantly to contemporary clinical management of sport-related concussion. An issue critical to the utility of neurocognitive assessment in the sport medicine setting is the identification of measures that accurately detect concussion. The purpose of this study was to determine the classification accuracy of a broad-based set of paper and pencil and computerized neurocognitive measures in the detection of sport-related concussion. Methods: Thirty-seven university athletes were assessed 2–5 days after sustaining a medically diagnosed concussion. A control sample consisting of 37 teammates matched for age, sex, education, estimated verbal IQ, sport, position played, and prior concussion history was also assessed. Area under the curve (AUC) derived from receiver-operating characteristic analysis was used as an overall indicator of classification accuracy for 22 indices obtained from a test battery that tapped a broad range of neurocognitive domains, including attention, learning and memory, processing speed, executive function, and simple and choice reaction time. Results: Five indices (Hopkins Verbal Learning Test-Total Acquisition, Delayed Recall, Percent Retention; Trail-Making Test-Part A; Ruff 2 and 7 Selective Attention Test–Controlled Search Speed) achieved AUC values of 0.7 (all p < .05). One index, the Trail-Making Test-Part B, achieved an AUC value of 0.8 (p < .05). Conclusions: These findings demonstrate that neurocognitive measures tapping selective attention, verbal learning and memory, processing speed, and executive function have acceptable to excellent classification accuracy in detecting sport-related concussion.

B-27
Baseline Predictors of Post-Concussion Depressive Symptoms in Collegiate Athletes

Abstract

Objective: Depression is a common symptom following concussion and is associated with functional outcome, cognitive performance, and quality of life after injury. However, little work has been done on baseline predictors of post-concussion depressive symptoms (PCDS). Methods: Seventy-seven college-aged varsity athletes were tested at baseline and following concussion. At both time points, they were given a battery of neuropsychological tests and several self-report measures, including the Beck Depression Inventory-Fast Screen (BDI-FS). The participants' average age was 18.4 at baseline and there were 59 men. Athletes were tested an average of 7 days post-injury, and the two time points were an average of 1.5 years apart. Results: Depression levels were mild overall and did not significantly differ between the two time points. Baseline predictors of PCDS-included BDI-FS score (r = .37, p < .01), baseline Post-Concussion Symptom Scale total (r = .23, p < .05), age at first organized sport (r = .23, p < .05), and number of previous head injuries (r = − .27, p < .05). After controlling for baseline depression, age at first organized sport (Δr2 = .05, p < .05) and number of previous head injuries (Δr2 = .08, p < .01) remained significant. Demographics and injury severity did not predict PCDS. Conclusions: Overall, there were a number of significant baseline predictors for PCDS. The best predictor was the baseline depression level, but earlier age at first organized sport and number of previous head injuries were also significant predictors of PCDS after controlling for baseline depression. Because depression impacts quality of life and may delay recovery from concussion, more research is necessary to better understand the predictors of depression following concussion.

B-28
A New Motivation Behavior Checklist for Measuring Approach to Testing in College Athletes

Abstract

Objective: The aim of the present study was to evaluate a behavior checklist designed to measure individual differences in athletes' motivation toward cognitive testing. Methods: We developed a motivation behaviors checklist (MBCL) of 26 behaviors with theoretical and anecdotal relevance to motivation toward testing. As part of a sports-concussion management program, 77 college athletes were administered a battery of neuropsychological tests at baseline, including the Vigil continuous performance task, the Computerized Assessment of Response Bias (CARB), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Examiners completed the MBCL based on athletes' behavior during testing. Examiners and athletes rated athletes' level of motivation on a 7-point scale. Results: Principal components analysis of the MBCL revealed components related to low motivation behaviors (LMBs) and high motivation behaviors (HMBs) with good internal consistency (α = 0.78 and 0.77, respectively). Scale scores were created for LMB and HMB scales by summing items. LMB was correlated with CARB response variability (r = .32, p < .01), athletes' (r = − .27, p < .05) and examiners' (r = − .58, p < .001) motivation ratings, and ImPACT Visual Motor Speed (r = − .24, p < .05). HMB was correlated with Vigil false alarm rate (r = − .32, p < .01) and ImPACT Impulse Control (r = − .23, p < .05). The two scales were uncorrelated with one another (r = .00, p = .99). Conclusions: Results provide preliminary support for the reliability and validity of the MBCL. Correlational findings suggest that the MBCL measures two orthogonal components of motivation toward testing—low motivation behaviors associated with self and other perceptions of motivation, response variability, and psychomotor speed; and high motivation behaviors related to attentiveness and impulse control.

B-29
The Predictive Validity of Neuropsychological Testing in the Context of Real World Disability following Traumatic Brain Injury

Abstract

Objective: This study examined the ecological validity of neuropsychological tests in a typical battery by examining the relationship between test performance and the ability to return to work following mild traumatic brain injury (mTBI). Methods: Archival data were collected from a random sample of mTBI patients (n = 45) who had been undergoing litigation and were referred for neuropsychological assessment due to complaints of cognitive impairment. All patients were free of neurological and psychiatric disorders, including substance abuse and previous head injury. The performance of disabled (n = 20) and non-disabled (n = 25) patients on each test of a typical neuropsychological battery was compared using independent two-tailed t-tests. Results: After utilizing a Bonferroni correction, it was determined that performance on the tests employed did not significantly differ between the disabled and non-disabled groups. We found differential sensitivity across test measures, however, as a number of tests demonstrated moderate (Cohen's d > 0.6) to large (Cohen's d > 0.8) effect sizes. Conclusions: The lack of significant findings in the tests examined suggests a lack of ecological validity with respect to the prediction of vocational status. It is important that the relatively larger effect sizes observed in a number of tests not be discounted, but rather be considered in clinical settings where time may be limited and only certain tests can be administered to inform clinical opinions of diagnoses and prognoses.

B-30
Examining the Differential Sensitivity of a Virtual Reality Test Measure of Executive Functioning in Traumatic Brain Injury

Abstract

Objective: The present study examined the ability of a novel, ecologically valid “Virtual Reality (VR) Office Task” (VROT) test of executive functioning (EF), alongside a battery of traditional tests of EF, to discriminate between a group of 30 non-injured control subjects and 5 traumatic brain injury (TBI) patients. It was expected that the ecologically valid VROT would better discriminate between the two groups. Methods: Both non-injured control subjects and TBI patients were administered a battery of traditional tests of EF including: the Tower of London–Drexel University Second Edition (ToL), Ruff Figural Fluency Test, and Wisconsin Card Sort Test 64 card edition. In addition, participants were administered the VROT, in which participants deliver a series of poorly labeled packages to the correct office. Group performances were compared using the Mann–Whitney U-test and the two-tailed t-test. Magnitude of differences was determined by Cohen's d effect sizes. Results: Of the traditional EF tests, only TOL execution time was significantly different; U = 19.5, p = .030. All scores of the novel VROT were significantly different between non-injured controls and TBI patients (“incorrect deliveries”: U = 11.0, p = .022; “failure to maintain set”: U = 7.50, p = .009; “perseverations”: U = 30.0, p = .002). All VROT scores showed large effect sizes (“incorrect deliveries”: d = − 2.33; “failure to maintain set”: d = − 2.54; “perseverations”: d = − 2.25). Conclusions: The VROT has clinical potential for assessing the presence of executive dysfunction in TBI patients, otherwise undetected by traditional EF tests. Further study is necessary to increase sample size.

B-31
Group Size Effects for Baseline and Post-Injury Sports-Related Concussion Assessment

Abstract

Objective: The purpose of this study is to examine group size effects when collecting baseline or post-injury sports-related concussion data on two computerized neuropsychological screening batteries. Research has suggested that group testing may create group inter-distraction, motivational impairment, or carelessness. Findings will help clinicians better understand group size effects in order to collect the most valid and reliable data. Methods: Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Concussion Vital Signs (CVS) were used to measure aspects of cognitive functioning. Participants were 1,132 high school and college student athletes who completed CVS and 642 high school and college students who completed ImPACT during baseline or post-injury assessment in small group sizes (1–3 student athletes) or large group sizes (7–20 student athletes). Average age was 17.8 years (SD = 2.3) and average education was 11.5 years (SD = 1.9). Results: There was a statistically significant effect of group size on the overall test battery mean for ImPACT—F(1, 640) = 4.81, p = .03—and CVS—F(3, 397) = 10.30, p = .001. Overall test battery means for ImPACT were: small group size = 99.6 and large group size = 93.4. Overall test battery means for CVS were: small group size = 93.8 and large group size = 89.1. Conclusions: ANOVA results revealed that the overall test battery means for ImPACT and CVS varied significantly by group size. Discussion of these results and implications for baseline and post-injury sports-related concussion assessment will be presented.

B-32
Sleep-Disturbance, Pain, and Depression: Predictors of Neuropsychological Performance Following Recent Traumatic Brain Injury?

Abstract

Objective: To examine the relationship between sleep-disturbance, pain, depressed mood, and neurocognitive ability among persons with traumatic brain injury (TBI). Methods: One-hundred and two patients with a history of mild-severe TBI admitted to comprehensive outpatient neurorehabilitation (M months since injury = 3.9, SD = 0.9) underwent comprehensive neuropsychological evaluation (Grooved-Pegs, Trails B, phonemic fluency, Digit-Symbol, Block Design, Symbol-Digit Modality Test [Written and Oral], Working Memory Component, Memory Assessment Scales) and completed measures of sleep disturbance (Pittsburgh Sleep-Quality Index, PSQI), pain (Multi-dimensional Pain Inventory), and depression (Beck Depression Inventory-II). Regression analysis was used to evaluate the predictive values of sleep disturbance, pain, and depression on neurocognitive performance. Results: Unexpectedly, hierarchical regression revealed that sleep disturbance and pain did not significantly improve the prediction of performance on selected measures of cognitive functioning, above injury severity and depression. Depression alone significantly accounted for variance on certain cognitive measures (Working Memory Component: 14% and Block Design: 13%, ps < .05). Pain significantly improved prediction of sleep disturbance, accounting for 30% of the variance beyond that accounted for by depression; the total model accounted for 52% of the variance in the PSQI (p < .001). Conclusions: Though sleep disturbance and pain have been found to significantly impact neurocognitive performance in other populations, these findings suggest that they may not be significantly associated with neurocognitive performance in the present sample. This may be due to recent injury effects overshadowing the impact of disturbed sleep and pain. Depression appears to have a unique, negative impact on aspects of cognition in this population.

B-33
The Clinical Utility of the LANSE-A and LANSE-C

Abstract

Objective: This study assessed the clinical utility of the Lebby Asbell Neurocognitive Screening Evaluation for Adolescents and Children (LANSE-A and -C). It was predicted that the LANSEs would accurately discriminate brain injured from non-brain injured subjects. Further statistical analysis evaluated three cutoff values with respect to sensitivity, specificity, and positive predictive value. Methods: Following consent, participants were tested on the LANSE-C or -A. The non-injured control group (NC) consisted of 190 individuals without prior history of head injury or neurological disorder. The TBI group consisted of 59 individuals from Children's Hospital Central California following a traumatic brain injury. Participants were recruited from multiple cultural backgrounds. A one-way between-subjects MANOVA was performed on the 14 subtests. Subjects completing all subtests were utilized (n = 249,190 NC and 59 TBI). Of the original 285 cases, 36 were dropped from analysis because of missing data. Results: Wilks' omnibus was significant, F(14, 234) = 46.530, p < .001, partial η2 = .736, with 95% confidence intervals in discriminating TBI from NC. There was a 97.69% positive predictive value using a cutoff of one failed subtest; a sensitivity of 94.62% using a cutoff of two failed subtests; and a specificity of 98.73% using three failed subtests as a cutoff. As the LANSEs are screening measures, using two or less missed subtests in order to provide the best sensitivity is the most appropriate classification technique. Conclusions: The LANSE-A and -C are useful clinical measures for screening brain injury.

B-34
Naive Participants Expect Posttraumatic Stress Disorder (PTSD) Symptoms from Traumatic Brain Injury

Abstract

Objective: To examine whether naïve participants expect PTSD symptoms from a traumatic brain injury (TBI). Vignettes that varied TBI injury severity were used to measure expected PTSD symptoms. These vignettes were modeled on those typically used to assess expected post-concussion syndrome (PCS) symptoms. Methods: Using online survey methods, 267 undergraduate students (Mage = 21.28, SD = 5.10; 76% women and 83.1% Caucasian) with a negative history of head injury or neurological disorder, and no history of treatment for a mental health problem in the previous 12 months, completed the PTSD Checklist-Civilian (PCL-C) after reading one of the three vignettes. These vignettes depicted: a very mild (n = 100), mild (n = 96), or moderate-to-severe (n = 72) TBI. Results: PTSD symptoms were expected for all vignettes: 20%, 30%, and 41% of the participants in the very mild, mild, and moderate-to-severe conditions, respectively, expected PTSD symptoms at a level above the PCL-C clinical cutoff. Participants' PTSD expectancies were significantly different for each vignette (all p < .004), such that PTSD symptom expectation increased with the increasing severity of the depicted TBI in each vignette (planned contrast effect sizes: r = .17–.34). Conclusions: PTSD symptoms are expected by naïve participants as a consequence of TBI. The focus of previous vignette studies, which predominantly depict mild TBI, has been on expected PCS symptoms. This study extends this past research by revealing that PTSD symptoms are also expected from TBI. This finding has implications for current discussions about the relationship between TBI and PTSD.

B-35
Syndrome of the Trephined Presentation in a Minimally Responsive Patient: In Search of Measures Sensitive to Neurologic Decline

Abstract

Objective: Present clinical course and neurobehavioral findings in a patient who developed Syndrome of the Trephined (AKA Sinking Skin Flap Syndrome), which is characterized by cognitive deterioration following initial improvement, perhaps due to intracranial pressure instability. The syndrome is observed following decompressive craniectomy. Symptoms typically improve following cranioplasty. There is scant literature describing its neurobehavioral course and measurement methods, particularly with minimally responsive patients. Methods: Patient is a 24-year-old active duty marine who sustained polytrauma injuries including severe TBI and bilateral transfemoral amputations during an IED explosion in 2011 (GCS, 9T). Initial neuroimaging revealed L SDH, L frontal and R basal ganglia IPH, R frontal and L MCA strokes, midline shift, and subfalcine herniation. Acute course was also significant for respiratory failure and multiple infections. He underwent bilateral frontal craniectomy and VP shunt placement. At 2-month post-injury was transferred to a Polytrauma Rehabilitation Center for comprehensive rehabilitation. His neurobehavioral status was serially monitored to track emergence from a minimally conscious state. Results: Neurobehavioral assessment included behavioral scales (Coma Recovery Scale–Original; Coma Recovery Scale–Revised, Coma/Near-Coma Scale) and actigraphy. Patient's neurologic course declined secondary to suspected syndrome of the trephined. Behavioral scale results showed reduced alertness, pain localization, and consistent oral movements (smiling). Worsening motor tremor was detected with actigraphy. Symptoms improved post-cranioplasty. Conclusions: The CRS-O and actigraphy appear more sensitive to neurologic change compared with CRS-R and CNC. Further data on decline-sensitive measures in minimally responsive patients are needed for enhanced patient management.

B-36
Traumatic Brain Injury in the Military Population: Differences in Neuropsychological Outcome, Examining Blast Subtypes Mounted versus Dismounted

Abstract

Objective: The purpose of this study was to describe the cognitive deficits of individuals who received traumatic brain injuries in the U.S. Military during combat operations in Iraq and Afghanistan. We also focused on the variable of blast mechanism, describing significant differences in the cognitive deficits associated with a “mounted” versus “dismounted” blast event. Methods: Results from over 13 neuropsychological tests as well as descriptive data about the injuries received were collected for 1,100 individuals. Criteria for inclusion were active/limited duty status, documented head injury on a military deployment, diagnosis of cognitive disorder NOS, and expression of proper effort during testing. Five hundered and sixty-five subjects met all requirements for this study. Subjects were then divided into blast versus non-blast injuries and subdivided by mechanism of injury. Stimuli: Controlled Oral Word Association Test, California Verbal Learning Test II, Grooved Pegboard, Halstead-Reitan, Hayling-Brixton, Minnesota Multiphasic Personality InventoryII, Stroop, Test of Memory Malingering, Wechsler Adult Intelligence Scale III and IV, Wechsler Memory Scale III and IV, and the Wide Range Achievement Test IV. Results: Twenty variables were described at or below a standard deviation from the normative sample. Semantic-Fluency (M = 30.06), Trails-B-Time (M = 33.11), MMPI-II elevated at (F, FB, Hs, D, Hy, Pt, and Sc), Colow-Word Task (M = 15.47), WAIS-IV (Coding, Processing Speed, Symbol Search, Similarities), WAIS III (Digit Symbol-Coding, Processing Speed), WMS-IV (Logical Memory-II), WMS-III (Visual-Delayed). Eight variables were found to be significantly different between the blast-mounted and blast-dismounted subgroups (Table 1). Conclusions: We have expanded the knowledge in areas of cognitive deficit associated with military TBI. We have also described differences found in mechanism of blast (subtype blast-mounted vs. blast-dismounted).

Table 1.

Differentiating blast from non-blast TBI

Test V variable Significance I Significance level 1 
COWA Test Letter Fluency .02 Strong [.000–.050] 
COWA Test Semantic Fluenty .03 Strong [.000–.050] 
Grip Strength Dom lland Grip Strength .009 Strong [.000–.050] 
Trail Making irails B limc .047 Strong [.000–.050] 
MMP-III Depression .027 Strong [.000–.050] 
MMP-III Psychasthenia .003 Strong [.000–.050] 
MMP-III Social introversion Strong [.000–.050] 
WAIS-III Processing Speed .049 Strong [.000–.050] 
WMS-III symbol Scarch .042 Strong [.000–.050] 
WMi-III Auditory Immediate .027 Strong [.000–.050] 
Wms-iii Visual Immediate .043 Strong [.000–.050] 
WMS-III Immediate Memory .012 Strong [.000–.050] 
WMS-III Auditory Delayed .02 Strong [.000–.050] 
WMS-III General Memory .031 Strong [.000–.050] 
Trail Making Trails A Time .075 Weak [050–.100] 
WMS-III Working Memory .086 Weak [.0.50–.100] 
Test V variable Significance I Significance level 1 
COWA Test Letter Fluency .02 Strong [.000–.050] 
COWA Test Semantic Fluenty .03 Strong [.000–.050] 
Grip Strength Dom lland Grip Strength .009 Strong [.000–.050] 
Trail Making irails B limc .047 Strong [.000–.050] 
MMP-III Depression .027 Strong [.000–.050] 
MMP-III Psychasthenia .003 Strong [.000–.050] 
MMP-III Social introversion Strong [.000–.050] 
WAIS-III Processing Speed .049 Strong [.000–.050] 
WMS-III symbol Scarch .042 Strong [.000–.050] 
WMi-III Auditory Immediate .027 Strong [.000–.050] 
Wms-iii Visual Immediate .043 Strong [.000–.050] 
WMS-III Immediate Memory .012 Strong [.000–.050] 
WMS-III Auditory Delayed .02 Strong [.000–.050] 
WMS-III General Memory .031 Strong [.000–.050] 
Trail Making Trails A Time .075 Weak [050–.100] 
WMS-III Working Memory .086 Weak [.0.50–.100] 

B-37
Relation of Post-Traumatic Amnesia and Loss of Consciousness to Current Cognitive and Emotional Functions in Veterans with Post-Concussive Symptoms

Abstract

Objective: Prior studies after moderate-to-severe traumatic brain injury (TBI) found that post-traumatic amnesia (PTA) is a better predictor of functional outcomes than loss of consciousness (LOC). Also, prior research on mild TBI indicated that some persisting post-concussive symptoms are due to emotional distress. The present study examined the relation of reported history of post-concussive PTA and LOC to current cognitive and emotional functions. Methods: Seventy-six veteran or active duty service members with positive screens for history of TBI, mainly of mild severity, completed the Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Trail Making A and B, Beck Depression and Anxiety Inventories (BDI and BAI), PTSD Checklist (PCL-C), and embedded effort measures. PTA and LOC were determined by interview. Results: Subjects reporting any occurrence of PTA had significantly lower RBANS total, attention and memory indices (p < .05), not due to test effort. They also endorsed significantly greater distress on the BAI and PCL-C. When BAI and PCL-C were partialled out, some cognitive effects were reduced, but memory effects remained significant. Reported LOC was unrelated to test scores (p = .7). Conclusions: These results indicate that, for people with a history of concussion, PTA is a better index of severity than LOC. Reported occurrence of PTA was associated with current attention and memory problems, as well as greater anxiety and posttraumatic distress. PTA's association with lower memory scores was independent of emotional indices. Thus, individuals who experience PTA after a concussion have elevated risk for persisting memory problems.

B-38
Are There Cumulative Effects of Past Concussions in Adolescent Athletes?

Abstract

Objective: There is concern that sustaining multiple concussions will result in cumulative negative effects on neurocognition. However, the existing literature is mixed, primarily adult focused, and there is no clear answer for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are cumulative effects with objective and subjective abilities from concussions in adolescents. Methods: Participants included 751 top tier hockey players between 12 and 17 years (mean age = 15.0, SD = 1.2) in Alberta, Canada, who reported on a previously validated pre-season questionnaire to have had zero (n = 371), one (n = 172), and two or more (n = 43) past concussions. Players with self-reported attention (n = 23) or learning (n = 2) disorders, a concussion within 3 months of baseline testing (n = 27), missing pre-season information (n = 76), as well as those with suspected invalid test profiles (n = 37) were excluded. Baseline testing included ImPACT. Age- and gender-adjusted composite percentile scores were examined. Results: Those with one prior concussion had worse visual memory than those with zero concussions (Mann–Whitney U = 2.52, p = .012, Cohen's effect size d = 0.23) and those with two or more prior concussions (U = 2.91, p = .004, d = 0.51). No differences in self-reported symptoms were found between zero and one concussion (U = 1.48, p = .14, d = 0.16), but there were significantly more symptoms in those with two or more prior concussions compared with those with zero (U = 3.54, p < .001, d = 0.82) or one (U = 2.58, p = .010, d = 0.57) prior concussion. Conclusions: There is a small effect of having one, but not two or more, previous concussions only on visual memory (no other cognitive domains). Increased self-reported symptoms were found with two or more prior concussions.

B-39
Examination of the BRIEF Validity Indicators When Assessing Pediatric Neurology Patients

Abstract

Objective: Determining response validity is important for assessment measures used with children. However, research on validity indicators in questionnaires is limited. The purpose of this study was to examine the frequencies of elevations for the validity scales on the Behavior Rating Inventory of Executive Function (BRIEF). Methods: Participants were clinically referred pediatric neurology patients ranging from 5 to 18 years of age. All patients (n = 389; mean age = 11.6, SD = 3.7; mean GEC T score = 57.3, SD = 16.6) had the parent version of the BRIEF, with a large proportion (n = 302; mean age = 11.1, SD = 3.8; mean GEC T score = 63.3, SD = 22.6) also having the teacher version. Frequencies of elevated ratings on the two validity scales, Negativity and Inconsistency, were examined. Results: On the Negativity Scale, 95.1% of parent protocols and 93.7% of teacher protocols were deemed “acceptable.” “Elevated” ratings were found in 4.1% of parent and 5.3% of teacher data. “Highly elevated” ratings were found in 0.8% of parent and 1.0% of teacher protocols. On the Inconsistency Scale, 95.6% of parent and 98% of teacher scales were deemed “acceptable.” “Questionable” ratings were found in 3.6% of parent and 1.7% of teacher data. “Inconsistent” ratings were found in 0.9% of parent and 0.3% of teacher protocols.

Conclusions: Similar to the test manual, the majority of parent and teacher forms were deemed acceptable based on the validity scales. It was uncommon for forms to be deemed “elevated” or “questionable,” and very uncommon for forms to be deemed “highly elevated” or “inconsistent.” This provides further evidence of the utility of these validity scales for clinically referred children.

B-40
Pediatric Neurology Patients Readily Pass the TOMM: Further Evidence of Utility

Abstract

Objective: Increasingly, clinicians are recognizing the need for symptom validity measures in pediatric neuropsychology. Although there is some evidence that children with various neurological disorders readily pass the TOMM (i.e., failure rates ranging from 3% to 10%), more research is needed to support the utility of this measure in children. The purpose of this study was to examine performance on the TOMM in a sample of clinically referred pediatric neurology patients. Methods: This study included 164 neurology patients 5–18 years of age (mean age = 13.0, SD = 3.4; mean FSIQ = 89.2, SD = 18.5) who were assessed in a tertiary care hospital. Participants were administered the TOMM as part of their neuropsychological assessment. Passing the TOMM was based on the established cutoff scores from the test manual and/or adequate performance on Trial 1 (i.e., see Brooks, Krol, & Sherman, 2012). Results: The overall fail rate was 2.4%; however, of those failing, one patient fell just below the cutoff on Trial 2 and another was very low functioning with chance-level performance. Mean performances for the entire sample were: Trial 1: 47.3 (SD = 4.2); Trial 2 = 48.3 (SD = 4.8); and Retention = 47.7 (6.2). In those passing the TOMM, a significant minority scored ≥2 SDs below the mean on measures of IQ (14%), sustained attention (19%), verbal memory (9%), visual memory (12%), and adaptive functioning (22%). Conclusions: This study supports the hypothesis that children and adolescents with neurological disorders can readily pass the TOMM. The authors recognize that more research is needed, but encourage the use of symptom validity measures in assessments with school-aged youth.

B-41
Efforts to Increase the Sensitivity/Specificity of the Test of Memory Malingering

Abstract

Objective: The classification accuracy of the standard TOMM, TOMM Trial 1, and errors on the first 10 items of the TOMM Trial 1 (TOMM T1–10) were examined. Methods: An archival of analysis was conducted on 44 forensic files. Logistic regressions were used to examine the classification accuracy of standard TOMM criteria, the cutoff of ≤40 correct on TOMM Trial 1, and the cutoff of ≥1 errors on TOMM T1–10 compared with failing two or more of four symptoms validity tests (Word Memory Test, Rey-15 Item Test, Victoria Symptom Validity Test, and Reliable Digit Span). Model 1 investigated the standard TOMM criteria in classifying performance invalidity among examinees. Model 2 examined correct responses on TOMM Trial 1 in predicting performance invalidity, and Model 3 used errors on the first ten items of the TOMM Trial 1. Results: Results indicated that the standard TOMM criteria did not significantly predict performance invalidity, accounted for a small amount of variance, and had the poorest overall classification accuracy and sensitivity. TOMM Trial 1 and TOMM T1–10 were both significant predictors of performance invalidity; however, TOMM Trial 1 showed better classification accuracy and accounted for a larger amount of variance. Conclusions: The standard TOMM criteria were not accurate predictors of performance invalidity. Although TOMM T1–10 significantly predicted performance invalidity, TOMM Trial 1 was the best predictor in correctly classifying performance invalidity with the highest overall classification accuracy and increased sensitivity compared with the standard TOMM criteria, while maintaining specificity over 0.90.

B-42
Examining Divergent Validity of the TOMM and MMPI Symptom Validity Indices in Sample with Average or Higher Memory

Abstract

Objective: The present study examines the relationship between the Test of Memory Malingering (TOMM) and the L, F, VRIN, and TRIN scales of the MMPI-2 in an effort to determine the degree to which such tests can be said to measure similar domains. Methods: A mixed clinical sample of adults (18–81) was selected. Participants included 100 men and 114 women, with an average age of 35.13 years (SD = 14.99), of various ethnicities with an average education of 12.39 (SD = 2.66). Participants were administered a comprehensive neuropsychological battery, which included the MMPI-2, TOMM, and WMS-III. Individuals who evidenced memory impairment or weakness as demonstrated by a General Memory Index score of <85 were excluded from the present study. Results: Partial correlations between the L, F, VRIN, and TRIN and TOMM Trial 2 and Retention Trial were conducted. After controlling for education, significant correlation between F and TRIN scales (r = .230, p = .027), VRIN and TRIN (r = .358, p = .000), and TOMM Trial 2 and the Retention Trial (r = .925, p = .000) were found. No other correlations reached significance. Conclusions: The lack of association between L, F, VRIN, and TRIN with the TOMM confirms the divergent validity of memory malingering measures and symptoms validity indices of the MMPI-2 within a clinical population with no memory impairment. This further indicates that such symptom validity measures should not be used to assess the exaggeration of cognitive symptoms, but rather should be employed as supplements within a cognitive testing context.

B-43
The Malingering Probability Scale (MPS) and the Personality Assessment Inventory (PAI): A Concurrent Validity Study

Abstract

Objective: To establish correlation of validity and clinical scales on the Malingering Probability Scale (MPS) and the Personality Assessment Inventory (PAI). Methods: Data consisted of 78 archived outpatient clinical evaluations from a private practice. Inclusion criteria consisted of individuals who were administered both the MPS and PAI as part of an evaluation process and produced valid interpretable results. Pearson's correlational statistics were conducted on the validity scales Inconsistency Score and Malingering Score (MAL) of the MPS and Negative Impression Management scale (NIM), Malingering Index, and Rogers Discriminant Function index of the PAI. Correlation of comparable clinical scales was also evaluated. Results: Significant positive correlations were observed between MAL and NIM (r = .716, n = 78, p < .001), as well as between MAL and the Malingering Index (r = .457, n = 78, p < .001). Additional correlations between clinical scales are also available. Conclusions: Relatively little concurrent validity evidence is available for the use of the MPS. The extent to which MPSs yield similar results to the scales of the PAI, the greater the concurrent validity evidence in support of the use of the MPS to aid in the process of identifying non-credible performers. This study suggests that such validity is both possible and in need of further research. Discussion of purpose and population use to be included.

B-44
Suboptimal Effort on Neuropsychological Evaluation Is Associated with Increased Healthcare Utilization

Abstract

Objective: Patients who exert suboptimal effort on neuropsychological examination might not receive accurate diagnoses and recommendations and might not cooperate fully with other aspects of healthcare. This study examined whether suboptimal effort is associated with increased healthcare utilization. Methods: Of 229 patients seen for routine, clinical neuropsychological examination at a VA Medical Center, 183 showed adequate effort and 46 showed suboptimal effort, as determined at time of evaluation using standard measures (e.g., Word Memory Test, Test of Memory Malingering). All patients for whom complete data were available were included; a broad range of referral questions and diagnoses was represented. Utilization data included the number of Emergency Room (ER) visits and the number of inpatient hospitalizations in the year following evaluation. Results: Wilcoxon's rank-sum tests indicated that patients with suboptimal effort had more ER visits in the year following evaluation (p < .05; Tables 1 and 2). As utilization is highly dependent on patient comorbidities, the adjusted independent association of effort with utilization was estimated via Poisson's count models. After adjusting for the number of comorbidities, suboptimal effort was associated with higher numbers of both ER visits and inpatient hospitalizations (p < .05), with ∼60% higher incidence of ER visits and 117% higher incidence of hospitalizations. Conclusions: Patients who exerted suboptimal effort showed greater healthcare utilization in the year following evaluation. Such patients might use more resources since diagnostic evaluations are inconclusive. Suboptimal effort on examination might also serve as a “marker” for more general failure to cooperate fully in one's healthcare, possibly resulting in greater utilization.

Table 1.

Unadjusted means (SD) by effort status

 Adequate Effort (n = 183) Suboptimal Effort (n = 46) 
Emergency room visits* 0.69 (1.69) 1.06 (1.76) 
Hospital admissions 0.17 (0.49) 0.32 (0.81) 
Number of comorbidities 4.53 (1.64) 4.15 (1.56) 
 Adequate Effort (n = 183) Suboptimal Effort (n = 46) 
Emergency room visits* 0.69 (1.69) 1.06 (1.76) 
Hospital admissions 0.17 (0.49) 0.32 (0.81) 
Number of comorbidities 4.53 (1.64) 4.15 (1.56) 

*p < .05.

Table 2.

Incidence rate ratios adjusted for effort and comorbidities (95% confidence interval)

 Emergency room visits Hospital admissions 
Suboptimal effort 1.60 (1.15;2.23) 2.17 (1.17;4.04) 
Number of comorbidities 1.11 (1.02;1.22) 1.41 (1.18;1.67) 
 Emergency room visits Hospital admissions 
Suboptimal effort 1.60 (1.15;2.23) 2.17 (1.17;4.04) 
Number of comorbidities 1.11 (1.02;1.22) 1.41 (1.18;1.67) 

B-45
The Influence of Effort on Neuropsychological Test Performance

Abstract

Objective: This study explored differences in neuropsychological test scores and domains of cognitive functioning relative to performance on measures of effort in Veterans of Afghanistan and Iraq (OEF/OIF). Methods: Four hundred and eighteen OEF/OIF Veterans participated in a large, multisite study and were administered a neuropsychological test battery. Average age was 32.1 (8.9) years, modal education 42% “some college,” and 84% of the sample was white/Caucasian. Effort measures included the Medical Symptom Validity Test and the Test of Memory Malingering, as well as two embedded indices, the California Verbal Learning Test–2nd Edition Forced Choice Recognition and WAIS-III Reliable Digit Span. Neuropsychological measures included WAIS-III Digit Span and Digit Symbol subtests, Trail-Making Test Parts A and B, CVLT-II Trials 1–5 T-score and Long-Delay Free Recall SS, and the Delis–Kaplan Executive Function System Set Shifting and Fluency subtests. These represent domains of working memory, verbal learning and retention, processing speed, set shifting, and fluency. Results: Individuals failing two or more of the four effort measures were grouped as “insufficient” effort (n = 35), and those failing one or none were grouped as a liberal measure of “sufficient” effort (n = 383). Means for all 11 neuropsychological tests were significantly lower in the insufficient effort group compared with the sufficient effort group (p < .005, corrected for multiple comparisons). Conclusions: As expected, individuals with “insufficient” effort performed more poorly across all measured neuropsychological domains. This demonstrates the criterion validity of effort measures in a returning Veteran sample and critically serves to flag false-positive cognitive decline.

B-46
Malingering or Impaired? A Patient with Poly-Etiologies

Abstract

Objective: This case describes a 38-year-old Jamaican woman with generalized epilepsy seeking exemption from the U.S. Citizenship examination due to memory deficits and illiteracy. Cognitive abilities were deficient. She met criteria for several psychiatric disorders and suboptimal effort was suspected. However, this case raises concerns about the validity of effort tests (ETs) for such patients. Methods: Patient endorsed refractory complex partial and secondary generalized seizures since youth. A victim of childhood neglect, she never attended school and is illiterate. She reported lifelong memory problems. Since her daughter's birth, she experienced persistent/distressing thoughts (e.g., worries about forgetting to care for her daughter). She neutralizes these thoughts through compulsive checking. Patient also endorsed auditory hallucinations. She is diagnosed with Obsessive Compulsive Disorder, Post-traumatic Stress Disorder and Psychosis NOS. Results: Full-Scale IQ was 53. Verbal and visuospatial memory were deficient on immediate/delayed recall and recognition. Four/five domains on the Structured Inventory of Malingered Symptomatology were slightly elevated. Test of Memory Malingering (Trial 1 = 32, Trial 2 = 28, Retention = 25) and California Verbal Learning Test Forced-Choice Recognition (69%) suggested suboptimal effort. Yet, she recalled nine items on the Rey 15-Item Test (cutoff = 9) and her Personality Assessment Inventory was valid despite an elevated Negative Impression Management score (T = 73). Conclusions: Research on the utility of traditional cutoffs for ETs in mentally retarded is mixed. Even though literacy was not shown to impact ETs in a study of forensic patients, no research has examined the combined influence of neurological and psychiatric disorders, mental retardation, and illiteracy on ETs. This case highlights the need for more appropriate ETs for cross-cultural patients with poly-etiologies.

B-47
Utility of the Response Bias Scale (RBS) of the MMPI-2-RF in Relation to Structured Malingering Criteria in a Criminal Population

Abstract

Objective: Research supports the use of specific cutoff scores of the Response Bias Scale (RBS) in civil litigant populations using structured malingering criteria (Dionysus, Denney, & Halfaker, 2011; Wygant et al., 2011); however, previously published studies have not examined the utility of the RBS in criminal populations using structured malingering criteria (Wygant et al., 2010). The purpose of the current study is to expand upon previous research by examining the utility of the RBS in relation to structured malingering criteria for malingered neurocognitive dysfunction in an incarcerated criminal population. Methods: The study used archived data consisting of 103 participants who were past inmates at the Federal Medical Center in Springfield, MO. Inclusion criteria in the study consisted of having available MMPI-2 protocols and validity test data. The sample was divided into “Valid” (n = 42), “Probable” (n = 40), and “Definite” (n = 21) groups using criteria developed by Slick, Sherman, and Iverson (1999). Results: RBS scores differed between the classified groups, F(2, 100) = 8.92, p = .00, η2 = 0.15. There was no significant difference between the “Probable” and “Definite” groups. ROC analysis found an AUC of 0.717. Conclusions: Sensitivity and specificity were examined and a cut score of 11 was found to produce the greatest sensitivity and specificity when the “Probable” group was separated from the “Valid” group and included with the “Definite” group. Various cut scores and classification analysis are explored, and the implications for forensic evaluations are discussed.

B-48
A Comparison of Motor Dysfunction Profiles in a Known Groups Sample of Litigants

Abstract

Objective: To establish support for a motor dysfunction profile for those who exaggerate or malinger chronic pain such as established by Greiffenstein, Baker, and Gola (1996) through comparing a control simulator sample to a clinical sample of litigating and non-litigating individuals referred for traumatic brain injury, chronic pain, and post-conssuive syndrome. Methods: The archival sample consisted of 82 outpatients who had been referred to a private practice for neuropsychological testing. Grip Strength, Grooved Pegboard (GPB), and the Finger Oscillation Test (FoT) were administered as part of a larger battery. Participants were classified as having Malingered Neurocognitive Dysfunction (MND) and the presumed valid (PV) group based on criteria set for by Slick, Sherman, and Iverson (1999). Results: Independent sample t-tests were conducted to compare t-scores on the Grip Strength, FoT, and GPB for the MND and No MND group. There was no significant difference in scores for FoT or Grip Strength. However, there was a difference in GPB scores for the MND group (M = 79.91, SD = 21.65) and PV group (M = 66.18, SD = 19.29); t (82) = − 3.05, p = .003 (two-tailed). Conclusions: Differences were found between groups with GPB scores, but not for FoT or Grip Strength scores. These findings were dissimilar from previous research (Griffenstein et al., 1996) with brain injury or chronic pain (Biddle et al., 2011) samples and suggests that the use of a motor dysfunction profile in mixed clinical groups is not supported.

B-49
Assessing Effort with Sequencing Tests from the WAIS IV

Abstract

Objective: This study examined the use of sequencing scores from WAIS-IV subtests as measures of effort in a simulated malingering study. Methods: Data were collected as part of a larger, posttest only experiment conducted at a Midwestern university during 2009–2011. Undergraduates without reported neurological history who completed the WAIS-IV were included; 88.8% were women, 76.6% Caucasian, 15.9% African American, 7.5% other ethnicities, and 94.4% right-handed. Mean age was 23.0 years (SD = 7.5), and mean education level was 12.7 years (SD = 1.1) completed. Random assignment resulted in groups of naïve malingering (n = 32), coached malingering (n = 36), and control (n = 38) participants. Each group received performance instructions and underwent a comprehensive test battery. Testing included the WAIS-IV Digit Span (DS) and Letter Number Sequencing (LNS) scales. Results: Mean performance on LNS, F(2, 104) = 5.22, p = .007, a novel measure created by summing scores on Longest DS Sequence (LDSS) and Longest LNS, F(2, 104) = 3.89, p = .023, and the LDSS, F(2, 104) = 3.56, p = .032, were significantly different. Post hoc analysis (Games–Howell) found that differences existed between control and coached groups, but not with the naive malingering group. This led to additional examination and creation of a score using the first six LNS items. This score was significantly different, F(2, 104) = 5.29, p = .007, across all groups, but offered limited diagnostic accuracy when compared with other metrics (e.g., Word Memory Test) in this sample. Conclusions: Further examination of sequencing is suggested using other samples.

B-50
Sensivitity and Specificity of Three Symptom Validity Tests Using a Bayesian Latent Class Model for Effort as a Gold Standard Criterion

Abstract

Objective: This study used Bayesian latent class modeling to determine the sensitivity and specificity of the Test of Memory Malingering (TOMM), Word Memory Test (WMT), and Computerized Assessment of Response Bias (CARB) in their ability to correctly identify good or poor effort. Methods: Data from 1,412 individuals from a larger sample of 3,075 individuals who completed a neuropsychological evaluation in a private practice setting were used. A majority of individuals were evaluated in a medico-legal context. The sample was 67% men, mean age 42, and mean IQ 93. To be included, the individual had to have completed the TOMM, WMT, and CARB. Results: An estimated latent model with two classes was derived from the following cut scores: TOMM Trial 2 <45, WMT Immediate Recall <82.5, and CARB Total Score <89.1. Estimated class population share was 15% for class 1 (poor effort) and 85% for class 2 (good effort). Model fit statistics were acceptable. Respective sensitivity and specificity numbers were: TOMM 0.684 and 0.985, WMT 0.933 and 0.922, and CARB 0.729 and 0.942. Conclusions: Our study demonstrates a new approach to determining sensitivity and specificity for symptom validity tests which has previously been used in medical studies when there is no gold standard criterion. We believe a particular strength of this approach is a better estimate of specificity than previous known-group design studies that often remove indeterminate cases.

B-51
Base Rates of Effort Test Failure in Ceterans Diagnosed with Dementia: Alternative Cutoffs to Reduce False Positives in a Clinical Sample

Abstract

Objective: Measures to detect the exaggeration of cognitive deficits have not been as rigorously studied in large dementia samples. This study provides base rates of effort test failure and proposed cutoffs for freestanding and embedded measures in a sample of Veterans diagnosed with dementia. Methods: Review of patients seen in a VA Neuropsychological clinic and diagnosed with dementia (n = 144, mean age = 73, mean education = 11; men = 98%, Caucasian = 90%). The Medical Symptom Validity Test (MSVT), Test of Memory Malingering trial 1 (TOMM1 total, and errors on the first 10 items—TOMMe10), and embedded measures derived from the WAIS-III (Digit Span, Reliable Digit Span, WMI, and PSI), Brief Visuospatial Memory Test-R (recognition hits), Finger Tapping (dominant hand), and CVLT-II (forced choice) were included. Standard cutoffs were used for each measure and proposed cutoffs were derived with attempts to minimize false positives (FPs). Results: There were high FP rates across most embedded measures ranging from 28% to 48% at standard cutoffs with the only acceptable measure being Digit Span (ACSS < 5, 8% FP rate). There was a 56% failure rate on the MSVT; however, the “Dementia Profile” accurately identified 93% of patients (7% FP rate). Adjusting TOMM1 from <40 (29% FP rate) to <30 resulted in a 9% FP rate. Conclusions: Base-rate data are sparse for how dementia patients perform on embedded and freestanding measures of cognitive exaggeration. Lower cutoffs appear warranted except for digit span and MSVT. Future studies may benefit from combining embedded and freestanding measures to reduce FP rates in dementia.

B-52
Combining the Test of Memory Malingering Trial 1 (TOMM1) and Errors on the First 10 Items of the TOMM (TOMMe10) with Behavioral Responses Improves the Prediction of Test Validity in a Veteran Sample

Abstract

Objective: Using two short forms of the Test of Memory Malingering (TOMM), we assessed whether combining TOMM performance with behavioral observations (during the test itself) improved upon the accuracy of the TOMM measures alone in predicting performance on the Medical Symptom Validity Test (MSVT). Methods: Retrospective database study of consecutive referrals to an outpatient VA Neuropsychological clinic excluding those with dementia (n = 135, mean age = 51, mean education = 12.6; men = 91%, Caucasian = 90%). TOMM trial 1 (TOMM1) and errors on the first 10 items of TOMM1 (TOMMe10) were combined with the patient's behavioral responses (while completing the first 10 items of TOMM1) to predict non-credible performance on the MSVT. Scores on TOMM1 and the TOMMe10 were combined with five possible behavioral responses using binomial logistic regression analyses to predict performance on the MSVT (pass/fail). Area under the curve (AUC) analysis was used to assess overall accuracy. Results: The only behavioral response that was a significant predictor of MSVT performance was the “Point and Name” (the picture) response. Combining the number of “Point and Name” responses with the two TOMM measures slightly improved accuracy compared with the TOMM measures alone (TOMM1: [AUC] = .92, TOMM1 + “POINT and NAME” [AUC] = .96; TOMMe10, [AUC] = .87, TOMMe10 + “POINT and NAME” [AUC] = .93). Conclusions: Short forms of the TOMM (TOMM1 and TOMMe10) may be further enhanced by combining test performance with overt behavioral responses noted during portions of the test administration (e.g., first 10 items). Further validation in larger populations is warranted.

B-53
Efficacy of the TOMMs Albany Consistency Index in a Forensic Neuropsychological Sample

Abstract

Objective: According to a survey of neuropsychologists' beliefs and practices, the Test of Memory Malingering (TOMM) is the most frequently used symptom validity test. Despite its popularity, the test has been criticized for yielding relatively low sensitivity rates. In an attempt to address this concern, Gunner, Miele, Lynch, and McCaffrey developed a new TOMM index, the Albany Consistency Index (ACI). When the Word Memory Test was used as the reference criteria, the ACI yielded sensitivity and specificity rates of 71% and 100%, respectively. These are impressive initial findings, but the index currently lacks validation in other forensic samples. Methods: Archival data from 62 medico-legal cases (59% were claimed traumatic brain injuries) were examined. Criteria developed by Slick, Sherman, and Iverson were used to classify patients into groups of credible and non-credible performance. Scores were analyzed between groups using the Mann–Whitney U and ROC analyses. Results: Non-credible group ACI scores were significantly worse than credible group ACI scores (Mann–Whitney U = 69.500, p < .001). In addition, the ACI achieved a high area under the curve (0.926) in differentiating patients by the Slick and colleague criteria. The recommended cutoff of 10 errors yielded sensitivity and specificity rates of 77% and 89%, respectively. Sensitivity and specificity rates for additional cutoffs are provided. Conclusions: The ACI is able to differentiate credible versus non-credible performance among our sample of forensic neuropsychological patients divided by the Slick and colleagues criteria. These findings provide further evidence for the utility of the ACI.

B-54
Agreement between the Medical Symptom Validity Test and Test of Memory Malingering among Mixed Forensic Referrals

Abstract

Objective: The Medical Symptom Validity Test (MSVT) is a brief test that has demonstrated excellent utility in discriminating credible versus non-credible performances among various samples. A sample that has received little attention among studies of the MSVT is that of mixed outpatient referrals with financial incentive. The present study examines the rate of agreement between the Test of Memory Malingering (TOMM), a widely used and well-validated measure of effort, and the MSVT among mixed, incentivized outpatient referrals. Methods: Archival data from 67 outpatients who underwent comprehensive neuropsychological evaluations were examined. The sample was comprised of individuals receiving or applying for disability, worker's compensation claimants, and those involved in other litigation (e.g., plaintiff claiming damages secondary to injuries suffered as the victim of a motor vehicle accident). Crosstabs analysis was conducted to obtain percent agreement and Kappa between the two measures. Results: The MSVT identified 22 examinees falling below cutoff scores, compared with nine on the TOMM. Fifteen individuals fell below cutoffs on the MSVT but above on the TOMM; two individuals fit the reverse case (above on MSVT, below on TOMM). Crosstabs analysis indicated overall agreement of 75% (n = 50). This was fair agreement (Landis & Koch, 1977) when controlling for chance (kappa = 0.32, p = .002). Conclusions: The MSVT and TOMM identified non-credible performance in the majority of cases in this sample. The use of the TOMM and MSVT in similar clinical samples will likely provide consistent evidence of performancevalidity.

B-55
Patients Applying for Disability Versus Patients Already Receiving Disability: Is There a Difference in Medical Symptom Validity Test Failure Rates?

Abstract

Objective: Malingering is the intentional amplification of symptoms for primary or secondary gain. It is well documented that a large number of patients are classified as malingering cognitive dysfunction during disability-related evaluations. However, most research does not differentiate these patients based on disability status—applying for disability versus currently receiving disability. Both groups of patients have external incentives to amplify their symptoms (gaining disability versus potentially maintaining disability), and the current research evaluates whether disability status impacts symptom validity test failure rates. Methods: Archival data from 37 outpatients who underwent comprehensive neuropsychological evaluations were examined. Of the 37 patients, 23 were applying for disability and 14 were currently receiving disability. Mean scores and failure rates on the Medical Symptom Validity Test (MSVT) were determined for each group. Results: Of those applying for disability, 8 (34.78%) failed the MSVT (mean MSVT scores = 71.88, 78.75, and 73.13 for Immediate Recognition [IR], Delayed Recognition [DR], Consistency [CNS], respectively). Of those currently receiving disability, 7 (50%) failed the MSVT (mean MSVT scores = 73.57, 71.43, and 73.57 for IR, DR, and CNS, respectively). A Mann–Whitney U indicated between groups failure rate sampling distributions were not statistically significant at the .05 level. Conclusions: Our results indicate that patients who are applying for disability fail the MSVT at similar rates as patients currently receiving disability. These results emphasize the importance of including symptom validity testing in all neuropsychological evaluations.

B-56
Evaluation Context and Symptom Validity Test Performance in a U.S. Military Sample

Abstract

Objective: The primary aim on the current study was to evaluate the base rates of symptom validity test (SVT) failure in two groups of active duty military members: those seen for neuropsychological evaluation in the context of a pending medical evaluation board (MEB) and those evaluated in a non-MEB/clinical context. A secondary aim was to examine the impact of cognitive effort on a neuropsychological test battery. Methods: The study included 335 US active duty military service members assessed at an outpatient TBI clinic located at a Southeast US Army facility. Over 95% of the sample had mild TBI. Cognitive effort was assessed with the Word Memory Test (WMT). Individual cognitive measures were combined to create composite T-scores. Results: Overall, 41.8% of the sample failed the WMT; however, significantly more individuals in the MEB group (54%) failed the measure relative to the non-MEB/clinical group (35%). Effect sizes on neurocognitive domains as a function of WMT performance were as follows: attention (d = 0.94), processing speed (d = 1.05), memory (d = 0.85), verbal reasoning (d = 0.31), visual reasoning (d = 0.39), and motor (d = 1.02). On the Personality Assessment Inventory, those who failed the WMT had elevated scores on Negative Impression Management, Malingering Index, and eight clinical scales (d = 0.40–0.83). Conclusions: This study showed that SVT failure is a relatively frequent occurrence in military samples, especially among those involved in MEB. Furthermore, SVT performance had a notable impact on neurocognitve test scores, but was less strongly associated with psychological symptoms.

B-57
Symptom Validity Testing (SVT) in a Military Sample with Mild Traumatic Brain Injury: The Effect of Multiple SVT Failure on Neuropsychological Testing

Abstract

Objective: This investigation examined the effect of invalid symptom validity test (SVT) performance on neuropsychological test performance in a military population with a history of mild traumatic brain injury (MTBI). Methods: Records from 243 patients evaluated at a military treatment facility were reviewed. Participants who completed the Test of Memory Malingering, the Victoria SVT, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Trail-Making Test Part B (TMTB) were included (n = 67) and grouped based on SVT performance. Thirty-eight MTBI participants performed in the valid range on both SVTs (Valid), 11 performed in the invalid range on only one SVT (Questionable), and 6 performed in the invalid range on both SVTs (Invalid). Twelve participants had a moderate or severe TBI and performed in the valid range on both tasks (Mod/Severe TBI). Results: A multivariate analysis of variance revealed an omnibus effect (Λ = 0.43, p < .001, ηp2 = 0.25). The Invalid group performed significantly worse than all other groups on the Immediate Memory, Attention, and Delayed Memory indices of the RBANS as well as TMTB. The Questionable group did not differ from the Mod/Severe TBI group on any measure. Conclusions: The results highlight the value of relying on multiple SVT failures when making conclusions of insufficient effort. The differences between those with one SVT failure and those with two is believed to reflect better classification accuracy of effort, but further research is needed to determine the generalizability and clinical relevance of these results.

B-58
Memory for Complex Pictures: Initial Development and Validation of a New SVT with Dementia Patients

Abstract

Objective: Identifying patients who provide suboptimal effort during cognitive evaluation has become increasingly important. The Memory for Complex Pictures (MCP) test is a symptom validity test (SVT) currently in the process of continued development and validation. As shown by other symptom validity researchers (e.g., Tombaugh, 1996), patients with dementia represent a key validation group in the development of a psychometrically sound and empirically useful SVTs. Given that severe memory deficits are the hallmark of dementia, this patient population is a very useful comparison group against subpopulations prone to poor effort (e.g., patients with mTBI currently involved in litigation). The primary purpose of this study is to establish at what degree of dementia severity patients will reliably fail SVTs. It is hypothesized that the overwhelming majority of patients with moderate–severe dementia (as defined by patient diagnosis and Mini Mental Status Score <23) will fail reliable and frequently used SVTs. Methods: Data were collected from 34 patients with a diagnosis of dementia (25 men and 9 women, mean age = 77), who were referred for outpatient neuropsychological evaluation. A relatively brief battery of standard neuropsychological measures was also administered to all patients. All patients had at least moderate (<2 SD) memory deficits and the majority had severe (<3 SD) memory deficits. Results: Seventeen patients had MMSE scores at 24 or above (50%). Of those patients, 11 (65%) passed the MCP (defined as a Trial 2 score > 44). The average MCP Trial 2 score for these patients was 47.5. Sseventeen patients had MMSE scores below 24 (50%). Of those patients, only four (24%) passed the MCP. The average MCP Trial 2 score for these patients was 38.0. Conclusions: As hypothesized, the overwhelming majority of patients with moderate–severe dementia reliably failed the MCP. Additionally, many patients with mild dementia received passing scores. These results provide important information as to the utility of SVTs, and the MCP, in particular, in dementia populations.

B-59
Initial Development and Validation of the Memory for Complex Pictures (MCP) Test with HIV+ Patients

Abstract

Objective: Several measures have been developed to detect effort during neuropsychological assessment (e.g., WMT, TOMM). This list includes the Memory for Complex Pictures (MCP) test, a new SVT. The primary purpose of this test was to examine the performance of HIV-related dementia patients with severe memory impairment on the MCP. It was hypothesized that this population would perform well on the MCP, despite having severe memory impairments. Methods: Data were collected from 28 patients with a diagnosis of HIV-related dementia (17 men and 11 women, mean age = 25.6), who were referred for outpatient neuropsychological evaluation, primarily due to memory complaints. A relatively brief battery of standard neuropsychological measures was also administered to all patients. All patients had at least moderate (<2 SD) memory deficits and the majority had severe (<3 SD) memory deficits. Results: Patients with HIV-related dementia with moderate–severe memory deficits scored relatively well on the MCP, with all achieving passing scores (Trial 1 average score = 46.7, Trial 2 average score = 48.95). Conclusions: As hypothesized, all patients with HIV-related dementia and moderate–severe memory deficits achieved passing scores on the MCP. This result adds to the growing literature on the MCP and increases its utility as an emerging SVT.

B-60
True Chance on the Test of Memory Malingering (TOMM): An Item Analysis

Abstract

Objective: This study investigated chance performance on the Test of Memory Malingering (TOMM) and conducted an item analysis. Methods: One hundred undergraduates were administered the TOMM in a novel research format where they completed only the Recognition portion of Trials 1 and 2 with the learning trials omitted. Feedback for responses during Trials 1 and 2 was conserved as in the standard TOMM. During the delay, participants completed the Wechsler Test of Adult Reading (WTAR) as a proxy of WAIS-III Full-Scale IQ and the Victoria Symptom Validity Test as a measure of effort. True chance was investigated by item responses on Trial 1. Results: Participants' average age was 19.83 (2.1) years and average WTAR score was 102.5 (9.8). 61% of the sample was women; 60% of participants self-identified as white/Caucasian, 16% as Black, 10% as Asian. No participants failed the VSVT. Only 14% failed the TOMM, and for all cases except one, this was due to Trial 2 scores. Although Trial 1 scores averaged around 25 of 50 (expected), Z-test statistics revealed that items were selected at rates statistically different from chance responding for 21 of 50 pairs. A gender bias was identified for two thirds of the Trial 1 pairs. Conclusions: The majority of the sample passed the TOMM using only a single recognition trial for learning of the correct items for Trial 2. The preferential responding for certain items and/or the presence of gendered items has important implications for test reconstruction. At present, these preferential items may serve clinicians during instances of unclear effort determination.

B-61
Introduction of the Rey Complex Figure Forced-Choice Recognition Task

Abstract

Objective: Embedded measures of symptom validity have joined the neuropsychology arsenal to evaluate performance validity, forced-choice recognition memory embedded (CVLT-II and WMS-IV) entering the field more recently. This project introduces a 16-item forced-choice recognition task developed for the Rey Complex Figure Test (RCFT). Methods: Archival data include 221 adults (mean age = 53.8 years; education = 13.1 years; FSIQ = 90.1; 68% Caucasian; 90% men) from a metropolitan VA medical center. All cases had at least two performance validity measures administered. Data were grouped by passing all (PASS, n = 148) or failing at least two measures (FAIL, n = 73). Participants completed a 16-item forced-choice RCFT recognition task (RCFT-FC). The items were derived from the RCFT Recognition (12 items) and four items in which the drawings were presented in the orientation as in the drawing or were rotated 90°. Results: Performance on both RCFT-FC and traditional scores differed between the PASS/FAIL groups (p < .001; see the table below). A discriminate function analysis found overall classification of 77% using the RCFT-FC (40% sensitivity and 93% specificity). Receiver operating characteristic analysis showed area under the curve of 0.72, using a cutoff score of 13 or less as indicative of poor effort. Conclusions: Preliminary studies offer RCFT-FC as a potential additional embedded measure of performance validity.6

Variable PASS FAIL 
Immediate Recall (t-score) 40.8 (14.3) 32.8 (13.1) 
Delayed Recall (t-score) 39.4 (14.8) 30.6 (13.0) 
Recognition (t-score) 42.8 (12.6) 34.2 (12.1) 
FC (raw score) 14.0 (1.7) 12.4 (2.2) 
Variable PASS FAIL 
Immediate Recall (t-score) 40.8 (14.3) 32.8 (13.1) 
Delayed Recall (t-score) 39.4 (14.8) 30.6 (13.0) 
Recognition (t-score) 42.8 (12.6) 34.2 (12.1) 
FC (raw score) 14.0 (1.7) 12.4 (2.2) 

B-62
Effect of Intelligence, Psychopathy, and Narcissism on Malingering in College Students

Abstract

Objective: The purpose of this study was to examine the influence of intelligence, psychopathy, and narcissism on malingering. In particular, we predicted that higher intelligence and higher psychopathy would be associated with more sophisticated malingering. We did not have a specific hypothesis for the narcissism measure, but included it as an exploratory measure. Methods: Fifty-nine undergraduate students at a large southeastern university participated. Participants first completed the Wechsler Test of Adult Intelligence to assess intelligence and the Narcissistic Personality Inventory and the Psychopathic Personality Inventory to assess personality. They were then presented malingering instructions to feign as if they had been in a car accident and had suffered a traumatic brain injury. Even though their symptoms had resolved, they were instructed to convince the examiner that they were still impaired. Several effort measures were then administered including the Word Memory Test. Results: Intelligence, psychopathy, and narcissism were dichotomized so that for each variable there were lower and higher scores. These were the independent variables, whereas performances on the malingering measures were dependent measures. A series of ANOVAs found that only the interactions between intelligence and narcissism were significant (p < .05) for the WMT Multiple Choice, Free Recall, and Paired Associates Recognition. In each case, participants higher in intelligence and narcissism performed best and evidenced a more successful malingering style. Conclusions: Little research has examined personality characteristics in malingering research. This study demonstrated that high narcissism, in combination with high intelligence was associated with more sophisticated malingering on the WMT.

B-63
Assessment of Effort in a Mixed Chemical Dependency Treatment Population

Abstract

Objective: This study investigated utility of the Test of Memory Malingering (TOMM) in assessment of effort in a mixed chemical dependency treatment population. We also investigated use of the Effort Index (EI) from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in this group. Correlations between these two measures were studied. Methods: Subjects for this study were 55 individuals (39 men) participating in residential chemical dependency treatment and referred for neurocognitive assessment. Mean age was 49.2 years (range 19.5–76.1). All were administered neuropsychological batteries including TOMM and RBANS. Subjects with scores of 49 or 50 on TOMM Trial 1 were not administered Trial 2 (n = 43). EI for RBANS was calculated using the formula described by Silverberg and colleagues (2007). Spearman's correlations between EI and TOMM scores were computed. Results: The TOMM Trial 1 and 2 means were 48.76 and 49.58, respectively. TOMM 1 range was 40–50 and TOMM 2 range was 46–50. EI ranged from 0 to 3. Correlation between EI and TOMM Trial 1 was non-significant. A moderate inverse correlation between EI and TOMM Trial 2 was observed (n = 12, r = − .60, p < .05). Neither TOMM Trial was associated with EI, when EI was categorized as zero or greater than zero. Conclusions: Findings support the conclusion that TOMM may be a useful and valid measure of effort in a mixed chemical dependency population. Results raise questions about the utility of the EI as a valid effort measure in this group.

B-64
Another View of Third Party Observation: Exploring its Effects on Malingering

Abstract

Objective: A recent meta-analysis of 62 studies investigating Third Party Observation (TPO) effects concluded that TPO has a negative impact on cognitive performance and that non-human observers (e.g., video recorders) have a larger effect size on cognitive performance than human observers. However, research fostering such interest in TPO effects on cognitive performance has exclusively utilized effortful samples. In the present study, we examined whether TPO is related to performance in individuals simulating cognitive impairment related to traumatic brain injury (TBI). Methods: University students (n = 46) with a history of mild TBI were included in this study. They were asked to simulate cognitive impairment during a 2-h, neuropsychological battery, and they were randomly assigned to complete the battery in the absence (n = 22) or the presence (n = 24) of an adjacent video camera, which served as the TPO. Results: Observed and unobserved simulating malingerers did not perform differently on the Word Memory Test (p = .81), visual memory tests (p = .39), verbal memory tests (p = .48), or motor tasks (p = .98). However, observed simulating malingerers performed better than unobserved simulating malingerers on a verbal fluency task (p = .03) and showed improved performance on a visual-perceptual organization copy task (p = .05). Conclusions: Preliminary evidence suggests that TPO can improve simulated malingerer performance on some neuropsychological tasks, and TPO may allow for a more sophisticated feigning profile. This potentiality provides a new reason to refrain from allowing TPO of neuropsychological evaluations and reinforces the importance of utilizing credibility measures during evaluations.

B-65
The Degree of Conation on Neuropsychological Tests Does Not Account for Performance Invalidity Among Litigants

Abstract

Objective: Conation has been defined as the ability to focus and maintain persistent effort throughout task completion. Through a series of experiments, Reitan and Wolfson (2000, 2004, 2005) showed conation to contribute to the magnitude of test score differences between brain-damaged and non-brain-damaged examinees. The current investigation sought to determine if conation might similarly account for differences in test scores among performance valid and performance invalid examinees. Methods: Archival analysis was performed on data from 52 examinees who were administered the Halstead-Reitan Neuropsychological Battery (HRNB) and several symptom validity tests (SVTs) in a medico-legal context. The vast majority of examinees had sustained a mild traumatic brain injury; average age was 44.63 (10.51) years and 52% of the sample was women. “Performance invalid” examinees failed two or more SVTs. Mean test scores of both effort groups were compared across 19 HRNB tests ranked according to their conative load. Results: Mean comparison revealed that performance invalid examinees performed worse than performance valid examinees on 18 of 19 tests, with significant differences between groups emerging on both low and high conative load tests. Spearman's rank correlations between the conative load of each HRNB test and both mean test score differences between groups and t-ratios between groups failed to achieve significance. Conclusions: Analyses revealed that conation has nearly no impact on the magnitude of test score differences between performance valid and performance invalid examinees. Instead, performance invalid examinees performed worse than performance valid examinees across nearly all tests, including those with low and high conative loadings.

B-66
Cross-Validation of Psycho-Assistant with the Word Memory Test

Abstract

Objective: Cross-validation of Psycho-Assistant test for Malingering against the Word Memory Test. Methods: The sample consisted of 86 consecutively assessed compensation claimants who were 50% men with an average age of 34.8 years (SD = 14.8) and 13.2 years of education (SD = 4.3). Failure on Psycho-Assistant (PA) was defined as performance 2.5 SD below normal controls on the PA memory retest (post-corrective feedback subtest) and PA “distorted” final subtest. Word Memory Test (WMT) failure was defined as failing WMT-IR and WMT-DR (both <85.0% correct). Binary logistic regression with backwards L-R elimination was used to predict failure on each test, in turn, using raw subtest results that also included average and standard deviation in response times. Results: Failure on PA at 95.1% specificity was achieved with 77% sensitivity and overall classification accuracy of 92%, with the final model including WMT-DR as the only significant predictor (χ2 = 38.3, p < .001). Failure on WMT at 96.1% specificity, 66% sensitivity, and overall classification accuracy of 85% was achieved (χ2 = 51.8, p < .001) with the final significant predictors including PA percent correct as well as average and standard deviation response time variables. Conclusions: The novel PA test produced acceptable sensitivity at 95% specificity when compared with the WMT. Results are similar to previously observed PA comparisons with TOMM, CARB, CVLT recognition hits, and embedded ability measures. Variables associated with PA response times significantly contributed to identifying WMT failure, but this was not observed in reverse.

B-67
Examining the Dementia Profile on the Word Memory Test

Abstract

Objective: The Dementia Profile (DP) on the Word Memory Test (WMT) was developed to differentiate individuals with genuine memory difficulty from individuals feigning impairment. This study examined the DP in a simulated malingering paradigm. It was hypothesized that the DP would not be observed among non-clinical participants randomly assigned to perform suboptimally on neuropsychological measures. Methods: Data were collected at a Midwestern university during 2007–2011 using an experimental, post-test-only research design. Undergraduates without neurologic history were randomized to control (n = 72), naïve simulator (n = 72), and coached simulator (n = 72) groups. The sample was 87% women, 81% Caucasian, and 94% right-handed; average age was 22 years; average education level was 13 years. Outcome measures included the WMT, Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and a protocol adherence questionnaire. Results: Groups were not different on demographic variables or protocol adherence. Control participants scored higher on performance validity measures than simulators. The WMT identified 65% and 55% of naïve and coached simulators, respectively, and 97% of control participants. Contrary to expectation, the DP was observed in 6% of cases and at similar rates in both simulator groups. Participants who met DP criteria demonstrated mean performance on the TOMM (Trial 1 = 36; Trial 2 = 38; Retention = 37) and RDS (6) comparable with published data on individuals with dementia. Conclusions: A subset of non-clinical volunteers feigned the DP without test-specific instruction, which raises concerns about its utility in distinguishing individuals with genuine from feigned memory difficulty.

B-68
Is Forensic Neuropsychology Different? A Discussion for Practitioners and Field Leaders

Abstract

Objective: There is some controversy in the field whether forensic neuropsychology represents a distinct subspecialty within clinical neuropsychology. Such a distinction could carry significant training and practice implications. Prior research is presented along with results from a national survey of these practitioners' experience, training, and practice to inform this discussion. Methods: The current study sample consisted of licensed clinical neuropsychologists (n = 59, 17% response rate) recruited from the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology.

Participants completed an electronic survey focused on their neuropsychological and forensic experience, training, and practice. Participants were predominantly men (58%), middle-aged (M = 53.53 years, SD = 9.41), and White (97%). Participants reported working within multiple practice settings across 34 states. Results: The majority of participants reported practicing in both civil and criminal forensic contexts (64%), with a minority restricting their practice to civil cases only (34%); practicing solely in the criminal forensic context was rarely reported (2%). Participants reported conducting forensic assessments across a variety of legal questions, primarily personal injury (97%) and civil (71%) and criminal competencies (42%). The majority of participants' graduate and post-doctoral training was in neuropsychology, supplemented by forensic training through post-graduate continuing education. The majority of participants reported testifying in court (97%), though challenges to admissibility appeared rarely successful. Conclusions: Though certain trends are noted, results suggest substantial variability among practitioners. Implications regarding the training and practice of clinical neuropsychologists are discussed, as are implications for field leaders as they advance the practice of clinical neuropsychology in the forensic context.

B-69
Neuropsychological Features of Civil Litigators and Criminal Offenders: Comparative Analyses of Brain, Behavior, and Cognitive Functioning

Abstract

Objective: The purpose was to determine neuropsychological performance across different types of forensic cases. Methods: Participants (n = 160) aged 18–71 (M = 39.15, SD = 12.52) were collected from an archived database of forensic neuropsychological assessment and are represented by four forensic domains: personal injury litigators (PI; n = 36), Social Security disability applicants (SS; n = 43), worker's compensation claimants (WC; n = 37), and death penalty inmates (DP; n = 44). Ethnicities represented were Caucasian (C; n = 91), African American (A; n = 15), and Hispanic (H; n = 54). Analyses involved a between-subjects design where ANOVAs and MANOVAs (and post hoc tests) of individual neuropsychological assessments and their domains included participant data from: Wechsler Adult Intelligence Scale 3rd Edition (IQs and Indices); Wide Range Achievement Test (reading, spelling, arithmetic); Trail-Making Test parts A and B; Stroop Color-Word; Finger Tapping Test (dominant, non-dominant); Halstead Category Test; FAS; Hooper Visual Organization Test; Ruff 2 and 7 Test of Attention (speed, accuracy); and Beck Depression Inventory-II; also for the Rey-15 and Dot Counting tests of effort. Results: Significantly lower scores for DP were on measures of intelligence, verbal ability, memory and learning, executive functioning, and motor skills, and for H on measures of academic ability, verbal fluency, and attention. PI performed significantly higher on measures of intelligence, verbal learning, verbal ability, and executive function (refer to Table 1). WC showed the highest percentage of suspect effort in testing. Conclusions: The present findings support and extend prior literature.

Table 1.

Tukey's HSD pairwise comparisons significant (α) at 0.05, 0.01, and 0.001 (differences between means are in parenthesis)

Measures F-value p = −.017 Tukey's HSD pairwise comparisons
 
General Intelligence 
 VIQ 5.53 .002 (DP < PI)** (DP < WC)** (SS < PI)* (WC C PI)** 
 PIQ 5.66 .002 (DP < PI)*** (DP < WC)* (SS < PI)* 
 CAT 4.05 .011 (DP < PI)***  (SS < PI)* 
Memory and Learning 
 WMI 4.25 .011 (DP < PI)***  (SS < PI)* (WC < PI)* 
 VIQ 7.63 .000  (SS < PI)** 
Language and Verbal Ability 
 VIQ 7.63 .000 (DP < PI)***  (SS < PI)** (WC < PI)* 
 VCI 6.86 .000 (DP < PI)***  (SS < PI)** (WC < PI)* 
 WMI 4.25 .011 (DP < PI)***  (SS < PI)*  
Abstraction and Reasoning 
 POI 5.21 .003 (DP < PI)*** (DP < WC)* (SS < PI)* (WC < PI)** 
 CAT 3.76 .016 (DP < PI)***  (SS < PI)*  
Concept Formation 
 VCI 5.55 .001 (DP < PI)** (DP < WC)*  (WC < PI)* 
 CAT 4.61 .003 (DP < PI)**    
Motor Function 
 PIQ 5.05 .003 (DP < PI)*** (DP < WC)*   
Attention and Concentration 
 PIQ 3.62 .008 (DP < PI)*    
Academic Ability 
 WRATR 9.83 .000 (H < C)*** (H < A)**   
 WRATS 4.18 .016 (H < C)*** (H < A)**   
Measures F-value p = −.017 Tukey's HSD pairwise comparisons
 
General Intelligence 
 VIQ 5.53 .002 (DP < PI)** (DP < WC)** (SS < PI)* (WC C PI)** 
 PIQ 5.66 .002 (DP < PI)*** (DP < WC)* (SS < PI)* 
 CAT 4.05 .011 (DP < PI)***  (SS < PI)* 
Memory and Learning 
 WMI 4.25 .011 (DP < PI)***  (SS < PI)* (WC < PI)* 
 VIQ 7.63 .000  (SS < PI)** 
Language and Verbal Ability 
 VIQ 7.63 .000 (DP < PI)***  (SS < PI)** (WC < PI)* 
 VCI 6.86 .000 (DP < PI)***  (SS < PI)** (WC < PI)* 
 WMI 4.25 .011 (DP < PI)***  (SS < PI)*  
Abstraction and Reasoning 
 POI 5.21 .003 (DP < PI)*** (DP < WC)* (SS < PI)* (WC < PI)** 
 CAT 3.76 .016 (DP < PI)***  (SS < PI)*  
Concept Formation 
 VCI 5.55 .001 (DP < PI)** (DP < WC)*  (WC < PI)* 
 CAT 4.61 .003 (DP < PI)**    
Motor Function 
 PIQ 5.05 .003 (DP < PI)*** (DP < WC)*   
Attention and Concentration 
 PIQ 3.62 .008 (DP < PI)*    
Academic Ability 
 WRATR 9.83 .000 (H < C)*** (H < A)**   
 WRATS 4.18 .016 (H < C)*** (H < A)**   

Notes: VIQ = Verbal IQ; PIQ = Performance IO; CAT = Category Test; VCI = Verbal Comprehension Index; WMI = Working Memory Index; POI = Perceptual Organization Index; DP = Death Penalty; PI = Personal Injury; WC = Worker's Compensation; SS = Social Security Disability; Η = Hispanic; C = Caucasian; A = African American; Significant main effect of p < .013 when analyzing four variables (e.g., Language and Verbal Ability): Significant main effect of p < .017 when analyzing three variables.

*p < .05.

**p < .01.

***p < .001.

B-70
Feigning the Severe Impairment Profile on the MSVT

Abstract

Objective: The Severe Impairment Profile (SIP) has been shown with high specificity on the MSVT to identify dementia, but a large proportion of simulators (40%) produce the SIP (Howe & Loring, 2009; Singhal, Green, Ashaye, Shankar, & Gill, 2009). In previous studies of Social Security Disability (SSD) claimants, the SIP was removed in order to eliminate true impairment from consideration of validity problems (Chafetz, 2010, 2012); however, concern remained about the feigning of the SIP in claimants motivated to appear impaired. This study's objective was to determine if the SIP is produced at a significantly high rate in claimants motivated to appear impaired versus claimants motivated not to appear impaired. Methods: The frequencies of various forms of the SIP obtained by SSD claimants (50) were compared with those of Child Protection (CP) claimants (33) who are motivated to have their children returned from state custody. All claimants had IQ <76. Results: SSD versus CP claimants showed significantly higher (χ2 = 8.5, p < .05) rates (42% vs. 9%) of the least restrictive SIP. SSD claimants identified as malingering (using other tests) showed significantly higher rates of the least restrictive SIP compared with SSD claimants not identified as malingering (82% vs. 28%; χ2 = 7.6, p < .01). The differences are not found for the more restrictive SIP because order violations help exclude invalidity. Conclusions: The SIP is easily produced by claimants motivated to feign impairment and thus should not be used in forensic workups to exclude invalidity on the basis of impairment.

B-71
The Effectiveness of the MMPI-2-RF Validity and Cognitive/Somatic Scales in Predicting Symptom Validity Failure in TBI Litigants Tested for Effort

Abstract

Objective: The objective of this study was to further validate the somatic/cognitive and validity scales of the MMPI-2-RF regarding their utility in detecting symptom validity test (SVT) failure in head injury litigants. Methods: Data from 105 litigants were collected. All participants were administered the MMPI-2 and at least two of these SVTs: Word Memory Test, Validity Indicator Profile, Test of Memory Malingering, b-Test, Victoria Symptom Validity Test, Portland Digit Recognition Test, Rey 15 Item Test, and Reliable Digit Span. MMPI-2 protocols were rescored for the RF scales. The sample was divided into those who passed all SVTs (valid) or failed at least one (invalid). Result: Non-significant differences were found for demographic variables between the valid/invalid groups. There were no significant differences between groups on these scales: F-r, Fs, and Fp-r. One-way ANOVAs revealed significant differences for COG, p = .002, η2 = 0.08; FBS-r, p = .89, η2 = 0.09; HPC, p = .005, η2 = 0.06; MLS, p = .03, η2 = 0.03; and NUC, p = .008, η2 = 0.06, which resulted in these ROC AUCs: COG = 0.66 (0.56 − 0.77); FBS-r = 0.68 (0.58 − 0.78); HPC = 0.64 (0.54 − 0.75); MLS = 0.60 (0.49 − 0.71); and NUC = 0.65 (0.54 − 0.75). Conclusions: The MMPI-2-RF appears to have a modest effect in predicting SVT failure among these data. AUCs demonstrated weak predictive utility for all scales. These surprisingly poor results may be due to criterion contamination. Further research is needed to generalize these results.

B-72
Heritability of Functioning in Schizophrenia and Relationship with Neurocognition

Abstract

Objective: Role function or daily functioning in schizophrenia is an integral part of the schizophrenia (SZ) phenotype and has been demonstrated to be related to neurocognition. Deficits in this trait appear to be present in both affected persons and some unaffected relatives; hence, we have examined its heritability in our cohort of African-American schizophrenia families. There is now ample evidence that deficits in cognitive function can impact family members who are not themselves diagnosed with SZ; there is some, but less, evidence that role function behaves likewise. We evaluate whether role function tends to “run in families” who were ascertained because they contain an African-American proband diagnosed with SZ. Methods: We analyzed heritability for selected traits related to daily function, employment, living situation, marital status, and Global Assessment Scale (GAS) score; modeling age, gender, along with neurocognition, and diagnosis as covariates in a family based African-American sample (n = 2,488 individuals). Results: Measures of role function were heritable in models including factor analytically derived neurocognitive summary scores and demographics as covariates; the most heritable measure was obtained from the current GAS scores (h2 = 0.72). Neurocognition was not a significant contributor to heritability of role function. Conclusions: Commonly assessed demographic and clinical indicators of functioning are heritable with a global rating of functioning being the most heritable. Unlike several previous studies in other populations, measures of neurocognition had little impact on heritability of functioning overall.

B-73
Do MMPI-2 Content Scales Influence Measures of Auditory and Visual Memory?

Abstract

Objective: This study seeks to investigate the hypothesis that Bizarre Mentation and Fears content scales would significantly predict performance on measures of auditory memory and visual memory in an outpatient clinical setting but other scales would not. Methods: One hundred and sixty-six adults were administered the personality inventory as a part of a larger neuropsychological battery at a mental health clinic. Ages ranged from 17 to 80 years, M = 33.1, SD = 1.40 and education ranged from 8 to 20 years, M = 14.24, SD = 2.43. 75.8% of the sample was Caucasian, 10.1% Hispanic, 10.7% African American, and 44.5% men. Anxiety, Fears, Obsessiveness, Depression, Health Concerns, Bizarre Mentation, Anger, Cynicism, Antisocial Practices, Type A, Low Self-Esteem, Social Discomfort, Family Problems, Work interference, and Negative Treatment scales were used. Results: Using a p < .05 level, Bizarre Mentation (−.254), Antisocial practices (−.206), Low Self-Esteem (−.157), and Fears (−.154) were significantly correlated with auditory memory on the WMS-III. Only Bizarre Mentation (−.189) was correlated with visual memory. No other content scales showed significant correlations with memory. Conclusions: Face valid reports of cognitive disturbance symptoms are associated with poorer performance on both auditory and visual memory for outpatient populations as well as for mild head trauma populations. The results supported the usefulness of Bizarre Mentation and Fears in predicting memory, but also found unexpected correlations with Low Self-Esteem and Antisocial practices. Interpretation of how self-report of antisocial behavior and poor self-esteem relates to memory performance requires further research.

B-74
Memory Performance Contrasts Between Those With and Without Major Depressive Disorder

Abstract

Objective: The present study assessed the memory performance of individuals with and without an MDD diagnosis on semantic memory, executive functioning, processing, and a verbal comprehension. Methods: Participants included 68 clinical outpatient and 44 non-clinical adults given a neuropsychological evaluation with the average age of 31.87 and education of 14.42. Participants were 48% men, 68% Caucasian, 8% African American, and 17% Hispanic. Semantic memory performance was assessed using Logical Memory I and Logical Memory II (WMS-III). Verbal comprehension was assessed using Comprehension from the NDRT. Executive functioning was assessed using the WCST, Category, and Trails B. Processing speed was assessed using Trails A as well as Symbol Search and Digit Symbol Coding. Results: Independent t-tests revealed significant differences at a .01 level. MDD individuals performed significantly lower than controls on both Logical Memory I and Logical Memory II. There were significant differences among all three executive functioning measures where controls outperformed those with MDD. There were significant differences on all measures of processing speed. There was no significant difference on Comprehension. Conclusions: These findings suggest that adults with depression perform more poorly than adults with no psychiatric diagnoses on semantic memory tasks, executive functioning tasks, and processing speeds. These findings extend previous findings that individuals with MDD perform worse than healthy controls on rote memory tasks. Deficits in executive functioning may suggest frontal lobe impairment. Deficits in processing speed indicate either slowed motor functioning, or problems with selective attention.

B-75
Performance on Measures of Perceptual Reasoning and Processing Speed between Depressed Men and Women

Abstract

Objective: This study assessed the performance of adults on Perceptual Reasoning and Processing Speed from the WAIS-III hypothesizing elevated T-scores on Scale 2 of the MMPI-2 would be associated with poorer performance in men. Methods: The sample was comprised of 54 participants, between the ages 17 and 73 and between 8 and 19 years of education. Majority of the sample was Caucasian (77%), men (52%), and right-handed (88%). Participants were distributed into two groups according to scores on Scale 2 of the MMPI-2. One group (T > 70) had 22 participants; the other (T < 70) had 32 participants. The effect of gender and Scale 2 T-score on Full-Scale IQ, Performance IQ, Perceptual Organization Index, Processing Speed Index, Block Design, Matrix Reasoning, Picture Completion, Digit Symbol-Coding, and Symbol Search were analyzed by means of a MANCOVA, controlling for age, race, and education. Results: Only gender had a significant multivariate effect on the indexes and subtests—F(9) = 3.374, p = .004. Men performed better than women on FSIQ, PIQ, POIQ, PSIQ, Block Design, and Matrix Reasoning. Conclusions: Previous research suggests the performance of women to be less affected by depression, yet these findings do not support that claim. The severity of depression by means of elevated T-score on MMPI-2 does not impact performance on Perceptual Reasoning or Processing Speed when controlled for age, race, and education. Scale 2 is subject to interpretation, therefore, not the most accurate measure of the severity of depression. Future research should be conducted with valid established measures of depression severity.

B-76
Deficits in Functional Capacity are Associated with Psychotic Symptoms in Bipolar Disorder

Abstract

Objective: Studies indicate that individuals with schizophrenia (SZ) and bipolar disorder (BD) demonstrate deficits in functional capacity, with SZ exhibiting more severe impairment. Psychotic features in BD are associated with a number of negative outcomes, although their role in functional capacity deficits remains unclear. This study utilized the University of California, San Diego Performance-based Skills Assessment (UPSA) which allows for the assessment of functional capacity in real-world settings. We hypothesized that the presence of psychotic features in BD would be associated with greater impairment in functional capacity. Methods: Participants included 48 individuals with BD, 24 who had experienced psychotic symptoms (BD+) and 24 who had not (BD−), as well as 30 individuals with SZ and 25 healthy controls (HC). Patients were clinically stable at the time of evaluation. All participants were administered the UPSA and scores were evaluated for group differences. Results: There were significant differences in UPSA scores among groups. The SZ group performed significantly worse than the HC group on all five UPSA domains, whereas the BD+ group performed significantly worse than the HC group on the Comprehension/Planning and Transportation domains and the UPSA total score. The BD and HC groups did not differ. Conclusions: Findings indicate that psychotic features in BD are associated with greater functional impairment on performance-based measures of functional capacity. Moreover, psychotic symptoms may increase disability by negatively impacting an individual's ability to plan daily activities and use written information to navigate transit systems.

B-77
Auditory Perception Deficits Are Present in Patients with Bipolar Disorder with Psychotic Features

Abstract

Objective: Studies of schizophrenia suggest that psychotic symptoms, particularly auditory hallucinations, are associated with primary auditory cortex abnormalities. Similar auditory cortex abnormalities may also be expected for individuals with bipolar disorder with psychotic features (BP+), since auditory hallucinations are often present. The study investigated these matters by comparing a BP+ group to a BP group without psychotic features (BP−) and controls on a tone discrimination task likely to activate the auditory cortex. Methods: Participants included 46 euthymic individuals with BP (23 BP+ and 23 BP−) and 24 controls. Groups did not differ on age (M = 36.2; SD 13.1) education (M = 13.9; SD = 2.0) or IQ (M = 101.5; SD = 12.4). The tone discrimination task consisted of 120 tone pairs that differed in frequency by 0%, 5%, or 20%. Participants were instructed to indicate whether tones were the same or different. Results: Results indicated that the BP+ group performed worse (p < .05) than the other two groups only on identifying same tone pairs, suggesting the response bias. After controlling for response bias, the BP+ group performed worse on the 5% and 20% frequency difference pairs as well (p < .05). Conclusions: To our knowledge, this is the first study to investigate auditory perception abnormalities in among patients with BP+. Results indicate that on this auditory perception task, a history of psychosis is associated with auditory perception abnormalities, thus suggesting that similar to schizophrenia, frequency discrimination deficits are present in BP+. Whether a common underlying neural mechanism exists for BP+ and schizophrenia awaits further investigation.

B-78
Verbal Memory in Younger Veterans Diagnosed with PTSD: An Effort-Controlled Investigation

Abstract

Objective: Although memory problems are a frequent complaint of veterans suffering from post-traumatic stress disorder (PTSD), objective evidence of such impairment is inconclusive, particularly given that effort has not always been controlled for. The purpose of current investigation was to examine whether veterans diagnosed with PTSD and displaying adequate effort display objective evidence of verbal memory impairment. Methods: Archival data were analyzed from 51 veterans (age ≤ 45 years) diagnosed with PTSD and administered the California Verbal Learning Test-II and/or the WMS-IV Logical Memory subtest as part of a comprehensive neuropsychological evaluation. Credible Effort (n = 22) and Non-Credible Effort (n = 29) groups were classified based on performance on the Word Memory Test, Test of Memory Malingering, and/or Computerized Assessment of Response Bias. Results: The Credible Effort group performed significantly better on total list learning (p = .01), short-delay free and cued recall (p ≤ .002), long-delay free and cued recall (p = .001), and recognition hits (p < .001) on the CVLT-II. Similarly, the Credible Effort group outperformed the Non-Credible Effort group on immediate recall (p < .001), delayed recall (p = .002), and recognition trials (p = .01) of Logical Memory. Mean performance of the Credible Effort group was in the unimpaired (broadly average) range on all examined verbal memory indices. Conclusions: Findings offer preliminary evidence that the association between PTSD and memory deficits on testing is due in part to suboptimal effort. Additional findings and plans/implications for future research are discussed.

B-79
Cognitive Dysfunction as an Intermediate Phenotype of Genetic Susceptibility to Schizophrenia

Abstract

Objective: Unaffected first-degree relatives (FDR) of persons with schizophrenia (SZ) can show subtle forms of cognitive dysfunction relative to healthy adults (NC). However, SZ, FDR and NC groups often differ in terms of demographic characteristics that affect performance on test performance, potentially confounding group differences. We compared these groups after calibrating each person's test performance for his or her demographic characteristics and estimated premorbid ability. Methods: We administered 13 neuropsychological measures to 517 adults (275 NC, 162 SZ, and 80 FDR). The samples included more women than men and more whites than blacks. The participants averaged 42.3 years of age, completed a mean of 13.9 years of schooling, and produced a mean premorbid IQ of 104.3. As expected, the three groups differed all of these characteristics. Results: After adjusting for these characteristics using the Calibrated Neuropsychological Normative System (Schretlen et al., 2010), a MANOVA confirmed the overall group differences—Wilks' λ = 0.633; F(26, 1,002) = 9.918; p < .0001. Post hoc comparisons revealed that SZ patients performed more poorly than NCs on all 13 measures and more poorly than FDRs on 11 measures, but the FDR group performed more poorly than NCs on just two: the Modified Wisconsin Card Sorting Test and Category Word Fluency from the Calibrated Ideational Fluency Assessment. Conclusions: While every cognitive test distinguished persons with SZ from healthy adults, and most distinguished SZ patients from unaffected FDRs, only two measures proved to be sensitive markers of genetic susceptibility. These assess semantic word retrieval and attentional shifting, both of which represent aspects of executive functioning.

B-80
Neuropsychiatric Symptoms Following Severe Traumatic Brain Injury: Impact on Functional Outcome and Length of Stay

Abstract

Objective: To document the frequency and severity of neurobehavioral symptoms following severe traumatic brain injury (TBI) and to determine the relationship between symptoms and functional cognitive outcome and length of stay (LOS). Methods: A cohort of persons with severe TBI (n = 392) completing rehabilitation in our neurorehabiliation program over 2 years (mean age = 29.9 + 13.2; mean days injury to admission 32.6 + 25.0; mean admission Functional Independence Measure Cognitive score 13.8 + 6.8) were assessed by clinical neuropsychologists on a weekly basis using 4-point neuropsychiatric rating scale (none/mild, moderate, severe, and profound). Results: Our data revealed a very high incidence of moderate to profound agitation (53%), disinhibition (73%), and impaired initiation (87%) that exceeded rates observed by Ciurli and colleagues (2010) many months post-injury. When these symptoms were examined to determine their association with acute rehabilitation discharge FIM Cognitive total scores and LOS using regression, agitation, disinhibition, and initiation accounted for 8.3% of variance in FIM cognitive discharge score and 15.3% of variance in LOS. Conclusions: Neuropsychiatric symptoms following severe traumatic brain injury (TBI) were first described many decades ago (Symonds, 1937). Our data show that neurobehavioral symptoms are very common following severe TBI. Neuropsychiatric symptoms account for a significant amount of variance in LOS, which means these symptoms merit intervention in order to reduce LOS and healthcare costs. Implications of data are discussed.

B-81
Investigating Ganser Syndrome Using Neuropsychological Measures of Effort: A Case Study

Abstract

Objective: A 33-year-old man presented for his first inpatient psychiatric hospitalization with Ganser-like symptoms. A combination of inconsistent historical data, the guardian's declination of records, and the client's erratic behaviors led examiners to consider motivation as a contributing factor. Given this client's complex presentation, it is imperative to incorporate effort measures when considering atypical neuropsychological symptoms. This case highlights the importance of utilizing effort measures when diagnosing atypical disorders such as Ganser Syndrome, which is not yet standard practice. Methods: Immediately prior to hospitalization, the client sustained a concussion followed by a significant functional decline including a loss of expressive language, poor hygiene, odd behaviors, and an inability to state personally identifying information. He was referred for neuropsychological testing based on a history of multiple prior head injuries reported by his mother/temporary guardian. Results: A functional behavioral analysis indicated that maternal presence is negatively correlated with his display of maladaptive behavior. Neuropsychological testing with explicit and embedded effort measures revealed inconsistent effort on every measure administered with many measures “below chance.” The client's level of impairment was difficult to reconcile with his professional and academic success as a civil engineer and negative head CT scans. The client's report of impaired memory, personal identity loss, unexplainable medical complaints, and inability to perform simple tasks lead the clinician's to consider a diagnosis of Ganser Synrome. Conclusions: This case demonstrates that Ganser-like symptoms and atypical neuropsychological presentations warrant close scrutiny with measures of effort and motivation.

B-82
Evidence for a Cogniform Disorder Subtype: An Examination of Cognitive Symptoms in Medical Patients

Abstract

Objective: Patients with somatoform disorders, who present with excessive physical and medical symptoms, may also present with excessive cognitive complaints. Recently, a subtype of somatoform disorder related to cognitive symptoms was proposed (Delis & Wetter, 2007). We examined the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Cognitive Complaints (COG) scale in individuals referred for screening due to cognitive concerns related to a medical condition. We expected the COG scale would be related to other physical symptoms report scales, as well as personality characteristics consistent with somatoform disorders. We also examined the relationship of the COG scale with neuropsychological performance. Methods: Participants were 25 community-dwelling individuals (19 women), on average 44 years of age, with a mean educational level of 14 years, who reported cognitive concerns. Disorders for which individuals were referred included hypothyroidism, hypertension, and arthritis. All participants received a neuropsychological screening evaluation, and the MMPI-2-RF was also completed as a part of this larger battery. All participants were provided feedback on their performance on the cognitive measures. Results: Of the sample, 68% showed clinical elevations on COG. High scores on COG were related to elevations on validity and clinical MMPI-2-RF scales, the Response Bias Scale, and other somatization scales. COG was unrelated to cognitive performance and an effort measure (Word Memory Test). Conclusions: Overall, results provide some validity for the cognifirm disorder subtype of somatoform disorders. Elevated self-reported cognitive symptoms were related to high physical symptoms and to personality variables associated with somatoform disorder.

B-83
Selective Impairments in Recognizing Emotions Are Present in Bipolar Disorder with Psychotic Features

Abstract

Objective: It has been demonstrated that some euthymic patients with bipolar disorder (BD) perform worse than normal controls on emotional recognition tasks. The presence of psychotic symptoms has been associated with emotion recognition impairments in psychiatric populations. The current study investigated whether patients with BD and psychotic features (BD+) have greater difficulty identifying specific emotions when compared with those without psychotic features (BD−) and normal controls. Methods: Seventy-two individuals (24 BD + , 24 BD − , and 24 healthy controls) were administered the Bell–Lysaker Emotion Recognition Task, in which they were prompted to watch a series of short video vignettes portraying different emotions (happiness, sadness, anger, surprise, disgust, fear, and neutral) and then identify the primary emotion exhibited by the actor. Mean age of the sample was 35.9 years (SD = 13.1) and 37.5% were men. Results: There were significant differences in performance among groups for the seven emotions. Compared with the NC group, the BD+ group had more errors for sadness, anger, surprise, and fear, and was more likely to mistake anger for happiness, surprise for neutral, and fear for anger and neutral. There were no differences between the BD− group and the NC group. Conclusions: These findings indicate that patients with BD+ have difficulty identifying certain primary emotions compared with controls. Patients with BD+ were also more likely to mistake certain emotions for others in a consistent pattern. These findings suggest that a history of psychotic features in BD may lead to unique impairments in emotion recognition that are spared when there is no such history.

B-84
Defeatist Performance Beliefs Predict Neuropsychological Impairment, Functional Outcome, and Negative Symptoms in Schizophrenia

Abstract

Objective: It is well-documented that individuals with schizophrenia display significant deficits in social and vocational outcomes. Neuropsychological impairment and negative symptoms (e.g., anhedonia, avolition, and apathy) have been shown to be important predictors of functional outcome deficits. In the current study, we examined whether psychological factors, such as defeatist performance beliefs, predict the associations between neuropsychological impairment, functional outcome, and negative symptoms in individuals with schizophrenia. Methods: Participants included 71 outpatients with schizophrenia and 46 controls who completed the Defeatist Performance Belief Scale, measures of functional outcome and negative symptoms, and a neuropsychological test battery with assessments for the domains of processing speed, attention/vigilance, problem-solving, verbal and visual memory, working memory, executive function, and social cognition. Results: Patients endorsed significantly more defeatist performance beliefs than controls, and these beliefs were associated with poor vocational and social outcome, higher negative symptom severity, and greater neuropsychological impairment. Path analyses suggest that the magnitude of a patient's defeatist performance beliefs predicts the strength of relationship between neuropsychological impairment and measures of negative symptoms and functional outcome. Conclusions: These findings suggest that psychological factors may play an important role in determining a patient's neuropsychological status and community-based functioning and have implications for psychosocial treatment and cognitive remediation.

B-85
Abstract Conceptual Learning Scores Predict Performance on a Film-Based Social Perspective-Taking Task in Schizophrenia

Abstract

Objective: To determine whether higher-level conceptual reasoning on the Wisconsin Card Sort Test (WCST) predicts performance on a novel social reasoning task, the Movies Clip Task (MCT). Higher-level conceptual reasoning (Conceptual Level Response) on the WCST will predict performance on the MCT among individuals with SZ and healthy (non-psychiatric) control subjects. Methods: Participants: Adults (aged 18–60) who met diagnostic criteria for current DSM-IV schizophrenia and schizoaffective disorder (n = 33) and an age- and sex-matched sample of healthy (non-psychiatric) control subjects (n = 26) with IQ > 80 and free from neurologic or medical disorder were recruited by advertisement to participate in a laboratory-based study of social cognition conducted at the VA Pittsburgh Healthcare System and a clinical setting at the University of Pittsburgh Medical Center. Measures/variables: Structured Clinical Interview for DSM-IV (SCID) diagnosis, IQ (Peabody Picture Vocabulary Test), Conceptual Learning (WCST), MCT—a novel film-based perspective-taking task developed to assess inferential reasoning skills across social cognitive domains using interpersonal scenes to engage both affective and non-affective cognitive processing. Results: Conceptual level response scores predicted MCT scores for schizophrenia (r = .46, p < .01) but not for healthy control subjects (NS). Conclusions: Deficits in abstract conceptual learning (on the WCST) appear to predict deficits in inferential social reasoning in schizophrenia.

B-86
The Neuropsychological Performance in Refractory Major Depression and Non- Refractory Major Depression

Abstract

Objective: Refractory Major Depression is characterized by two failed courses, from different classes, of anti-depressant medication. The association between RD and neuropsychological impairment is not well-understood. This study investigated the neuropsychological differences between patients with refractory depression (RD) and non-refractory depression (NRD). Methods: RD participants (n = 25) and NRD participants (n = 47) were recruited at Stanford University from two separate studies. Participants were administered a battery of neuropsychological measures including the CVLT-2, WMS-III: Logical Memory (LM), Trail-Making Test: Parts A and B, Stroop Color Word test, Controlled Oral Word Association Test, Digit Span and Letter-Number Sequence Test. ANOVAs examined neuropsychological performance differences between depressed groups, with depression type as the between-subjects factor and testing performance scores as the dependent variables. Age, education and depression severity were covariates. Results: For the LM test of the WMS-III, performances were significantly different between groups for immediate recall (p = .03), for recognition (p < .03), and trending for delayed recall (p = .07). Surprisingly, the RD group performed better on all LM trials. There were no group differences on any other neuropsychological measure, with exception of the Stroop Word trial (p < .05). Conclusions: On most tasks of cognition, refractory depressed patients performed similar to non-refractory depressed patients. One exception was on the logical memory task. One possible explanation is the prose of the LM task provided the RD group meaning and context, contributing to better memory facilitation. However, it remains unclear why the refractory group would differentially respond to cuing. Future investigations are needed to see if these findings are replicable.

B-87
Relations between Memory Abilities and Premorbid Adjustment Abnormalities in Patients with Schizophrenia

Abstract

Objective: The Premorbid Adjustment Scale (PAS) has been used extensively to evaluate social and academic functioning prior to onset of schizophrenia and is sensitive to behavioral disturbances reflecting neurodevelopmental abnormalities. The aim of this study was to examine deficits in premorbid functioning as precursors to neuropsychogical deficits in adulthood. Methods: The sample consisted of 421 individuals (136 women) who met DSM criteria for schizophrenia (n = 382) or schizoaffective disorder (n = 39). Participants were 37.2 years old, with an age of onset of 24.6 years. All participants were assessed with the PAS, which evaluates premorbid adjustment in childhood, early adolescence, and late adolescence in five domains: sociability and withdrawal, peer relationships, scholastic performance, adaption to school, and social-sexual functioning. A subsample of these individuals (n = 205) were also administered the Repeatable Battery for the Assessment Neuropsychological Status (RBANS). Results: Principal components analysis indicated that, consistent with prior research, two PAS factors were present; one that assessed academic functioning and another that assessed social functioning. This factor structure was invariant across the three PAS developmental levels. Correlations between PAS factor scores and RBANS variables indicated significant negative relationships between academic and social functioning in early and late adolescence and RBANS delayed memory scores, although these correlations were small. Conclusions: Results indicate that associations among PAS domains remain stable from childhood through late adolescence. Early academic and social functioning is associated with performance on memory measures following onset of the disorder, although PAS scores appear to account for a relatively small amount of the variance in later memory test scores.

B-88
Measuring Social Behavior Differences on the AIPSS Between Bipolar Disorder With and Without Psychotic Features

Abstract

Objective: Individuals with bipolar disorder (BD) exhibit impairments in social behavior. Psychotic symptoms also have been shown to impair social functioning. Given that some individuals with BD exhibit psychotic features, they may therefore exhibit additional deficits in social behavior. To investigate this, the current study compares patients with BD with (BD+) and without (BD−) a history of psychotic features to patients with schizophrenia (SZ) and normal controls on the Assessment of Interpersonal Problem-Solving Skills (AIPSS), a performance-based measure of social functioning. Methods: Ninety-six individuals completed the AIPSS, including 24 with BD + , 24 with BD − , 24 with SZ, and 24 healthy controls (HCs). Mean age of the sample was 38.5 years (SD = 13.4) and 42.7% were men. The AIPSS consists of a series of video vignettes that portray actors interacting in social situations around a particular problem (e.g., inappropriate request). Participants are instructed to identify if there is a problem (Identification), describe the problem (Description), describe a solution (Processing), and role-play a proper solution to the problem (Sending). Results: The SZ group performed significantly poorer on the Description, Processing, and Sending scores compared with the BD groups, while the BD groups performed significantly poorer on the Description score compared with the HC group. The BD+ group also performed poorer on the Sending score compared with the HC group. Conclusions: Patients with BD appear to exhibit selective deficits in social problem-solving, which is consistent with studies examining theory of mind impairments in this population. Furthermore, patients with BD+ appear poorer at role-playing proper social behaviors.

B-89
Utility of the Test of Premorbid Functioning in a Mixed Clinical Sample

Abstract

Objective: The Test of Premorbid Functioning (TOPF) is the new measure of estimated premorbid intelligence for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). The standardization study provides useful information about the validity of this measure; however, findings have not been replicated. Methods: A mixed clinical sample of 83 veterans (96% men) with an average age of 55.7 years (SD = 13.5) and average education of 12.7 years (SD = 2.5) was administered the TOPF as part of a neuropsychological evaluation. Participants were placed into three diagnostic groups: Dementia (n = 19), Cognitive Disorder (n = 36), and No Impairment (NI; n = 28). Pearson's r was used to examine relationships between TOPF, WAIS-IV, and other neuropsychological measures. A one-way ANOVA was conducted to examine group differences in TOPF minus WAIS-IV FSIQ (i.e., difference) scores. Results: The TOPF exhibited significant correlations with WAIS-IV indices (r ranged from .21 to .81) in all three groups. The Cognitive Disorder group exhibited significant correlations between TOPF and phonemic fluency (r = .51), mental flexibility (r = .40), verbal learning (r = .38), and confrontation naming (r = .35), while there were no significant correlations observed in either the Dementia or NI groups. The Dementia group showed a larger average difference score (14.7) than both Cognitive Disorder (7.2) and NI groups (3.8), which did not differ significantly from each other. Conclusions: In a mixed clinical sample, the TOPF demonstrated good convergent validity and adequate divergent validity. The difference score differentiated the Dementia group from the Cognitive Disorder and NI groups, further establishing its construct validity as a measure of estimated premorbid intelligence.

B-90
Cold Pressor Pain Leads to Slight Reduction in CVLT-2 Performance

Abstract

Objective: Examines whether cold-pressor induced pain causes impaired CVLT-2 performance in healthy volunteers. Inconsistent findings from past research suggest that pain may cause impairment, but little research has examined standard neuropsychological instruments. This study allows for an estimate of the degree to which pain, separate from confounds associated with chronic pain samples, may affect CVLT-2 performance. Methods: Study 1: A between-groups study compared participants with (n = 21) and without (n = 24) induced pain during CVLT-2 administration. Study 2 compared normally administered CVLT-2 performance with subsequent CVLT-2 Alternate Form performance during induced pain (n = 18); the control group (n = 19) took the second CVLT-2 version during non-painful warm water immersion. Results: In Study 1, the scores of the pain group were non-significantly worse than controls for nearly every variable (Trials 1–5 Correct, SDFR, SDCR, Repetitions, Intrusions); only List B performance was significantly worse (mean = 5.1 pain, 6.4 control, p = .005). In Study 2, scores during pain were non-significantly worse than during standard administration for most variables, reaching significance for Trial 1 (6.9 vs. 5.4 words), Trial 2 (9.5 vs. 8.0), and Short-Delay Cued Recall (11.8 vs. 10.3). Conclusions: CVLT-2 performance during pain induction was slightly, and mostly non-significantly, lower on nearly all variables. Results suggest that pain slightly reduces CVLT-2 learning and memory performance, but also that significant impairment should not be expected as a result of pain per se. Generalizability of results to chronic pain patients may be limited.

C-1
A New Model of Neurodevelopmental Assessment for Clinical Research Protocols: Improving Access, Feasibility and Quality

Abstract

Objective: To increase access and feasibility of neurodevelopmental assessments for clinical research projects in a pediatric University-affiliated tertiary care hospital, while ensuring quality and compliance. Further, to measure sustainability and raise awareness throughout the institution of the role of neuropsychology in research. Methods: Led by the Director of Neuropsychology, a segregated core service (NDRC) with dedicated resources was developed. Tests are administered by psychometrists, under the supervision of a clinical neuropsychologist. Standard operating procedures were approved by the local IRB. Marketing activities included presentations at departmental meetings, tabling at research-based events, participation in research-based committees and adding the NDRC to regulatory applications. Study volume, number of departments, allocated time and number of contacts to schedule an assessment were compared between the pre-program period (12 months) and NDRC initiation to date (8 months). Results: Both active and pending study volumes increased significantly between the pre-program period (n = 6) and the NDRC (n = 22; p < .001). Protocols originated from four departments during the pre-program period and more than doubled to 10 departments under the NDRC.There was no time allocated for a neuropsychologist to supervise research testing during the pre-program period, but 10% was set aside under the NDRC. The average number of contacts to schedule a single visit significantly decreased between the pre-program period (M = 4.5 [1.76]) and under the NDRC (M = 1.54 [1.39], p < .001). Conclusions: In a short period, this new model has proved to be both feasible and sustainable, while broadening the inclusion of neuropsychological assessment in research protocols throughout the institution.

C-2
Validity of Videoconference-based Assessment in American Indian Elders

Abstract

Objective: Preliminary research suggests videoconference-based neuropsychological assessment to be a valid and reliable method for remotely evaluating cognitive impairment. However, little is known about the validity of teleneuropsychology in cultural and ethnic minority (CEM) groups. The purpose of this investigation was to demonstrate the comparability of neuropsychological test results from older American Indians with and without dementia tested via videoconference and in-person. Methods: Fifty-five American Indian controls (mean[SD] age = 62.7 [8.5], education = 13.0 [2.2], 73% women, GDS-15 1.4 [1.8]) and 23 with dementia (mean [SD] age = 72.2 [9.5], education = 11.7 [2.8], 48% women, GDS-15 2.0 [1.9]) were administered the MMSE, Digit Span Forward and Backward, Hopkins Verbal Learning Test-Revised (HVLT-R), letter and category fluency, and an abbreviated Boston Naming Test (BNT-15) in-person and via videoconference. Testing modality and test forms were counterbalanced, and groups were determined by independent a priori diagnosis. ANCOVAs were performed on raw scores using age, education, gender, and depression scores as covariates. Results: All subjects completed both in-person and videoconference-based testing. Means for all tests across modalities were similar. Scores on MMSE, HVLT-R total, HVLT-R recall, letter fluency, category fluency, and BNT-15 were significantly different (p < .05) between control and dementia groups in both testing conditions. Digit Span Forward and Backward scores did not distinguish the groups in either testing modality (Tables 1 and 2). Conclusions: Videoconference-based assessment distinguished cognitively intact and impaired American Indians as effectively as traditional in-person testing. These findings lend further support for the utility of teleneuropsychology to assess dementia in CEM groups.

Table 1.

In-person ANCOVA results

Measure Control
 
Dementia
 
p-value 
Mean SD Mean SD 
MMSE Total* 28.636 1.128 25.348 3.214 .000 
Digit Span Forward 6.036 1.261 5.565 1.619 .424 
Digit Span Backward 4.473 1.069 3.870 1.217 .268 
HVLT-R Total* 24.473 4.537 16.261 6.390 .000 
HVLT-R Delay* 8.418 3.017 4.087 3.988 .002 
Letter Fluency* 35.673 11.840 24 091 12.417 .010 
Category Fluency* 18.018 4.170 12.652 4.579 .001 
BNT-15 Total* 13.618 1.459 11.261 2.958 .000 
Measure Control
 
Dementia
 
p-value 
Mean SD Mean SD 
MMSE Total* 28.636 1.128 25.348 3.214 .000 
Digit Span Forward 6.036 1.261 5.565 1.619 .424 
Digit Span Backward 4.473 1.069 3.870 1.217 .268 
HVLT-R Total* 24.473 4.537 16.261 6.390 .000 
HVLT-R Delay* 8.418 3.017 4.087 3.988 .002 
Letter Fluency* 35.673 11.840 24 091 12.417 .010 
Category Fluency* 18.018 4.170 12.652 4.579 .001 
BNT-15 Total* 13.618 1.459 11.261 2.958 .000 

Data presented as raw scores.

*p < .05.

Table 2.

Teleneuropsychology ANCOVA results

Measure Control
 
Dementia
 
p-value 
Mean SD Mean SD 
MMSE Total* 28.537 1.255 25 000 3.542 .000 
Digit Span Forward 5.673 1.233 5.217 1.476 .364 
Digit Span Backward 4.345 1.022 4.087 1.164 .832 
HVLT-R Total* 25.055 5.122 17.870 6.798 .005 
HVLT-R Delay* 9.036 1.972 4.261 3.922 .000 
Letter Fluency* 35.855 12.316 23.696 11.064 .007 
Category Fluency* 16.964 4.060 12 000 4.563 .012 
BNT-15 Total* 13.182 1.657 10.609 3.615 .002 
Measure Control
 
Dementia
 
p-value 
Mean SD Mean SD 
MMSE Total* 28.537 1.255 25 000 3.542 .000 
Digit Span Forward 5.673 1.233 5.217 1.476 .364 
Digit Span Backward 4.345 1.022 4.087 1.164 .832 
HVLT-R Total* 25.055 5.122 17.870 6.798 .005 
HVLT-R Delay* 9.036 1.972 4.261 3.922 .000 
Letter Fluency* 35.855 12.316 23.696 11.064 .007 
Category Fluency* 16.964 4.060 12 000 4.563 .012 
BNT-15 Total* 13.182 1.657 10.609 3.615 .002 

Data presented as raw scores.

*p < 0.05.

C-3
Normative Performance on the RBANS in a Multi-Ethnic Bilingual Cohort: The Texas Mexican American Normative Studies

Abstract

Objective: The use of neuropsychological testing among culturally diverse individuals is becoming more common. Most neuropsychological assessments are normed using individuals of non-Hispanic White racial affiliation and little to no normative data exist for culturally diverse groups. The Texas Mexican American Normative Studies (TMANS) was undertaken to fill this gap by combining data across multiple studies. The current study sought to establish reference group norms for this sample. Methods: Data were analyzed from a sample of 182 English-speaking (n = 95) and Spanish-speaking (n = 87) Mexican Americans (137 women and 45 men) recruited as part of Project FRONTIER, an ongoing epidemiological study of health among rural-dwelling individuals. Approximately half of the Mexican-American sample reported having greater mastery of Spanish (n = 87) than English (n = 95). Education level was 8.1 ± 3.8 (range = 0–18) and age was 53.2 ± 8.8 (range = 40–79). Our analyses were consistent with other normative projects. Data were grouped into overlapping midpoint ranges at 5-year intervals for midpoint age ranges of 45–79. The age range around each midpoint was 10 years. Results: Normative tables were created for English- and Spanish-speaking Mexican Americans on The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which is a brief, general assessment of neuropsychological functioning. Conclusions: The Mexican American population is the largest ethnically diverse group in the USA; however, there is a shortage of normative neuropsychological data on this population. The normative tables, although preliminary, provide neuropsychologists with a useful resource in assessing Mexican Americans.10

TMAMS scaled scores
 
Midpoint age :55 (age range 50–60, n = 47) English
 
ss LL SM FC LO PN SF DS Co LR Lreg 5R FR 
— — — — — — — — — — — — <1 
— — — — — — — — — — — — 
0–15  0–8 — — 0–11 — 0–25 0–2 — 0–2 — 
16–17 0–6 — — 0–8 12 0–5 26–27 — — — 0–4 3–5 
18–19 0–11 — 13 — 28 — — 6–10 
20–22 8–9 10 12 — 14–15 29–37 0–9 4–5 11–18 
23 10–12 11 13 16 — 38–41 — — 19–28 
24–25 13–14 12 14 — 17–13 42–44 — 7–8 29–40 
10 26–27 15 13–14 15 — 19 8–9 45–48 — 9–10 41–59 
11 28–29 16–17 15 16–17 — 20 — 49–51 — 11 60–71 
12 30 18 16 18 — 21 10 52–53 — — 12 72–81 
13 31 19 17 — — 22–23 11–13 54–58 10–16 10 13–14 82–89 
14 32 — IS 19 — 24–25 14 59–60 — 17–19 — 15 90–94 
15 33–34 20  — — 26 15 61 — — 11 16–17 95–97 
16 — 21 — — — 27 — 62 — — — — 98 
17    — — — — — — — — — 99 
18 >35 >22 >19 >20 >10 >28 >16 >63 >10 >20 >12 >18 >99 
TMAMS scaled scores
 
Midpoint age :55 (age range 50–60, n = 47) English
 
ss LL SM FC LO PN SF DS Co LR Lreg 5R FR 
— — — — — — — — — — — — <1 
— — — — — — — — — — — — 
0–15  0–8 — — 0–11 — 0–25 0–2 — 0–2 — 
16–17 0–6 — — 0–8 12 0–5 26–27 — — — 0–4 3–5 
18–19 0–11 — 13 — 28 — — 6–10 
20–22 8–9 10 12 — 14–15 29–37 0–9 4–5 11–18 
23 10–12 11 13 16 — 38–41 — — 19–28 
24–25 13–14 12 14 — 17–13 42–44 — 7–8 29–40 
10 26–27 15 13–14 15 — 19 8–9 45–48 — 9–10 41–59 
11 28–29 16–17 15 16–17 — 20 — 49–51 — 11 60–71 
12 30 18 16 18 — 21 10 52–53 — — 12 72–81 
13 31 19 17 — — 22–23 11–13 54–58 10–16 10 13–14 82–89 
14 32 — IS 19 — 24–25 14 59–60 — 17–19 — 15 90–94 
15 33–34 20  — — 26 15 61 — — 11 16–17 95–97 
16 — 21 — — — 27 — 62 — — — — 98 
17    — — — — — — — — — 99 
18 >35 >22 >19 >20 >10 >28 >16 >63 >10 >20 >12 >18 >99 

C-4
Training Disparities in Neuropsychology: Results of the National Academy of Neuropsychology (NAN) Culture and Diversity Committee Survey

Abstract

Objective: The diversity of backgrounds among trainees in clinical neuropsychology has been understudied. We conducted a needs assessment with the hypothesis that trainees of diverse backgrounds would report more interest in training and mentoring opportunities than those of majority backgrounds. Methods: A 50-item Survey Monkey questionnaire aimed toward students and early career professionals was distributed via professional neuropsychology list serves. Questions addressed professional background, demographics, and perceived impact of diversity on training. χ2 analyses were conducted to analyze majority versus racial/ethnic minority group differences. Results: Of 193 respondents, 27% identified as racial/ethnic minorities. While 61% of respondents were members of NAN, 58% had never attended a NAN conference. Minorities made up a smaller proportion of new members and were more likely to cite cost and lack of familiarity as principle reasons for not joining. Majority students tended to be more in-the-know regarding accommodations offered to volunteers (p = .08). Majority students cited a mentor's recommendation as a reason for joining significantly more than minorities (p = .002), while networking with other students tended to be more important to minority students (p = .051). Seeking specialty board certification in clinical neuropsychology was a significantly less common goal for minorities (p = .026). Conclusions: Within the minority group, cost is a greater barrier to conference participation; they are less likely to be aware of training opportunities and less likely to aspire to board certification. Mentoring was an important motivator for joining professional neuropsychology organizations and, regardless of background, respondents indicated that a peer-mentoring program would be useful.

C-5
The Relationship between English Proficiency and Verbal Abilities in a Spanish/English Bilingual Sample

Abstract

Objective: The goal of this study is to examine the relationship between self-reported language proficiency, the Bilingual Verbal Ability Test (BVAT), and the Spanish/English bilingual's performance on a categorical fluency and a verbal learning task. Methods: Participants were 22 bilingual adults, ranging in age from 18 to 48 (M = 28.82, SD = 7.43). Seventeen participants were women and 5 were men. The average education level of the sample was 16.29 (SD = 1.89). Participants were administered the Bilingual Verbal Ability Test in English and Spanish as well as the Categorical Fluency and Verbal Learning subtests from the Nova Multilingual Neuropsychological Battery in English. Results: Pearson's correlation analyses revealed a significant correlation between participants' self-report of English proficiency and performance on the Categorical Fluency, r(22) = .606, p = .003. Significant correlation was also found between English proficiency as assessed by the BVAT and the performance on the Categorical Fluency, r(22) = .630, p = .002. There was a non-significant correlation between self-report of English proficiency and the BVAT r(22) = .337. Conclusions: Results from this study indicate that both self-reported English proficiency and standardized assessment of English language proficiency have a moderate and positive relationship with the Categorical Fluency subtest. These results further suggest that the acquisition and retention of verbal information may not be a function of language proficiency. English language proficiency measures appear to be useful in predicting performance on English verbal tasks, and hence may aid neuropsychologist in determining the language of administration that will elicit the best performance on neuropsychological test when assessing bilingual individuals.

C-6
The Effect of Language of Administration on Verbal Tasks with a Bilingual Sample

Abstract

Objective: The purpose of this study is to examine the performance of Spanish/English bilingual adults on Spanish and English verbal tasks. Methods: Data were collected from volunteers who participated in the Nova Multilingual Neuropsychological Battery Study (NMNB). The sample included 22 Spanish/English bilinguals, with a mean age of 29.05 (SD = 7.54) with education of 16.26 (SD = 1.93). Sixteen were women. Thirty-six percent rated their English abilities as strong and 41% rated their Spanish abilities as strong. Participants were evaluated on Semantic Memory, Semantic Memory Delay, Categorical Fluency, Verbal Learning, Verbal Learning Delay, Oral Word Recognition, Oral Word Recognition Delay, and Vocabulary. Results: Paired samples t-test analysis revealed significant differences between the Spanish and English administration of the Oral Word Delay Recognition subtest, t(21) = 2.434, p = .024. Participants obtained higher scores on the English version (M = 19.05, SD = .95) than the Spanish version (M = 18.55, SD = 1.01). No other significant differences were observed. Conclusions: Results from this study suggest that English/Spanish bilinguals performed better in English on measures of verbal memory recognition than in Spanish. There were no significant differences on the other verbal subtests, which ratifies the idea that the NMNB appears to be unaffected by cultural differences. Thus, performance on verbal tasks including verbal memory and verbal fluency in English and Spanish appear to be impervious to language of administration. These results indicate that bilinguals from this sample did not lose proficiency on their language of origin. However, it must be remembered that most neuropsychological batteries currently used are influenced by acculturation.

C-7
Adaptation and Norming of the Boston Naming Test for Spanish-Speaking Older Adults in the USA

Abstract

Objective: The Boston Naming Test (BNT) is one of the most common measures of confrontational naming. Although several linguistic translations and scoring modifications have been proposed, currently no version of the BNT includes alternative responses with corresponding normative data appropriate for Spanish-speaking older adults in the U.S. Objectives of this study were to compare classification accuracy of the extant BNT norms, provide normative data for this sample, present alternative linguistic responses, and examine the sequence of stimuli presentation. Methods: One hundred and fifty-two primarily Spanish-speaking, cognitively-intact volunteers between ages 50 and 80, with 6–18 years of education, from 14 Spanish-speaking countries, who had resided in the USA for ∼20 years, were administered the BNT. Results: Age comparable groups were stratified by level of education (basic education [BE] = 6–12; college education [CE] = 13+). In comparison with Heaton and colleagues (2004) normative data, 29% of the BE group scored within the borderline impaired range and 9% scored within the deficient range. Thirty-two percent and 28% of the CE group scored within the borderline and deficient ranges, respectively. Clinical classifications improved when alternate words were accepted as correct responses. Normative data, with alternate word suggestions and stimuli order, will be presented. Conclusions: Findings suggest that the current BNT norms are inappropriate for use with this population. Results support the inclusion of several correct alternative responses and adaptation in item presentation which may improve neurodiagnostic accuracy.

C-8
A Qualitative and Quantitative Comparison of the English, Mexican, Puerto Rican, and Spaniard Versions of the Wechsler Adult Intelligence Scale Third Edition

Abstract

Objective: The present study involved a qualitative and quantitative comparison of the English, Mexican, Puerto Rican, and Spaniard versions of the Wechsler Adult Intelligence Scale–Third Edition. The purpose was to identify similarities and dissimilarities across the four versions of the WAIS-III, and how scores differ across them given the same raw scores. Methods: A qualitative comparison across the four versions was conducted within the following domains: structure, standardization procedure, concept of items, order of items, item responses, teaching items, confidence intervals, range of scale, Index, and IQ scores. A total of 192 WAIS-III profiles, consisting of raw scores for each subtest, were used to determine the effects of test version on scores. Results: Though the four versions appear to be superficially the same, results show that they are different across analyses. The quantitative comparison determined that even though the same raw scores were used to compute the four indices and three IQs, the Spanish translations of the WAIS-III tend to overestimate scores. Conclusions: The different Spanish versions of the WAIS-III, though standardized in Mexico, Puerto Rico, and Spain, are currently used with Spanish-speakers of different origins. As available literature regarding these tests is limited and because these tests are continually used for decision-making purposes, the present study is the first to qualitatively and quantitatively compare the three Spanish versions with the English version.

C-9
Language Preference and Performance on the Demsky-Golden Interference Task

Abstract

Objective: The goal of this study is to examine the relationship between language preference and performance on an interference task in a sample of Spanish/English bilinguals. Methods: Data were collected from volunteers who participated in the Nova Multilingual Neuropsychological Battery Study. The sample included 22 Spanish/English bilinguals, with a mean age of 28.02 (SD = 7.43). The average education level of the sample was 16.29 (SD = 1.89). Seventeen participants were women. Sixty-four percent of the participants reported Spanish as their preferred language. Participants rated their proficiency in Spanish as strong (40.9%) and above average (31.8%). Participants reported their proficiency in English as above average (36.4%) and as strong (36.4%). Participants were tested in English and Spanish on the Demsky-Golden Interference Task. This is a Stroop test like task. Results: A paired samples t-test analysis revealed no significant difference in the performance on both versions of the task, t(20) = 1.643, p = .116. There was a significant correlation between language preference and performance on the Spanish version of the interference task, r(22) = − .436, p = .048. Conclusions: Previous studies have reported that bilingualism confers an important cognitive benefit that leads to better performance on executive function tasks in comparison with English monolinguals. Results indicate that there was a moderate, negative correlation between language preference and performance on the Spanish version of the task. These results may suggest that the ability to inhibit a response that interferes with the demands of a task may not be a function of language preferences or how adept individuals consider themselves speaking a language.

C-10
Self-Report Versus Objective Findings of Relative Language Proficiency in Spanish-English Bilinguals

Abstract

Objective: To compare objective performance and self-report of the ability to understand written and spoken language in English and Spanish bilinguals. Methods: Participants (n = 75; age = 46.3 ± 14.8; education = 14.3 ±2.7) self-rated their proficiency in reading and auditory comprehension in both languages. They completed the Reading Fluency/Fluidez en la Lectura (RF) and Oral Comprehension/Comprensión Oral (OC) subtests from the Woodcock–Johnson III Tests of Achievement (WJ-III ACH)/Batería III Muñoz Pruebas de Aprovechamiento (Batería III). Relative Proficiency Index (RPI) scores from the WJ-III ACH subtests were compared with their self-report. The RPI indicates an individual's level of proficiency on comparable tasks that typical age- or grade-peers would perform with 90% proficiency. Results: Significant correlations were found between reading comprehension self-report in the corresponding language and RF and OC RPI—r(66) = − .393, p = .001; r(67) = − .311, p = .010; r(65) = − .643, p = .001; r(64) = − .723, p = .001, respectively—and auditory comprehension self-report and RF and OC-English version's RPI—r(65) = − .639, p = .001; r(64) = − .699, p < .001, respectively. Paired t-tests showed significant differences in English and Spanish in the RF, t(65) = − 8.596, p < .001, and OC subtests, t(64) = − 9.829, p < .001. Conclusions: Comprehension of written or spoken language was weakly correlated with self-report of Spanish proficiency and moderately correlated with self-report of English proficiency. Despite reporting proficiency in both languages, participants' performance was average on the Spanish subtests and below average on the English version. Results highlight the importance of both objective testing and self-report in determining actual language proficiency prior to conducting neuropsychological evaluations with bilinguals.

C-11
Comparability of the Computerized Halstead Category Test (HCT-CV) with the Original “Gray-box” Version

Abstract

Objective: To determine the comparability of the computerized Halstead Category Test (HCT-CV) with the original Category Test. In particular, the relationship of the HCT-CV with other subtests from the Halstead–Reitan Battery (HRB) was examined to determine if its inter-relationships were the same as those obtained with the original gray box version.

Methods: Fifty adults were evaluated clinically in an outpatient setting (mean age = 64.2 years [SD = 15.4]; mean education = 15.1 years [2.8]). Twenty-five patients were tested with the HCT-CV, and 25 patients, tested with the gray box, were selected, matched on a pairwise basis, on medical diagnosis, age, and education. T-test comparisons were made on subtest and total scores. Pearson's correlations were computed for the respective Category Test and each HRB subtest. Results: The groups did not differ in terms of age, education, gender, or IQ. There were no significant group differences on any of the HRB subtests. The correlations between the respective Category score and each score from the HRB were found to be statistically comparable between groups. Further, there were no differences between groups on any of the Category subtest scores. Conclusions: Within this patient population, the HCT-CV appears to be comparable with the original Halstead Category Test. Not only were the Category total score and subtest scores comparable between groups, but the HCT-CV was also found to inter-relate with the other HRB measures in a way that is comparable with the relationships found with the original gray-box version.

C-12
Creation of Subscales on the Neuropsychological Symptom Scale: A Comparison of Classical Test Theory and Item Response Theory Approaches

Abstract

Objective: The Neuropsychological Symptom Scale (NSS; Dean, 2010) is an electronic self-report measure of neurological and psychiatric symptoms. The NSS has three primary factors related to emotional, cognitive, and somatosensory functioning (Lutz, 2012). Using these factors as the basis for scales, Classical Test Theory (CTT) and Item Response Theory (IRT) approaches were applied to each scale to compare the two methods and offer recommendations for calculating standard scores on the NSS. Methods: The sample consisted of 1,134 adult volunteers who were recruited via e-mail. Participant ages ranged from 17 to 76 (x = 29.05, SD = 14.6). Previous medical and psychiatric diagnoses were reported by 18.2% and 18.3% of participants, respectively. Results: Although there was no clinically meaningful difference between average scores calculated using CTT versus IRT, the use of IRT produced marked differences in individual scores. For instance, a scaled score of 105 (63rd percentile) calculated using CTT was obtained by respondents with a raw score of 102 on Scale 1, regardless of the individual items they endorsed. Depending, however, on the items endorsed, raw scores of 102 produced scaled scores ranging from 98 to 115 (44th to 84th percentiles) when scores were calculated using IRT. Conclusions: Use of IRT appears to capture information that is missed when using CTT to derive scores. The principles of IRT suggest that these differences in scores are due to the fact that item responses are weighted according to the extent to which they are related to the latent variable of interest. Recommendations for scoring and further developing the NSS will be discussed.

C-13
Attention Span and Working Memory in Serial Digit Learning 9

Abstract

Objective: The factorial relationships among attention span, working memory (WAIS-III Digit Span-forward [DSP-F], Arithmetic [ARI], and Letter Number Sequencing [LNS]), use of the semantic clustering strategy on the California Verbal Learning Test (CVLT), and performance on the initial, middle, and final trials of Serial Digit Learning Test-9 (SDL-9) were explored. Methods: A three-factor model was derived for the 12 SDL-9 trials; it represented initial, middle, and final trial subgroups. A two-factor model was derived that differentiated DSP-F from LNS and ARI. The CVLT semantic clustering score and a previously derived factor scale that modeled the middle trials of the CVLT learning trial series were included in the subsequent analyses. Results: It was found that the early trials of SDL-9 forms are a measure of verbal attention span and both the middle and late trials of SDL-9, CVLT Semantic, and CVLT Middle trials are a measure of working memory. Simultaneous analysis of all variables in a principal component analysis showed that the early trials of SDL-9 grouped with the DSP-F auditory attention span construct. The middle and late trial SDL-9 constructs, the CVLT semantic clustering index, and the CVLT middle trial factorial construct were grouped with the LNS and ARI working memory constructs.

Conclusions: Initial SDL-9 trials appeared to be part of an attention-driven, pre-strategic learning process, whereas middle and late trials of SDL-9 and the middle trials of CVLT where most verbal learning occurs were factorially related to both use of a logical (semantic grouping) strategy and working memory constructs.

C-14
Does the Quality of Paced Auditory Serial Addition Test Materials Affect Performance?

Abstract

Objective: Obvious practical aspects of neuropsychology include knowing how to administer, score, and interpret neuropsychological tests. However, it is less clear when our tests no longer do what they are supposed to do. For example, is the Vocabulary card from the WRAT-4 too worn to be easily read? Are WCST response cards too frayed or smudged? Is the hand dynamometer still accurate after 10 years? The PASAT appropriately offers a caution to users that their tape is only good for up to 75 uses. However, early dissemination of the PASAT did not offer such caution. For this analysis, the timing of PASAT audiocassettes was assessed to determine the degree to which they did or did not perform as originally intended. Methods: Cassette tapes of the Levin and colleagues (1987) 50-item version of the PASAT from two clinical practices were timed to determine the length of administration. These were compared with standard administration times based on the original interstimulus intervals (i.e., 2.4, 2.0, 1.6, and 1.2 s per trial). Results: In our practices, the times for administration of all four trials of the PASAT were 461 and 465 s. The actual administration time for a new tape should be 352.8 s. Our tests were 31% slower, likely resulting in the appearance of better performance than provided in the various normative samples. Conclusions: The example is given as a warning to all clinicians, as well as test publishers, to monitor test materials in an ongoing manner to ensure consistency of older stimuli with new items.

C-15
Measurement Invariance of the American National Adult Reading Test by Age, Cognitive Status, Gender, and Ethnic Group

Abstract

Objective: The American National Adult Reading Test (AMNART) is commonly used to estimate premorbid verbal intelligence. The validity of this estimate is contingent upon measurement invariance in diverse samples. The current study used item response theory (IRT) and logistic regression to examine the differential item functioning (DIF) of the AMNART based on age, cognitive status, gender, and ethnicity. Methods: Participants were 528 individuals in Project FRONTIER, an ongoing epidemiological study of rural healthcare. In separate analyses, participants were grouped based on age (300, <65; 228, ≥65), gender (363 women and 165 men), ethnicity (329 Non-Hispanic and 198 Hispanic), and cognitive status (380 normal and 148 impaired). Each item was included in a graded response IRT model to estimate ability. Logistic regression was used to determine whether, after controlling for ability, there were significant differences in item response probabilities based on group membership. Results: Although DIF was observed based on age (7 items), gender (7 items), and ethnicity (10 items), its effect on the overall test results was negligible. Large group differences based on ethnicity and cognitive status were observed when the AMNART was scored according to the standard protocol; however, these differences were substantially reduced when the test was scored using IRT. Conclusions: Several AMNART items lack measurement invariance for age, gender, and ethnicity. Nevertheless, at the test level, the effect of this bias is minimal. Premorbid verbal intelligence can be estimated with little to no bias using the AMNART. However, this lack of bias can only be assumed when IRT scoring, as opposed to conventional scoring, is utilized.

C-16
Relationship Between Embedded Indicators of Effort and Construct Validity on the Road Sign Perception Test

Abstract

Objective: Green's Roadsign Perception Test (RSPT) is a new computer-based test measuring cognitive abilities related to driving. Data were collected examining the operating characteristics of the RSPT (Ory, 2012). However, many participants in the sample appeared to be poorly motivated on the RSPT and other measures. The RSPT is intended for use as an effort test by examining differences in performance across easy versus difficult trials (Green, 2008). The present research examined the relationship between variable performance on the RSPT and performance on tests of attention, working memory, and visuoperception in a college sample. Methods: Subjects were divided into valid and invalid test groups using Dr Green's preliminary effort indicators. Pearson's r correlations were conducted to estimate the relationship between raw score on the RSPT and other neuropsychological tests, and z-tests were conducted to determine which correlations differed significantly. Finally, a z-test for the significance of proportion was conducted to determine whether the general direction of change in correlation represented a significant relationship. Results: Correlations were generally medium to small for valid RSPT profiles and small to negligible for invalid profiles, but differences were generally not significant between groups (Table 1). The overall trend of change indicated a pattern which supported the use of the RSPT as an estimate of consistent effort (z = 2.121, p < .05). Conclusions: The embedded indicator of poor effort on the RSPT is identifying participants whose RSPT score is less predictive of performance on other neuropsychological tests, but the differences were generally small and not significant.

Table 1.

Pearson's r correlations between performance on measures of convergent and discriminant validity and total stimuli correctly recognized on the RSPT for valid vs. invalid profiles.

Convergent Measure RSPT-Valid
n = 63 
Effect Size RSPT-Invalid
n = 35 
Effect Size Significance of Difference a 
RSPT-Retest .741 Large .480 Medium z = 1.105, p > .05 
TEA-Map Search .191 Small −.069 Negligible z = 1.190, p > .05 
TEA-Vis El-Accuracy .334 Medium .223 Small z = 1.265, p > .05 
TEA-Vis El-Switch .111 Small −.166 Small z = 1.265, p > .05 
WMS-Spatial Span .361 Medium .285 Small z = 0.627, p > .05 
WAIS-Digit Span .278 Small .236 Small z = 0.351, p > .05 
Benton FRT .133 Small −.201 Small z = 2.522, p < .05* 
Benton JLOT .269 Small −.019 Negligible z = 2.209, p < .05* 
Hooper VOT .293 Small .201 Small z = 0.731, p > .05 
Convergent Measure RSPT-Valid
n = 63 
Effect Size RSPT-Invalid
n = 35 
Effect Size Significance of Difference a 
RSPT-Retest .741 Large .480 Medium z = 1.105, p > .05 
TEA-Map Search .191 Small −.069 Negligible z = 1.190, p > .05 
TEA-Vis El-Accuracy .334 Medium .223 Small z = 1.265, p > .05 
TEA-Vis El-Switch .111 Small −.166 Small z = 1.265, p > .05 
WMS-Spatial Span .361 Medium .285 Small z = 0.627, p > .05 
WAIS-Digit Span .278 Small .236 Small z = 0.351, p > .05 
Benton FRT .133 Small −.201 Small z = 2.522, p < .05* 
Benton JLOT .269 Small −.019 Negligible z = 2.209, p < .05* 
Hooper VOT .293 Small .201 Small z = 0.731, p > .05 

*Correlations differ significantly at p < .05 level.

a The general direction of change in correlation represented a significant relationship (z = 2.121, p < .05).

C-17
The Influence of Distractor Trials on Green's Road Sign Perception Test

Abstract

Objective: Green's Road Sign Perception Test (RSPT) is a new test intended to measure abilities related to driving performance. However, the test includes distractor stimuli which are not included in the recognition bank and which do not figure into the test's results. It is hypothesized that these stimuli introduce an unaccounted for the source of variance into the test. Methods: This research used data from Ory (2012). The sample was 98 undergraduate students (72 women and 26 men) recruited from psychology classes at Louisiana State University. A factorial ANOVA was completed (distractor: present and absent; gender: men and women; performance: valid and invalid) using the mean accuracy as a dependent measure. Results: Significant main effects were observed for distractor (no distractor > distractor), F(1, 94) = 37.833, p < .0005; η2 = 0.287, and performance (valid > invalid), F(1, 94) = 44.044, p < .0005; η2 = 0.319, but not for gender. A significant interaction was observed for invalid profiles, as they displayed more variability on distractor than no distractor trials—F(1, 94) = 24.091, p < .0005; η2 = 0.204). None of the interactions with gender were significant. Conclusions: RSPT validity is compromised by the presence of distractors which are not reflected in any of the scores generated by the software. Further research should focus on what construct the distractors are measuring and whether their inclusion is worth the loss of precision.

C-18
Intervening Tasks and Visuospatial Memory

Abstract

Objective: Verbal tasks are often administered during the Rey-Osterrieth Complex Figure Test (ROCFT) delay period in order to minimize interference resulting from similarity between tests. However, research has shown that similar intervening tests do not affect performance on the California Verbal Learning Test-II. Therefore, we examined whether tasks varying in degree of similarity to the ROCFT had different effects on performance.

Methods: Healthy Binghamton University students (n = 106) completed the ROCFT and one of the following tests during the 25-min delay interval between the copy and delayed-recall trials: (a) Wechsler Adult Intelligence Scale-III vocabulary subtest, (b) Benton's Facial Recognition Test and Judgment of Line Orientation Test, or (c) the Taylor Complex Figure Test. Results: Groups did not differ on copy (p = .398), immediate-recall (p = .447), and delayed-recall (p = .091) trials. A repeated-measures ANOVA revealed an interaction between group and trial—F(2, 103) = 13.188, p < .001. Post hoc contrasts comparing groups' performance on recognition trial and percent retention (number of features accurately remembered on delayed-recall trial relative to immediate-recall trial) indicate that the group completing two complex figure tasks performed significantly worse on both variables, t(39.283) = 3.148, p = .003, and t(51.794) = 4.960, p < .001, respectively. Conclusions: These results indicate that the group that completed two nearly identical tasks had poorer memory of the Rey-Osterrieth Complex Figure after the intervening task than the other groups, suggesting that the similarity of intervening tasks impacts memory performance on a complex figure test. Therefore, it is necessary to consider the potential impact of intervening tasks when administering the ROCFT. Future studies should investigate whether a similar pattern is seen in various clinical populations.

C-19
Investigating Discontinuous Administration of the Raven's Standard Progressive Matrices

Abstract

Objective: The Raven's Standard Progressive Matrices (SPMs) is considered a valid and reliable test of intelligence. Traditionally given in one sitting, this task takes ∼40 min and can be cumbersome for some subjects. Therefore, we examined whether a task given in the middle of the SPM would affect performance, and if the nature of the intervening task (visual or verbal) had an effect as well. Specifically, we investigated if the Figure Weights and Arithmetic subtests of the Wechsler Adult Intelligence Scale (WAIS)-IV as intervening tasks had an effect on accuracy and completion time of the SPM. Methods: Healthy Binghamton University students (n = 108) were given either the standard administration of the SPM, or the Figure Weights or Arithmetic subtest between sections C and D of the SPM. The variables considered are the number of correct items and completion time on the post-intervention sections (D and E). Results: Mean SPM scores and times for control and intervention groups are M = 18.98 and M = 491.16 s and M = 14.63 and M = 494.19 s, respectively. An independent t-test revealed no significant differences between control and intervention groups on SPM score (p = .35) or time (p = .96). Conclusions: We suggest that the SPM is a test robust to intervention using cognitively similar tasks. We found that continuous administration does not have significant advantages over discontinuous administration. These results have practical implications such that SPM administration may not have to be done in one sitting if that is not feasible or desirable. Further evaluation using clinical populations would reinforce the notion that the SPM is a useful measure of intelligence in different populations even when administered discontinuously.

C-20
Mexican American Normative References on Tasks of Memory and Language: The Texas Mexican American Normative Studies

Abstract

Objective: Over 50% of the increase in the U.S. population from 2000 to 2010 was due to growth in the Hispanic population, 70% of which is Mexican American. In addition, Hispanics are at 1.5× the risk for AD relative to non-Hispanic Caucasians. Yet, to date, there are few normative references available for this rapidly aging segment of the population. The Texas Mexican American Normative Studies (TMANS) was undertaken to fill this gap by combining data across multiple studies conducted in Texas. Methods: For the current project, data were analyzed from 489 Mexican Americans (332 women and 157 men). Participants were recruited through multiple Texas-based studies, including Project FRONTIER, the Texas Alzheimer's Research and Care Consortium (TARCC), and clinic-based studies from Baylor College of Medicine and the University of Texas Southwestern Medical Center. Approximately one third of the Mexican American sample was tested in Spanish (n = 125). Results: Normative tables were created for both English- and Spanish-speakers on the following tests: Weschler Memory Scale (WMS)–III Logical Memory (LM) and Visual Reproduction, Rey Osterrieth Complex Figure Test, Buschke Selective Reminding test, CERAD Word List Learning and Recall, Boston Naming Test, Controlled Word Oral Associations, Animal Naming, Texas Naming Test, and Ardila 15-item naming test. Below is an example of the normative table for the WMS-III LM I scores based on age and language for Mexican Americans (Table 1). Conclusions: Neuropsychologists do not have adequate normative references for the rapidly expanding and aging U.S. Mexican-American population. The Texas Mexican American Normative Studies (TMANS) was undertaken to fill this gap. The current references on memory and language measures will provide valuable information to neuropsychologists.

Table 1.

WMS-III LM1 scores by age and language in Mexican Americans

Scaled scores Spanish
 
English
 
Percenti ies 
Age < 64 (n = 31) Age > 65 (n = 16) Age < 65 (n = 157) Age > 66 (n = 131) 
≤11 ≤17 ≤10 ≤8 
  11 
  12 10 
  13–14 11–15 3–4 
  15–21 16–19 5–8 
12–21  22–23 20–23 9–14 
22–24 18 24–28 24–26 16–23 
25–26 19–23 29–32 27–29 25–34 
27–30 24–26 33–35 30–32 37–47 
10 31–35 27–2S 36–37 33–35 50–61 
11 36–37 29 38–42 36–37 63–73 
12 38 30 43–44 38–39 75–82 
13 39–44 31–32 45–47 40–43 84–90 
14 45 33–38 48–49 44–47 91–95 
15 ≥46 ≥39 ≥50 ≥48 96 
Scaled scores Spanish
 
English
 
Percenti ies 
Age < 64 (n = 31) Age > 65 (n = 16) Age < 65 (n = 157) Age > 66 (n = 131) 
≤11 ≤17 ≤10 ≤8 
  11 
  12 10 
  13–14 11–15 3–4 
  15–21 16–19 5–8 
12–21  22–23 20–23 9–14 
22–24 18 24–28 24–26 16–23 
25–26 19–23 29–32 27–29 25–34 
27–30 24–26 33–35 30–32 37–47 
10 31–35 27–2S 36–37 33–35 50–61 
11 36–37 29 38–42 36–37 63–73 
12 38 30 43–44 38–39 75–82 
13 39–44 31–32 45–47 40–43 84–90 
14 45 33–38 48–49 44–47 91–95 
15 ≥46 ≥39 ≥50 ≥48 96 

C-21
Demonstration of Diurnal Patterns of Brain Activity Using fNIRS

Abstract

Objective: Functional near-infrared spectroscopy (fNIRS) is a portable neuroimaging technology that offers the opportunity for conducting naturalistic studies of brain–behavior interactions. Like functional magnetic resonance imaging, fNIRS measures hemodynamic flow; however, the fNIRS signal is less understood. Defining characteristics of the fNIRS signal is critical to the neuropsychological application of this neuroimaging technology. To begin addressing this, we examined characteristics of diurnal cerebral blood flow in fNIRS during naturalistic behaviors throughout the course of an average day. Methods: One monolingual, right-handed, female participant (29 years old) completed six 1/2-h testing sessions over the course of one 8-h day. Testing sessions included fNIRS monitoring of hemodynamic activity within the prefrontal cortex, during a basic everyday activity (i.e., watching a pre-viewed DVD). Testing sessions were alternated with rest periods which included defined parameters for minimizing cerebral blood flow altering activities (i.e., exercise, caffeine). Results: Baseline rest periods were compared with activity periods for both cerebral hemispheres and a large variability in brain activity was observed across the span of testing sessions, fluctuating between periods of higher and lower activity. Interestingly, the concentration of oxygenated hemoglobin (oxy-Hb) at rest was consistently higher than oxy-Hb during activity, averaging 0.15 and 0.55 mM higher at each measurement time in each hemisphere. Conclusions: This case study is the first to demonstrate that the activation of the cerebral cortex shows some variability throughout the day. Defining these fluctuations is critical to establishing the interpretation of fNIRS measurement of cognitive performance. Nonetheless, a larger pool of subjects is needed to improve the generalizability of these initial results.

C-22
How Are the Cognitive Test Scores of Healthy Adults Distributed?

Abstract

Objective: If one administers a battery of neuropsychological tests to a healthy person, will his or her scores be normally distributed? We hypothesized that they would and tested this hypothesis in a community sample. Methods: We recorded the scores of 327 healthy adults on 30 cognitive tests. For each raw score, we computed (a) unadjusted, (b) age-adjusted, and (c) fully adjusted (i.e., for age, sex, race, education, and estimated premorbid ability) T-score using the Calibrated Neuropsychological Normative System (CNNS) software. Finally, we computed measures of central tendency (mean) and normality (z-skewness, z-kurtosis) for each person's 30 test scores. Results: Over 90% of participants produced normally distributed sets of scores. Nobody showed significant negative kurtosis. Fewer than 7% of participants showed significant positive kurtosis for unadjusted scores, and this decreased with score calibration. More people showed significant negative (5.5%–7.3%) than positive (1.8%–2.8%) skewness, and this increased with calibration. Measures of normality were unrelated to sex, race, education, and Full-Scale IQ. Skewness correlated negatively with age, but only for unadjusted T-scores. Conclusions: On a battery of tests, most healthy adults produce scores that are normally distributed. Departures from normality are both unusual and unrelated to sex, race, education, and IQ. These findings serve as an important basis for comparison with clinical populations to determine whether measures of within-person test score variability offer a useful method of inference in clinical neuropsychology.

C-23
Comparability of the Computerized and Original Versions of the Halstead Category Test

Abstract

Objective: The Halstead Category Test (HCT) is commonly used to assess abstraction, problem-solving, and concept formation. Studies have demonstrated that the original version of the HCT is highly sensitive to brain dysfunction and it remains widely used in clinical settings. However, the original HCT requires the use of a slide projector and other equipment, which make it difficult to transport and repair. Recently, a computerized adaptation of the HCT was developed that includes the salient features of the original version, but is easier to administer and score. The current study compared the original and computerized HCT scores for a sample of undergraduate students to investigate comparability between the two versions. Methods: Forty-six undergraduates with no history of neurological conditions were randomly assigned to complete either the original HCT (56.5%) or the computerized HCT. The mean age was 21.2 years (SD = 5.0) and 43.5% were men. The number of errors on each of the seven subtests and the HCT total errors were compared. Results: There were no significant differences between test versions on any of the HCT subtests or total error scores (p = .86). The mean error difference was 1.05 for the total error score. Conclusions: Results provide preliminary evidence that the computerized adaptation of the HCT is comparable with the original HCT. Given the advantages of the computerized version, psychologists may elect to switch to this version for research and practice. Future studies are required to establish the comparability of the two versions' test–retest reliability, criterion validity, and construct validity.

C-24
Validation of the Affective Verbal Learning Test as a Measure of Verbal Learning and Memory

Abstract

Objective: In this study, the Affective Verbal Learning Test (AVLT), a measure of affective bias, was evaluated as a measure of verbal learning and memory in the context of baseline concussion evaluations. Methods: Three hundred and seventy-nine participants were included from a university-based sports concussion program. The AVLT, designed like a traditional list learning test but with affectively positive and negative words, was compared with other measures of verbal learning to establish convergent validity and with measures of visual attention and processing speed to establish discriminant validity. Results: AVLT immediate recall demonstrated moderate correlations with the HVLT-R immediate recall (r = .40) and the IMPACT verbal memory composite (r = .36). A weaker, but still statistically significant (p < .001) correlation was found between the AVLT immediate recall and the RBMT story memory immediate recall (r = .22). Correlations among delayed recall measures on the AVLT and delayed recall indices from the verbal memory indices were comparable with immediate recall values. The AVLT total recall demonstrated strong discriminant validity with the average reaction time on the Vigil (r = .08), the percent correct on the CARB (r = .08), and the total correct on the PSU Cancelation Task (r = .004). The AVLT delayed recall measure demonstrated similar discriminant validity correlations with these indices. Conclusions: The obtained convergent and discriminant validity values suggest that the AVLT may have clinical utility as a measure of verbal learning and memory in concussion management and research, in addition to its use as a performance-based measure of affect. Future studies will need to establish its sensitivity to concussion.

C-25
Understanding Change on ImPACT and CVS Following a Sports-Related Concussion

Abstract

Objective: The purpose of this study is to examine the psychometric characteristics of two computerized neuropsychological screening batteries designed to assess sports-related concussion. Stability of test scores and calculation of reliable change confidence intervals were assessed using a sample the batteries are commonly used with. Findings will help clinicians interpret test results based on an understanding of measurement error for test–retest data and sensitivity of the batteries. Methods: Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Concussion Vital Signs (CVS) were used to measure aspects of cognitive functioning. Participants were ∼100 high school and college student athletes who completed ImPACT and/or CVS twice for the purpose of a test–retest study. Many of these student athletes completed both batteries. The average age was 18.6 years (SD = 1.6) and mean time between tests was 349 days. Results: Overall, test battery mean was 102.2 (SD = 11.1) at time one and 100.4 (SD = 11.4) at time two for ImPACT. Pearson's test–retest correlation coefficients based on the overall test battery score was .57 for ImPACT. Data were also collected for CVS and similar results were found. These results for CVS will be presented along with test–retest correlation coefficients for the individual domains of both computerized batteries. Conclusions: Results indicate that test–retest reliability was promising and comparable among the two computerized batteries. Reliability issues are perhaps the most important factor hindering use of computerized batteries in assessing sports-related concussion. More research and further refinement of these batteries to improve reliability is needed.

C-26
Validating a New Memory Measure: An Experimental Memory Task

Abstract

Objective: The purpose of this study was to develop a memory test that includes components of both verbal and visual memory tasks. This experimental memory task would provide clinicians and other professionals, such as those who produce computerized neuropsychological batteries, with the capability to administer a comprehensive memory test within specific time constraints. Methods: Eighty-two undergraduates from a southeastern university volunteered to be participants in this study. All were in the genuine condition. Participants completed the California Verbal Learning Test–Second Edition (CVLT-II) and a verbal and visual memory test in its pilot phase, the Experimental Memory Task (EMT). Participants were between the ages of 18 and 44 (M 22.24, SD 5.57), with a mean education of 13.02 (SD 1.52). Results: Correlations matrices were examined for the total combined scores for trials 1–5 of the CVLT-II, trials 1–3 of the EMT, as well as Recognition Hits for both the CVLT-II and the EMT. A moderate correlation (r = .512, p < .0001) was found between the EMT and the CVLT-II total combined scores. As a convergent test, the scores from the EMT were also compared with the Shipley–2 Abstraction subtest (r = .291, p < .0001 ). Additional results will be presented. Conclusions: Results suggest that although the EMT is still in development, it is comparative to and measuring the same construct as the CVLT-II. Implications for these results will be discussed.

C-27
Derived Affective and Cognitive Theory of Mind Scores for the Assessment of Interpersonal Problem-Solving Skills: A Methodological Study

Abstract

Objective: Theory of mind (ToM) refers to the ability to identify the thoughts (Cognitive ToM) and feelings (Affective ToM) of others. The Assessment of Interpersonal Problem-Solving Skills (AIPSS) is a measure of social problem-solving. It requires test subjects to watch a video vignette portraying two actors and identify if there is a social problem in their interaction, and then describe the problem and how to resolve it, thus requiring ToM. However, the AIPSS does not have scores that directly measure ToM. The current study demonstrates a methodological approach to deriving Affective and Cognitive ToM scores for the AIPSS. Methods: The AIPSS was administered to 48 participants with history of bipolar disorder (BD), 24 participants with history of schizophrenia (SZ), and 24 healthy controls. Two new items were administered: “What/How is the person feeling right now,” (Affective ToM) and “Why is s/he feeling that way?” (Cognitive ToM). Answers were documented verbatim and later blindly scored by two trained raters. Scoring criteria was established through a consensus panel of 6 − 8 researchers. Results: Inter-rater reliabilities for the Affective and Cognitive ToM scores were 0.90 and 0.86, respectively. Significant between group differences were present for both scores. Compared with controls, the SZ group performed poorer on Affective ToM, while both clinical groups performed poorer on Cognitive ToM. Conclusions: Results yield reliable new ToM scores which may be assessed with the AIPSS. These scores also demonstrate construct validity by replicating previous findings regarding distinctions between Affective and Cognitive ToM in BD and SZ.

C-28
Comparison between Traditional Neuropsychological Measures and Similar Measures Presented on a Mobile Electronic Device (iPad 2)

Abstract

Objective: The objective of this study was to compare performance on two traditional neuropsychological instruments with the performance on similar instruments administered on a mobile electronic device (iPad2). Methods: Participants were administered the traditional Finger Tapping Test and Trail-Making Test and parallel tests developed and presented on the iPad 2 mobile device. This study presents preliminary data of an ongoing study. The study sample, comprised of college students, consisted of 50 participants (38 women) with a mean age of 23.38 (SD = 6.87) and a mean education of 14.02 years (SD = 1.20). Pearson's r correlations were calculated between the scores obtained on traditional neuropsychological measures and parallel measures presented on the mobile device. Results: The correlations between scores on the traditional and the iPad2 test versions were generally in the moderate range. These correlations were smaller than anticipated, and these results are likely attributed to a combination of method variance (primarily on the Finger Tapping Test) and restricted variance (primarily on the Trail-Making Test). Correlation matrices are presented and the results described. Conclusions: This project is in its initial phase of testing and refinements will continue to be explored and examined. These preliminary results suggest that while it is probably feasible to develop electronic versions of some contemporary neuropsychological tests, there are likely to be numerous psychometric challenges. Suggestions for future research are presented.

C-29
Impact of Non-diagnostic Information in Assessment: Identification and Corrective Procedures

Abstract

Objective: The accuracy of neuropsychological evaluation may be degraded when non-diagnostic information, or information of no true value (e.g., graphical dimensions or coloration), impacts interpretation. If non-diagnostic information exerts an impact, it may lead to underutilization of diagnostic, or truly useful, information. It is posited that variation in visual presentation of psychological test data that is non-diagnostic may nevertheless influence interpretation, therefore increasing the potential for error. Certain interpretive practices that are based on configural relationships (e.g., scatter analysis) may be particularly vulnerable to influence from non-diagnostic visual alterations. Methods: This study examined judgments from neuropsychologists (n = 193) regarding normal scatter, whether non-diagnostic visual alterations impact judgments, and whether truncating the visual presentation of scatter would serve as a corrective intervention. Results: The results indicated that neuropsychologists under-perceived normal levels of scatter. The influence of non-diagnostic visual alterations was mixed. Percentiles represented at equal- and unequal-sized units did not alter judgments. Metric selection revealed a significant difference, and T-scores versus percentiles were judged as more normative. An intervention that truncated the visual scatter improved judgmental accuracy (i.e., larger visual scatter with mathematically identical information was found to be less normative). Conclusions: This study provides evidence for conceptual problems regarding the analysis of scatter and inconsistent interpretations across metrics. Future research should aim to replicate the current findings, advance the design of interventions as needed, and assist in developing evidence-based standards for representing graphical displays.

C-30
Cognitive Predictors of Successful Adaptation to an Advanced Multifunction Prosthesis

Abstract

Objective: To determine if cognitive test performance predicts successful use of an advanced multifunction prosthesis in persons with upper limb amputation. Methods: Participants (n = 28, age = 46 ±16 years, education = 14 ±2.8 years, 18% women) underwent a battery of cognitive tests prior to outfitting and training with an advanced multifunction prosthesis. The battery was comprised of commonly used published standardized neuropsychological tests including components of the RBANS and NAB batteries. Due to upper limb amputation, tests requiring motor output (e.g., Digit-Symbol Coding) were altered to allow verbal responding. At the end of their participation, participants were rated as Skilled (n = 19) or Unskilled (n = 9) users of the device based upon therapist and prosthetist judgments of their performance (prosthetic skill level). Results: Age and education level were not significantly associated with the prosthetic skill level. Unskilled users performed significantly worse than Skilled users on cognitive tasks of working memory, Digit Span backwards total score: F(1, 26) = 5.95, p = .02; semantic memory, RBANS Story Memory Learning: F(1, 26) = 6.95, p = .04, and RBANS Story Memory Recall: F(1, 26) = 6.86, p = .02; and cognitive switching, oral Trails B, F(1, 26) = 5.19, p = .03. Conclusions: Compared with Unskilled advanced upper limb prosthetic users, Skilled users had stronger working memory, cognitive switching, and semantic memory abilities. These cognitive abilities may contribute to sthe peed of acquisition of prosthetic skill and may be particularly important when learning to use a complex device that requires control of multiple degrees of freedom.

C-31
Preliminary Generalization Findings for an Intention Aphasia Treatment in Chronic Post-Stroke Non-fluent Aphasia

Abstract

Objective: An intention aphasia treatment involving left-hand movements during language production to activate right-hemisphere language homologs has been used in object naming and category member generation. This study examined intention treatment improvements and generalization to untreated stimuli. Methods: Fourteen chronic left-hemisphere post-stroke non-fluent aphasic subjects completed 2 weeks of picture naming and 1 week of category member generation treatment (10 sessions/week; 30 sessions total). Seven subjects used Intention left-hand movements during trial initiations and correction procedures (Intention), while another seven subjects completed treatment similar except for the hand movement (NoIntention). Treatment improvements were measured using Tryon's c-statistic for naming and category member probes administered prior to treatment sessions. Results: Both groups showed naming improvements when all probes were analyzed together, with the majority of subjects demonstrating naming improvements (5:6 Intention vs. 6:7 NoIntention, c2 = 0.01, p = 1.0). Naming improvements were also similar between the two groups when naming was further delineated into treated and untreated stimuli (5:6 Intention vs. 7:7 NoIntention treated, c2 = 1.3, p = .46; 3:6 Intention vs. 3:7 NoIntention untreated, c2 = 0.07, p = 1.0). Intention showed a treatment difference trend for category member generation (7:7 Intention vs. 3:6 NoIntention, c2 = 4.6, p = .07). When category member generation data were delineated by treated and untreated probe types, Intention showed significant treatment differences specifically for untreated stimuli (6:7 Intention vs. 4:6 NoIntention treated, c2 = 1.3, p = .46; 7:7 Intention vs. 3:6 NoIntention untreated, c2 = 9.48, p = .005). Conclusions: Intention treatment for eliciting language non-dominant (right) hemisphere activity may improve aphasia treatment generalization, particularly when paired with internally generated treatment stimuli.

C-32
Efficacy of Constraint-Induced Movement Therapy in Patients with Hemiparetic Progressive Multiple Sclerosis

Abstract

Objective: Determine if Constraint-Induced Movement (CI) therapy and Complementary and Alternative Medicine (CAM) treatments produce a differing effect on upper-extremity function in adults with hemiparetic progressive multiple sclerosis (PMS). Methods: Seventeen individuals (50.0 ± 8.2 years) with PMS with mild-to-moderate upper-extremity hemiparesis were recruited from local physician referrals and self-referrals. Patients were randomized to receive either CI therapy (n = 8) or CAM treatment (n = 9) for 3.5 h/day for 10 consecutive weekdays (35 h total). CI therapy was administered in an outpatient rehabilitation facility and consisted of massed practice with shaping, restraint of the less-impaired limb for a target of 90% of waking hour, and a set of behavioral techniques called the transfer package designed to induce whatever gains occurred in the laboratory to the life situation. CAM treatments consisted of relaxation exercises, pool therapy, and yoga; they were administered at a university-affiliated health club. The Motor Activity Log (MAL) measured reported the use of the more impaired upper-extremity in the life situation prior to and following therapy. Results: Patients receiving CI therapy exhibited much greater improvements (p < .001) in the use of their more impaired upper-extremity on the MAL (d′ = 3.25) than those receiving CAM treatment (d′ = 0.77). Conclusions: CI therapy was more efficacious in the improving movement of the more impaired upper-extremity than CAM treatment in patients with PMS. These results confirm previous pilot findings that CI therapy produces significant gains in impaired upper-extremity functioning in patients with progressive disease such as PMS.

C-33
Recovery from Traumatic Brain Injury: The Effect of Being Informed about Risk for Disability

Abstract

Objective: The present study examined improving patients' satisfaction with recovery by informing them about their risk for physical, cognitive, and/or emotional changes following traumatic brain injury (TBI). Methods: Fourteen moderate-severe TBI patients (eight men/six women, mean age: 36, post-injury 4 years) were asked what they were told by health professionals to expect during their recovery. Patients rated their functioning in somatization, motor, attention/memory, communication, depression, and aggression (Neurobehavioral Functioning Inventory, NFI), as well as their current and future satisfaction with recovery in these domains. Results: All patients were told to expect partial recovery, and no patients recalled being told they would recover to their pre-injury level. NFI ratings were average and did not differ based on what patients recalled being informed about sequelae. Patients who initially expected immediate, full recovery were currently less satisfied with their progress (rs = − .59). The more changes patients recalled being told to expect across physical, cognitive, and emotional areas, the more satisfied they were currently (r = .58) and anticipated being in the future (r = .40). Patients expecting changes with their motor skills, attention/memory, or communication were more satisfied with their recovery in those respective areas (p < .05). Fewer patients recalled being told to expect emotional problems; there was no pattern with satisfaction ratings. Conclusions: Explicitly informing patients about potential changes in physical functioning and cognition following TBI appears to enhance their satisfaction with recovery. Patients should repeatedly be informed of potential changes in these areas so as to enhance their memory for such, which may lead to more positive expectations and outcomes.

C-34
What do Rehabilitation Therapists Really Want to Know from Neuropsychology?

Abstract

Objective: The purpose of neuropsychological consultation and evaluation early on after admission to outpatient neurorehabilitation is to identify problems and/or specific parameters that may need to be addressed. Han and associates presented a poster at INS in Montreal (2012) about ways to reduce the waiting time for Neuropsychological Assessment. They found that the mean wait time in their Multidisciplinary Stroke Clinic (MSC) was 4–9 months and postulated how these wait times could be reduced. Methods: Fifteen referrals were reviewed. The following 23 possible parameters were available for assessment: aggression, attention, behavior, cognition, communication, cooperation, dependency, driving assessment, executive functions, fatigue, initiation, insight, irritability, lability, learning, memory, motor functions, organization, perception, self-awareness, self-centeredness, social interactions, and speech/language. Results: Of these 23 parameters, the following 7 were found to be the most salient: attention, cognition, driving assessment, executive functions, insight, memory, and organization. By employing a thorough evaluation of these parameters, not a mere screening of all parameters, baseline data were obtained that facilitated intervention and medication management. Conclusions: Using a neuropsychological evaluation at the beginning of outpatient neurorehabilitation, focussing on the seven different afore cited parameters, can greatly assist in improving the quality and effectiveness of care provided.

C-35
A Novel Approach to Treating Mood Symptoms and Enhancing Cognitive Skills in an Older Adult Stroke Victim Using RBANS Subtests

Abstract

Objective: Prior research indicates that post-stroke mood disorders are associated with impaired recovery in cognitive, social, and daily functioning. Cognitive impairment, anxiety, and depression are important treatment targets for stroke patients. This study investigates the feasibility and effectiveness of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a rehabilitation tool to normalize cognitive impairment and reduce mood symptoms. Methods: The case of a 63-year-old man (Mr J) who suffered a right-side ischemic stroke is described. Mr J presented 12-month post-stroke with complaints of depression, anxiety, and difficulties with memory and attention. Beck's Depression Inventory (BDI) and Anxiety Inventory (BAI) were administered at pretreatment, 4 and 8 weeks, and 6 and 12 month post-treatment. Pre- and post-session ratings of anxiety were collected. Ten sessions were held in which one RBANS subtest was administered and cognitive strategies tailored to Mr J's performance were discussed. Follow-up RBANS was conducted 12 months after therapy onset. Results: Pretreatment, Mr J reported moderate depression and minimal anxiety. Initial RBANS results indicated variable performance consistent with Mr J's presentation. Follow-up assessment found a reduction in mood symptoms (BDI = 7, BAI = 4). Improvements in List Learning, Story Recall, Delayed Memory, and Attention were found at follow-up. Mr J's perception of performance influenced mood symptoms and RBANS performance. Conclusions: This study pilots using the RBANS as a treatment strategy in neuropsychological rehabilitation. Results suggest potential utility and effectiveness of RBANS as a therapeutic tool with stroke patients in assessing, addressing and improving mood symptoms and cognitive functioning.

C-36
Assessing the Effect of Two Medications for Multiple Sclerosis Through Serial Neuropsychological Evaluations

Abstract

Objective: Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS) by damaging the myelin sheath through inflammation. While there is no cure for MS, medications have been developed to manage symptoms by slowing the progression rate (interferons) or suppressing immune system attacks (glatiramer). Unfortunately, these medications require infusions or daily/weekly injections. Recently, medications have been developed that trap immune cells in lymph nodes are administered orally with daily dosing and therefore are more convenient. The current study examines the efficacy of two MS medications by comparing serial neuropsychological examinations over time. Methods: A 61-year-old right-handed man with a 10-year history of MS was examined at the request of neurology with a comprehensive neuropsychological examination on three occasions: (a) pre-drug (baseline), (b) medication A (glaterimer), and (c) medication B (fingolimod). Results: When comparing baseline findings with medication A, functional improvement was observed in 13 cognitive areas, including intellect, processing speed, fine motor functioning, and memory. When comparing medication A with medication B, a mild decline or no improvement was observed in 15 cognitive areas. Conclusions: Neuropsychological reassessment suggests that medication B may be more effective than medication A for the treatment of MS in this particular patient. In addition to neuroimaging studies, serial neuropsychological testing is a valuable diagnostic tool that can be used by neurologists to determine subtle cognitive changes when assessing the effectiveness of MS medications, assessing the efficacy between different MS medications on an individual patient, and validating patients' subjective complaints and observations.

C-37
The Relationship between Medication Adherence and Cognitive and Emotional Functioning in Multiple Sclerosis

Abstract

Objective: Individuals with MS are at an increased risk for poor long-term adherence to disease-modifying therapies (DMTs). DMTs are self-injectable medications that must be taken on an ongoing basis to maximize their benefits of reducing exacerbations, formation of brain lesions, and disease progression. MS-related cognitive and emotional problems have been associated with poor medication adherence. The goal of this study was to examine rates of adherence and explore factors affecting adherence among patients with MS. Methods: Twenty-three individuals with clinically definite MS participated in the study. Sample was predominately women (86.7%) and Caucasian (65%) with a mean age of 46.5 ± 11.60 years and 14.6 ± 1.93 years of education. Participants included in the study were free of a history of prior neurological insult, significant psychiatric history, alcohol and drug history, and right-handed. Participants completed a thorough neuropsychological battery, which included a self-report measure of medication adherence. Results: Preliminary findings of this pilot study revealed that 87% of the participants (n = 20) exhibited poor adherence. Most common reason for non-adherence was forgetting to take medications. No significant correlations were found between measures of cognitive and emotional functioning and medication adherence. Conclusions: Individuals with MS have difficulty with adhering to prescribed medications. Further research exploring factors related to poor adherence is warranted. An increased understanding of factor(s) most associated with adherence problems will be important in designing rehabilitation interventions to optimize adherence, and thereby treatment efficacy and overall quality of life.

C-38
Does Mood Effect Size? An Investigation into the Rey Copy Figure in Children with Anxiety and Depression

Abstract

Objective: Limited empirical evidence for qualitative features of the Rey Complex Figure (RCF) are found in the literature; especially in children diagnosed with affective disorders. Research suggests sizes of projective drawings are impacted by emotions (Burkitt, Barrett, & Davis, 2009; Klepsch & Logie, 1988; Tomas & Jolley, 1998). The hypothesis is that the size of RCFs will be associated with scores across neuropsychological measures. Methods:

Data from 95 children's (boys = 52, girls = 43; ages 6–18) neuropsychological evaluations (WISC-IV, CMS, WIAT, TMT, WCST, VMI, and RCF) were compared with RCF scores (Meyers & Meyers, 1995) and also size (width and height) based on the original RCF. All children were diagnosed with anxiety or depression and divided into four groups: Wide, Skinny, Tall, and Short RCFs. ANOVAs and correlations were calculated and groups were compared. Results: Correlations revealed significant negative correlations between the Total Width and scores on the RCF Copy (r = − .317, p = .007), Delay (r = − .326, p = .012), and Recognition (r = − .274, p = .037). ANOVAs revealed children producing wider RCFs demonstrated higher scores across all neuropsychological measures with the WIAT-MR (F = 4.575, p = .036) and CMS-VisD (F = 4.224, p = .044) reaching significance. Total height was not significance. ANOVAs revealed children producing taller RCFs demonstrated higher scores on most neuropsychological measures (18 of 20) with the CMS-VisD reaching significance (F = 4.007, p = .049). Conclusions: Most children with affective disorders drew skinny RCFs. Those with wider RCFs performed better across neuropsychological measures. Those who produced taller RCFs had higher scores across neuropsychological measures. Figure size (width and height) may lend insight into a child's neuropsychological profile; particularly for children diagnosed with anxiety and depression.

C-39
Multitasking Ability in MS: Can It Inform Vocational Functioning?