Intelligence and Achievement Predictors of Attention-Deficit/Hyperactivity Disorder and Learning Disorders
Objective: Reading Disorder (RD) and Disorder of Written Expression (DWE) are among the highest co-occurring learning disabilities in children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, little information is available regarding IQ and achievement tests predicting diagnoses in comorbid groups. The current study examined children diagnosed with ADHD-Inattentive, ADHD-Combined, or ADHD with coexisting RD and/or DWE. Method: Participants included 135 children with ADHD-Inattentive (n = 59), ADHD-Combined (n = 36), and ADHD, RD, and/or DWE (n = 40). Children were 10.2-year old and 66.5% male with an IQ of 100.9. Diagnoses were established in a private practice through comprehensive evaluations, including administration of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and Woodcock Johnson Tests of Achievement Third Edition (WJ-III). Results: Discriminate function analysis was used to predict group membership based upon WISC-IV Indexes and WJ-III Broad Reading Cluster scores. An initial analysis examining all three groups provided an overall correct classification rate of 49.6%. The ADHD Inattentive and Combined groups were pooled to form one group in a second discriminate function analysis. Correct classification rates were 71.9% overall, with 75.0% of the ADHD group and 66.7% of the ADHD with RD/DWE group correctly classified. Conclusion: Results suggest the combination of WISC-IV and WJ-III Broad Reading scores are able to provide good classificatory accuracy in differentiating between children with ADHD alone compared with those with ADHD and RD/DWE. Results further suggest that children with ADHD and RD/DWE are at particular risk for poor performance on tasks requiring reading and verbal ability.
Comparison of Digit Symbol Coding Performance in Youths with Attention and Learning Disorders
Objective: Digit symbol coding tests are commonly included as part of a neuropsychological examination and previously have shown sensitivity to numerous neurocognitive/neuropsychiatric conditions. The purpose of this study is to evaluate the Wechsler Intelligence Scale for Children-fourth edition (WISC-IV) Coding's ability to discriminate between Attention-Deficit/Hyperactivity Disorder (ADHD) types and ADHD and Learning Disabilities (LD). Method: Participants included 459 children referred for a neuropsychological evaluation diagnosed with ADHD or LD. Participants were administered Coding as part of a comprehensive battery. Analysis of variances with follow-up measures was conducted between diagnostic groups and other clinical variables. Results: Analyses found significant differences with small to moderate effect size between ADHD combined and inattentive types, ADHD and LD overall, ADHD combined type and LD, but not ADHD inattentive type and LD. When including gender as a variable, effect size increased for males with the exception of ADHD and LD comparison, wherein effect size for females was larger. Coding discriminability between ADHD types and LD was not significantly different between children and adolescents. Conclusion: These finding suggest performance on Coding may provide a further indicator of the etiology when an individual is experiencing academic difficulties. These findings are not entirely unexpected, considering past findings of digit symbol coding tasks discriminative utility for various neuropsychiatric disorders. Nevertheless, care should be taken when evaluating the clinical utility of these findings given only small to moderate effect sizes were found.
Gender Differences in Social Cognition in Children with Attention-Deficit/Hyperactivity Disorder
Objective: Many studies have demonstrated that social cognition is impaired in children with ADHD. Without proper intervention following diagnosis, this can lead to poor long-term outcomes and social rejection from peers. In order to better understand the nature of social cognition deficits in children with ADHD, the current study compared neuropsychological measures of social functioning using an age-matched sample to determine if deficits present differently between genders. Method: Data were gathered from a private practice neuropsychological clinic. The experimental group consisted of an age and diagnosis matched sample of 40 children (20 boys and 20 girls) with a primary diagnosis of ADHD. Participants ranged in age from 6 to 13 (mean = 9.35, SD = 2.34). All received a full neuropsychological evaluation, including the Theory of Mind (TOM) and Affect Recognition (AR) Subtests from a Developmental Neuropsychological Assessment, Second Edition (NEPSY-II). Results: One-way ANOVAs were used to compare the two groups. Significant differences (p < .05) between gender groups were found in the raw scores of the AR subtest and TOM contextual task. Specifically, females performed better than males on tasks measuring visual perception of social cues. However, there were no significant gender differences found in the TOM verbal task or the total raw score for TOM. Conclusion: The results of this study suggest there are slight differences in the manifestation of social deficits in ADHD between genders. A better understanding of these differences will lead to more effective methods of intervention. Future research and clinical implications are discussed.
Executive Functioning in Children with ADHD: Does Gender Matter?
Objective: Most research conducted with ADHD children has focused on males. Due to the growing number of girls being diagnosed, it is essential that a more thorough understanding of the characteristics present in females be developed. The current study compared neuropsychological measures of executive functioning using an age and diagnosis matched sample to determine gender differences. Method: Data were gathered from a private practice neuropsychological clinic. The experimental group consisted of an age and diagnosis matched sample of 40 children (20 boys and 20 girls) with a primary diagnosis of ADHD. Participants ranged in age from 6 to 13 (mean = 9.35, SD = 2.34). All received a full neuropsychological evaluation. Measures used to determine executive functioning abilities included The Connors' Continuous Performance Test, version 2, the Digit Span and Letter-Number Sequencing subtests on the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV) as well as the Working Memory and Processing Speed Indexes on the WISC-IV. Results: One-way ANOVAs were used to compare the two groups on measures of executive functioning. No significant gender differences were found, even on more cognitively demanding working memory tasks used for executive functioning. Conclusion: These results suggest that females with a primary diagnosis of ADHD present with executive functioning abilities similar to males and will likely benefit from the same intervention techniques. Differences between the population examined and the general population are discussed in order to hypothesize why measures of executive functioning were not considered clinically impaired.
Changes in Executive Function as Children with Attention-Deficit/Hyperactivity Disorder Mature
Objective: Previous research has demonstrated that Attention-Deficit/Hyperactivity Disorder (ADHD) children and adolescents suffer from deficits in executive function (EF). Less is known about EF development during ADHD children maturation. The present study examines differences in objective and behavioral measures of EF between children and adolescents. Method: Data were collected from a private neuropsychological clinic. The sample (n = 54) consisted of participants with a primary diagnosis of ADHD separated into two groups: 6–8-year olds (n = 22, mean = 7.28, SD = 0.729) and 12–15-year olds (n = 22, mean = 12.91, SD = 1.231). Objective measures of EF were defined by scores on Working Memory and Processing Speed Indexes of the Wechsler Intelligence Scale for Children, fourth edition and the Connors' Continuous Performance Test-II. Behavioral measures of EF were defined by Metacognition Index (MI), Behavioral Regulation Index (BRI), and Global Executive Composite (GEC) t-scores from the Parent Behavioral Rating Inventory of Executive Function. Results: Using independent sample t-tests, no significant differences in objective measures of EF and BRI/GEC were found. However, there were significant differences in MI (p < .05), specifically Initiate and Plan/Organization scales (p < .001). Conclusion: Results indicate that as ADHD children mature, their ability to initiate, plan, organize, and sustain cognitively complex problem-solving does not progress as well as their ability to modulate emotions and behavior. Commonly used objective measures of EF might not be adequately sensitive to deficits in EF related to self-management such as task initiation and organization. These results have important treatment and assessment implications as children reach adolescence.
Absence of Changes in Social Functioning as Children with Attention-Deficit/Hyperactivity Disorder Mature
Objective: Previous research has demonstrated that children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) suffer from deficits in social functioning. Less is known about the development of social functioning during the maturation of ADHD children. The purpose of the present study was to assess differences in objective and behavioral measures of social functioning between children and adolescents. Method: Analyses were performed on data collected from a private practice neuropsychological clinic. The sample consisted of 54 children and adolescents with a primary diagnosis of ADHD according to the Diagnostic Statistical Manual-IV-TR separated into two age groups: Group 1, 6–8-year old (n = 22, mean = 7.28, SD = 0.729) and Group 2, 12–15-year old (n = 22, mean = 12.91, SD = 1.231). Objective measures of social function were defined by scores on the Affect Recognition and Theory of Mind subtests in a Developmental Neuropsychological Assessment-II (NEPSY-II). Behavioral measures of social functioning were defined by the Social Problems t-scores from the Achenbach Child Behavioral Checklist (CBCL). Results: Independent sample t-tests were used to compare the two groups. There were no significant differences in either the objective or behavioral measures of social functioning. Conclusion: Results indicate as ADHD children mature into adolescence their ability to perceive affect cues, comprehend outside perspectives, and appreciate the social problems observed by others does not change significantly. Clinically used objective social perception measures appear consistent with parent behavioral ratings of social behavior. These data also suggest that interventions in aiding social functioning can be an effective clinical application independent of age.
The Effects of Working Memory Training on Verbal Learning in Children
Objective: Children with working memory weaknesses often have difficulties retaining and manipulating pieces of information which can lead to learning challenges. We investigated the effects of interference and delays on the verbal learning of children with suspected working memory deficits who received a working memory intervention. Method: We tested 31 children (19 boys and 12 girls) who were either receiving academic services because of learning difficulties or referred because of concerns about learning. Their average age at baseline was 9.7 years (SD = 1.9) and Verbal Comprehension Index (VCI) scores ranged from 67 to 140 (M = 106.2; SD = 17.9). Of these children, 14 received 25 computer sessions of interactive working memory training (Cogmed, 2006). Results: The weaker the WISC-IV Working Memory Index, the more difficulties they had following interference and delay on the NEPSY-II list-learning task at baseline r(3, 27) = .38, p = .04 and r(3, 27) = .41, respectively, with age and VCI taken into consideration. For the 14 children with working memory training, these same correlations were not significant after the training, with ps > .70. With repeated measures analysis, there was a trend toward a significant increase in words learned on the list-learning task after working memory training, F(3, 9) = 3.52, p = .09. Conclusion: Following Cogmed training, working memory scores no longer correlated with interference or delayed recall verbal learning effects. This finding suggests that working memory training may help mediate effects of working memory deficits on verbal learning.
Differentiation of Children with and without ADHD using the DWSMB via a Boosted Tree Methodology
Objective: Research has demonstrated that standardized and norm-referenced sensory-motor measures have the ability to differentiate between healthy children and those with ADHD. The purpose of this study was to determine if a newer statistical technique, Boosted Tree Methodology, could differentiate between these groups and if it would achieve a better classification rate than logistic regression. Data Selection: Participants were 118 individuals diagnosed with ADHD (mean age = 12.4 years; SD = 5.5) and 118 healthy individuals (mean age = 12.6 years; SD = 5.6) who were matched by age and gender to the clinical sample. All participants were administered the Dean–Woodcock Sensory Motor Battery (DWSMB). Data Synthesis: Boosted Tree (BT) Analysis is a new statistical technique that improves upon Classification and Regression Tree analysis in that multiple decision trees are created with each subsequent decision tree drawing upon the previously fitted tree to improve prediction accuracy. The predictors were 35 scores from the DWSMB. Results of the analysis indicate that the BT method correctly predicted group membership for 96.2% of cases, compared with logistic regression, which accurately predicted group membership for only 72.5% of individuals. Conclusion: The results suggest that BT analysis is a promising new statistical technique for improving diagnostic classification rates when compared with more traditional methods. The most important predictors included measures of simultaneous tactile localization, auditory perception, and finger-to-nose tasks. The fact that the BT analysis was able to correctly classify individuals with ADHD at such a high rate is even more impressive when it is considered that only sensory-motor, and not cognitive, variables were considered.
Comparison of Reasoning, Processing Speed, and Executive Functions in Nonclinical Chinese and North Americans
Objective: The primary objective was to compare Chinese and American participant's performances on a standardized measure of reasoning (the Booklet Category Test). The secondary objective was to explore the contribution of processing speed and aspects of executive functions (working memory, response inhibition, and set shifting) to abstract reasoning across groups. Method: Participants included nonclinical university students at the largest public university in Macao, China (n = 64), and a large public university in the Southeastern United States (n = 42). Only native Cantonese speakers for the Macao sample and native English speakers for the U.S. sample were included. Participants received credit toward fulfilling course requirements. Participants were administered a group of standardized tests that included the Booklet Category Test, Color Trails Test, Stroop Color Word Test (Golden version), and Woodcock Johnson III subtests of Auditory Working Memory, Visual Matching 2, and Decision Speed. Macao participants were tested in Cantonese and U.S. participants were tested in English. Results: Groups did not differ significantly in reasoning ability as measured by the Booklet Category Test. For U.S. participants, processing speed and executive functioning variables explained 18% of the variance in reasoning, which was significant at p = .02. Standardized beta weights indicated that working memory was the strongest predictor. Processing speed and executive functioning variables explained only 6% of the variance in reasoning for Macao participants, which was not statistically significant. Conclusion: This study contributes to the limited knowledge of neuropsychological test performance in Chinese and indicates a similar level of competence on the Booklet Category Test.
Correlations Between Cultural Factors and Verbal Measures Administered in Spanish
Objective: The purpose of this study was to examine the relationship between acculturation, self-reported English Language Proficiency (ELP), measured ELP, Cognitive-Academic Language Proficiency (CALP), and test performance of Spanish/English bilingual adults on Spanish verbal tasks. Method: Data were collected from volunteers who participated in the Nova Multilingual Neuropsychological Battery Study (NMNB). The sample included 26 Spanish/English bilinguals, with a mean age of 28.38 (SD = 6.9). The average education level of the sample was 16.33 (SD = 1.77). Eighteen participants were females and eight males. Participants were administered the following verbal subtests of the battery: Semantic Memory, Semantic Memory Delay, Categorical Fluency, Verbal Learning, Verbal Learning Delay, Oral Word Recognition, and Oral Word Recognition Delay from the NMNB. Participants were also administered the Bilingual Verbal Ability Test. Results: Pearson's correlation analysis revealed significant correlations between acculturation and self-reported English proficiency (r = .554, p = .003), measured ELP (r = .587, p = .002), and CALP (r = .549, p = .004). There was only one significant correlation between measured self-reported acculturation and Categorical Fluency (r = − .592, p = .001). No other significant differences were observed on the other verbal subtests examined. Conclusion: Findings from this study indicate that verbal fluency as measured by the Categorical Fluency subtest evidenced a significant negative relationship with acculturation. This finding is consistent with previous studies, suggesting that Hispanic Americans do not maintain bilingualism status and tend to lose verbal fluency on their language of origin. Hence, it appears as bilinguals become more acculturated and proficient in the second language, verbal fluency in the first acquired language decreases. This relationship evidences interference from second language to first language.
Correlations Between Cultural Factors and Verbal Measures Administered in English
Objective: The goal of this study was to analyze the relationship between measured acculturation, self-reported English Language Proficiency (ELP), measured ELP, Cognitive-Academic Language Proficiency (CALP), and test performance of Spanish/English bilinguals on English verbal tasks. Method: Data were collected from volunteers who participated in the Nova Multilingual Neuropsychological Battery Study (NMNB). The sample included 26 Spanish/English bilinguals, with a mean age of 28.38 (SD = 6.9) and an average education of 16.33 (SD = 1.77). The average of years of completed education in the United States was 11.25 (SD = 4.9). Eighteen participants were females. The participants were administered the Bilingual Verbal Ability Test and the following verbal subtests: Semantic Memory, Semantic Memory Delay, Categorical Fluency, Verbal Learning, Verbal Learning Delay, Oral Word Recognition, and Oral Word Recognition Delay from the NMNB. Results: Pearson's correlation analysis revealed significant correlations including between self-reported acculturation and self-rated English proficiency (r = .554; p = .003), measured ELP (r = .587, p = .002), and CALP (r = .549, p = .004). There were no significant correlations between the cultural factors and cognitive test performance. Conclusion: Results indicate that measured acculturation is significantly correlated with self-reported ELP, measured ELP, and CALP. These results suggest that acculturation and second language proficiency do not affect performance on verbal tasks when the bilingual speakers are highly acculturated to the second culture acquired and the language of administration is English. Although the mechanism by which acculturation affects test performance on neuropsychological measures is not certain, it is likely that familiarity with testing situation may attenuate the effects of acculturation on neuropsychological performance.
1, 2, 3, 4 … I Declare Norms War! Comparison of the Mitrushina Meta-Norms, Heaton, and Comprehensive Neuropsychological Normative System Demographic Norms in a Matched African American and White Sample
Objective: Demographic correction of normative data is thought to be particularly important for minorities. We examined whether different normative systems on the Trail-Making Test (TMT) produced significantly different results between African Americans and Whites. Method: TMT data from 198 clinical cases were utilized. African Americans (n = 99) were individually matched to White participants (n = 99) on age, gender, education, and IQ. African American mean ± SD descriptors: age (23.7 ± 7.7), years of education (13.6 ± 2.0), and WAIS-III full-scale IQ (92.9 ± 13.0). White mean ± SD descriptors: age (23.7 ± 7.8), years of education (13.5 ± 2.0), and WAIS-III full-scale IQ (95.4 ± 11.1). Both were 55% male. TMT parts A and B raw scores were standardized using the Mitrushina meta-norms (age, education, gender), Heaton norms (age, education, gender, ethnicity), and Comprehensive Neuropsychological Normative System (CNNS) norms (age, gender). Results: Individual regressions predicting normed TMT-A scores ranged from 0.91 to 0.97 for African Americans and from 0.89 to 0.94 for Whites. For TMT-B scores, regressions ranged from 0.88 to 0.94 for African Americans and from 0.85 to 0.90 for Whites. Paired samples t-tests comparing norms systems by ethnic groups found significant differences for TMT-B for the CNNS norms, t(97) = − 2.74, p = .007, and Mitrushina meta-norms, t(97) = − 2.13, p = .035. Conclusion: The normative systems produced more similar results for African Americans than White individuals. Despite being the only system to correct for ethnicity, the Heaton norms did not produce significantly different results from either CNNS norms or Mitrushina meta-norms. The CNNS and Mitrushina norms produced disparate results between African Americans and Whites for TMT-B.
Ethnic Differences Among Core Subtests of the Wide Range Assessment of Memory and Learning, Second Edition
Objective: The purpose of this study was to determine if ethnic differences exist on the core subtests of the Wide Range Assessment of Memory and Learning, Second Edition (WRAML-2). Method: This study incorporated archival data from the School Neuropsychology Post-Graduate Certification Program. Participants included 225 children ages 6–18 belonging to one of the four ethnicities of Caucasian, African American, Asian, or Hispanic. Six WRAML-2 subtests were utilized: Story Memory, Verbal Learning, Design Memory, Picture Memory, Number/Letter, and Finger Windows. To determine if significant differences existed between groups, a multivariate analysis of variance (MANOVA) was computed. Results: Results confirmed a significant main effect for the subtests; Pillai's Trace was 0.177, F(18, 654), p = .002, partial eta squared = .059. Univariate tests indicated significant differences existed for Story Memory, F(3, 221) = 4.323, p = .006, partial eta squared = 0.055, and Verbal Learning, F(3, 221) = 6.107, p = .001, partial eta squared = 0.077. Tukey's post hoc analysis showed Asian children performed significantly lower than Caucasian children on Story Memory. For Verbal Learning, Asian children performed significantly lower than African-American children. Conclusion: Children from different ethnic groups performed similarly on most WRAML-2 subtests. However, Asian children appeared to perform significantly lower on Story Memory and Verbal Learning, which are both language-intensive subtests.
Cultural Specificity of Post-concussive Symptoms: An Investigative Study in Ghana
Objective: This study investigated the extent to which symptoms of post-concussive syndrome (PCS) are manifested in a healthy, indigenously resident tropical African population. PCS symptom expression has been extensively studied in the Western world and Asia, but not a single investigation of PCS has been conducted in sub-Saharan Africa to date. This study sought to fill this void. Method: Seven hundred and twenty-nine university students (41% males) in Ghana, recruited via campus-wide flyers, participated in this study. Exclusion criteria were history of neurological, psychiatric or psychological illness, and alcohol/illicit drug use. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Beck Depression Inventory-II (BDI-II) were administered. Participants' mean age was 25.22 (SD = 7.03) years. Results: There was no significant difference between the sexes on the RPQ (t = − 0.522, p = .54) or the BDI-II (t = 0.683, p = .45). Demographic variables of age and gender had no influence on PCS symptom expression. Results showed high base rates of post-concussive symptoms. Specifically, 1 in 10 of participants complained of moderate to severe problems in forgetfulness, poor concentration, and slowed thinking. Fifteen percent reported moderate/severe problems with irritability and anger. Almost 8% reported similar problems with restlessness. Comparisons of these data with those reported by healthy university students in China and Hong Kong (Wang et al., 2006) and Canadians (Iverson and Lange, 2003) show similar, high base rates. Conclusion: We showed that post-concussive symptoms elicited from self-report instruments lack specificity. We echo Zakzanis and Yeung's (2011) admonishment that clinicians should not rely on self-report symptoms as the sole means for diagnosing PCS because of the high base rates in the normal population across cultures.
Neuropsychological Test Performance of Ethnic Minority Juvenile Delinquents
Objective: Despite the lack of culturally appropriate normative data, neuropsychological test results are sometimes used in making high-stakes decisions about nondominant culture adjudicated youth. The current study compared neuropsychological test performance for Caucasian and non-Caucasian adolescent delinquents. Method: Participants were 46 adolescents ages 13–17 (mean = 15.54; SD = 1.15) who carried a diagnosis of Conduct Disorder and were mandated for treatment by the court. They resided at either a correctional facility or residential treatment facility in Oregon. Participants were placed into two groups: Dominant culture (Caucasian; n = 23) and Nondominant culture (all other ethnicities; n = 23). Groups were matched on gender (74% male, 26% female) and age (±4 months). Participants were assessed on measures of vocabulary, visuospatial construction, auditory-verbal memory, visual-graphic memory, spelling, word-reading, working memory, response inhibition, and conceptual reasoning. Results: Significant differences were found only for visual-graphic memory, F(1, 44) = 6.001, p = .018, with the non-dominant group outperforming the dominant group. There were no significant differences on other measures. Conclusion: Overall, these data do not suggest clinically significant differences based on ethnicity in a juvenile delinquent population. Significant findings on a test of visual-graphic memory were unexpected and need to be replicated to determine if they could be due to error or selection bias. A major limitation of this study is that the non-dominant ethnic group was composed of multiple ethnic minority groups, and future research should consider geographical influences, language fluency, literacy, SES, acculturation, and individual cultural groups.
Abdominal Fat and Cognitive Performance: The Dallas Heart Study
Objective: To explore the relationship between abdominal adiposity and subsequent cognitive performance in a community-based diverse sample by utilizing multiple measures of abdominal fat. Method: Four measures of abdominal adiposity that were collected during the first phase of the Dallas Heart Study, a multicultural investigation of cardiovascular risk factors, were examined: (a) waist circumference (WC), (b) body mass index (BMI), and MRI-derived measures of abdominal (c) subcutaneous fat (SAT) and (d) visceral fat (VAT). The Montreal Cognitive Assessment (MoCA) was administered to the same participants 7 years later (n = 1,374, mean age = 51). The relationship between these adiposity measures and MoCA was examined using the Pearson correlation and multiple-linear regression models accounting for traditional risk factors. Results: In the total sample, there were very small but statistically significant negative relationships between MoCA and WC (r = − .09, p < .01), BMI (r = − .08, p < .01), and SAT (r = − .05, p < .05), even when controlling for age, race, gender, education, poverty, diabetes, and hypertension. When stratified by ethnicity, the relationship was observed only in the African-American sample, WC, r(640) = −.07, p < .05, and VAT, r(640) = −.13, p < .001. Conclusion: Several measures of abdominal adiposity earlier in life showed small correlations with a global measure of cognition obtained several years later. Specifically, there were small inverse relationships between WC, BMI, and SAT with MoCA scores obtained later, particularly among African Americans. Findings support the idea that middle age abdominal obesity may have negative implications for cognition, in addition to cardiovascular and endocrine systems, and that effects may vary among ethnic groups.
Non-Simultaneous Bilateral Anterior Thalamic Lesions in a 46-Year-Old Caucasian Female
Objective: Damage to thalamic nuclei as the result of stroke or hemorrhage may cause impairment in cognitive and affective domains. Approximately 12% of all thalamic infarctions are in the anterior regions. This case illustrates assessment and intervention of a 46-year-old Caucasian female with bilateral, non-simultaneous, anterior thalamic lesions. This case is remarkable in that these strokes were sustained at separate times. A literature review did not yield a report of a similar case. Method: The patient presented to an outpatient psychiatric clinic with complaint of depressed mood, apathy, hypersomnia, and memory changes after suffering a stroke. Radiological studies demonstrated an acute, right-sided anterior thalamic infarct and an older, left-sided anterior thalamic infarct. She was referred for neuropsychological evaluation and started on Duloxetine 60 mg for depressive symptoms with good response. Neuropsychological testing was conducted ∼5 months post-stroke. The patient was administered tests of global intellectual ability, memory, executive functioning, and sensorimotor abilities. Results: Results of testing revealed memory scores in the Extremely Low range, largely consistent with the amnesic profile associated with lesioning of this kind. Results of executive functioning tests were mixed, with scores in the Average range or better on some tests; this was not expected. Conclusion: This unique case illustrates non-simultaneous infarcts to the anterior regions of the thalamus with neurocognitive and affective changes. It demonstrates the potential benefit of using psychotropic medications to treat affective changes and the use of neuropsychological testing for enhancing diagnostic clarity and additional management.
Impairments in Attention and Working Memory May Predict Steadiness and Accuracy of Force of Quadriceps Muscles in Subacute Stroke
Objective: We examined the relationship between measures of attention and working memory with measures of steadiness and accuracy during maintenance of isometric knee extension in inpatient stroke survivors undergoing rehabilitation. Impaired performance on lower extremity force tasks has been associated with worse mobility outcomes in stroke survivors. We hypothesized that patients with impaired attention and working memory would have greater difficulty maintaining force steadiness and accuracy. Method: Contralesional and ipsilesional legs were tested in a sitting position (n = 26, mean age = 59.9, SD = 14.29; days post-injury = 17.46, SD = 5.33). After the peak maximum voluntary contraction (MVC) of quadriceps was established, subjects maintained 10%, 20%, 30%, and 50% of MVC as steady and accurately as possible for 10 s, matching voluntary force to the target level displayed on a monitor. Coefficient of variation (CV) and root-mean-square error (RMSE) were used to quantify force variability (steadiness) and force error (accuracy), respectively. Attention and working memory were measured through WAIS-III Digit Span. Results: Digit span forward was significantly correlated with CV for the ipsilesional side at the lowest force level (10% MVC, p < .05), whereas digit span backward was significantly correlated with CV for the contralesional side (10% MVC, p < .05; 20% MVC, p < .05) and RMSE (20% MVC, p < .01; 30% MVC, p < .05) at lower force levels. Conclusion: Overall results suggest that impairments in attention and working memory may contribute to impairments in steadiness and accuracy of isometric force control in stroke survivors, particularly on their contralesional side.
Impact of Obesity upon Change in FIM Scores During Acute Rehabilitation from Cerebrovascular Accident
Objective: To determine the impact obesity has upon functional recovery from acute cerebrovascular accident (CVA) in patients receiving inpatient rehabilitation. Method: Participants (n = 64) were 51% Caucasian and 54% male (mean age = 67.25, SD = 10.3; mean education = 12.4, SD = 2.6; 44% left hemisphere, 42% right hemisphere, 14% bilateral), who experienced acute CVA prior to admission to an inpatient rehabilitation hospital. Data were collected through the retrospective chart review of all CVA patients admitted in late 2012. Rehabilitation outcomes were assessed through the cognitive and motor subscales of the Functional Independence Measure (FIM). The level of depression was assessed through the Geriatric Depression Scale (GDS), and Body Mass Index (BMI) scores were calculated upon admission. Results: Hierarchical regression was performed with age, ethnicity, CVA laterality, education, and GDS score at Step 1 and BMI at Step 2. BMI was found to be a significant individual predictor of FIM motor change at discharge (p < .05) and uniquely accounted for 29% of the variance in motor FIM score changes. BMI did not significantly predict changes in FIM cognitive scores and was not correlated with any cognitive variables. Conclusion: CVA patients with higher BMI scores upon admission demonstrated smaller changes in total motor FIM scores over the course of rehabilitation, suggesting a disadvantage in their ability to progress physically in comparison with their normal weight peers.
Attention, but not Processing Speed, Predicts Learning Curves on a Verbal Memory Task among Stroke Patients
Objective: The effects of attention and processing speed on memory for verbally presented information have been repeatedly explored in the literature. The current study seeks to add to the literature by examining the effects of these variables on the initial encoding of verbal information through learning curves among patients in an inpatient stroke rehabilitation unit. Method: Data from 47 inpatients (27 male, 20 female) in a stroke rehabilitation inpatient unit were examined. Average age and education were 64.65 (SD = 11.81) and 12.21 (SD = 2.75), respectively. Prior to discharge, each patient underwent a full battery of neuropsychological tests that included WAIS-III Digit Span and the RBANS. Mixed model analyses were run with age, education, RBANS Coding, and Digit Span raw scores predicting learning curves on the RBANS List Learning trials. Results: Higher WAIS-III Digit Span raw scores were significantly associated with steeper learning curves on the RBANS List Learning subtest (F = 7.47, p < .05). In addition, a trend toward a significant interaction of WAIS-III Digit Span scores and age was observed (F = 4.20, p = .05), in which attention scores made more of an impact on learning curve slopes as age increased. Coding scores were not associated with learning curves. Conclusion: Findings suggest that in an inpatient stroke population, more intact complex attention, but not processing speed, is associated with steeper learning curves on a verbal list learning memory task. This study provides additional evidence of the importance of attention in successful encoding of verbal information.
Differentiation of Alzheimer's Disease and Thalamic Infarction on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Objective: Lesions of the medial temporal and diencephalic regions can correspond to similar neurocognitive deficits. The RBANS is relatively short and reliable screener of neurocognitive functioning. The current study sought to evaluate what differences and similarities would emerge from groups associated with lesions of these aforementioned anatomical regions. Method: The performances of 48 patients diagnosed with Alzheimer's disease and 12 patients diagnosed with documented thalamic stroke were compared. All participants completed the RBANS in its entirety. Comparisons were made between groups across the five broad domains of immediate memory, visuospatial/construction, language, attention, and delayed memory. Results: Multivariate analysis suggested a significant difference existed between groups. Further analysis identified primary differences were found in immediate memory and delayed memory domains. In both cases, the Alzheimer's disease performed significantly worse though both groups were at least 2 SDs below the normative mean. Although no significant difference existed between groups across the additional domains, groups still demonstrated prominent impairments in attention, language, and visuospatial/constructional functioning. Conclusion: Overall, results demonstrate that while both Alzheimer's disease and thalamic infarction correspond with pronounced neurocognitive impairment on the RBANS, Alzheimer's disease is associated with significantly greater impairment in both immediate memory and delayed memory.
Neuropsychological Findings in a Patient with Limbic Encephalitis Associated with NMDA Receptor Antibodies
Objective: This case study describes the neuropsychological results of a 21-year-old, Caucasian, single right-handed female college student who was diagnosed with limbic encephalitis associated N-methyl d-aspartate (NMDA) receptor antibodies in May 2010. Method: The NMDA receptor is a specific ionotropic glutamate receptor. Syndromes associated with this type of encephalopathy often initially manifest with psychiatric symptoms. GE's initial symptoms of paranoia and other psychotic features warranted a 2-week inpatient psychiatric admission in January 2009. In March 2010, she developed an acute onset of physical symptoms including dysarthria and dominant right upper extremity weakness. A cerebral MRI was noteworthy for periventricular white matter lesions. Cerebral spinal fluid (CSF) analysis was negative. She was emergently admitted to a medical center for neurological observation. During that period, she developed a generalized seizure and placed on mechanical ventilation. Pelvic scans were negative for ovarian teratoma, a precursor for the syndrome. She was eventually diagnosed with limbic encephalitis in May 2010 and treated accordingly with chemotherapy. She was referred for baseline neuropsychological consultation. Results: Results of GE's neuropsychological evaluation (10/5/10) suggested suble adaptive impairments as indicated by scores on standardized neurological indices (Halstead Impairment Index 0.4, General Neuropsychological-Deficit Scale 14). Primary deficits were in areas of sustained attention/conentration, delayed visual memory, tactual localization memory, and bilateral upper extremity grip strength. Conclusion: This case study underscores the importance of obtaining baseline neuropsychological data in individuals diagnosed with limbic encephalitis associated with NMDA receptor antibodies to assist in developing treatment recommendations with specific emphasis toward educational reintegration.
Health Literacy in HIV-Associated Neurocognitive Disorders (HAND)
Objective: This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which represents the functional and critical competencies involved in accessing, understanding, appraising, and applying health information. Health literacy has clear implications for clinical neuropsychology and the management of chronic infectious disease, but has not been thoroughly investigated in HAND. Method: Participants included 46 HIV+ individuals classified into persons with (n = 17) or without (n = 39) HAND, and 15 demographically comparable seronegative comparisons who were matched on oral word reading. Each participant was administered validated measures of health literacy, including the Expanded Numeracy Scale (ENS) and the Newest Vital Sign (NVS), alongside a comprehensive neuromedical and neuropsychological evaluation. Results: A series of one-way ANOVAs revealed significant omnibus differences in performance on the ENS and NVS measures (ps < .05), which were driven by poorer performance in the HAND group relative to the seronegatives (ps < .05; Cohen's d = 0.8 and 0.9), who did not differ from HIV+ individuals without HAND (ps > .10). Within the HIV+ group, poorer health literacy performance was moderately associated with higher HIV RNA in CSF and with self-reported difficulty managing health care in daily life. Conclusion: Results demonstrate notable deficits on measures of health literacy in individuals with HAND that are associated with poorer HIV disease outcomes, which is consistent with prior research linking low health literacy to poorer medication management in HIV (Kalechstein et al., 1999). Further research should investigate the specific neurocognitive (e.g., decision-making) mechanisms of health literacy, as such insight may play a critical role in the management of HAND.
Lower Memory-Related Quality of Life in Older HIV-Infected Adults
Objective: Despite the propensity for HIV infection and normal aging to be associated with memory impairment and poorer quality of life (QoL), little is known about the direct effects of such cognitive deficits on QoL in older HIV-infected adults, a growing and vulnerable segment of the HIV-infected population. Method: Participants included HIV-infected and healthy comparison adults, who were stratified by age group in a 2 × 2 design (i.e., oldHIV+ [n = 103], youngHIV+ [n = 64], oldHIV− [n = 69], youngHIV− [n = 63]). In context of a comprehensive neuropsychological evaluation, all participants completed the Survey of Memory-Related Quality of Life (SMRQoL), a 30-item self-report questionnaire comprised of 15 prospective memory-specific (PM) and 15 retrospective memory-specific (RM) items linked to conventional QoL domains (i.e., general, mental health, physical functioning, social functioning, activities of daily living). Results: An ANOVA revealed a significant effect of HIV/age group status on the SMRQoL total score (p < .001), even when considering potential confounding factors on which the groups differed (e.g., depression). Planned comparisons revealed that the older HIV+ participants experienced significantly lower SMRQoL total scores relative to the other three study groups. Within the older HIV+ sample, the SMRQoL total score was significantly associated with poorer general health-related QoL, memory complaints, self-reported functional dependence, clinician-rated functional disability, and objective neurocognitive impairment (all ps < .05). Conclusion: Findings suggest that older HIV-infected adults may be particularly susceptible to diminished QoL due to self-perceived memory deficits, and highlight the need for cognitive rehabilitation efforts that may ultimately improve indices of daily living in this population.
Neuropsychological Findings Following Cerebellar Arteriovenous Malformation Rupture
Objective: We present two detailed cases referred for neuropsychological evaluations following extensive cerebellar vascular injury due to arteriovenous malformation (AVM) ruptures. The first case describes a 55-year-old Guyanese male (MB), and the second involves a 57-year-old, Caucasian female (CM). While they differ extensively in proximity to and lateralization of injury, as well as in social, educational, and cultural factors, both highlight the emerging view of the cerebellum as integral for a diverse array of neuropsychological functions. Method: MB presented to the emergency department in 2010 with headache, numbness, and seizures. Neuroimaging revealed hemorrhage in the right cerebellum, intraventricular hemorrhage, subarachnoid hemorrhage, vermian AVM, ruptured posterior inferior cerebellar artery (PICA) aneurysm, and acute hydrocephalus. CM presented to the emergency room in 2006 with the “worst headache of her life,” left dysmetria and nystagmus. Imaging showed bilateral cerebellar hemorrhages, left greater than right. Subsequent resection revealed a grade 3 left cerebellar AVM with PICA and superior cerebellar artery feeders and deep venous drainage. Results: Neuropsychological evaluation revealed two distinct cognitive profiles, though both individuals showed slowed processing speed, executive dysfunction, and low mood. Areas of discrepancy are reviewed in light of differing demographic factors, lateralization of injury, and extent of associated neurological damage. The importance of poly-etiologies on cognitive status and confounding factors to profile interpretation are also discussed. Conclusion: Although traditionally regarded as subserving motor functions primarily, these cases underscore the complexity of cerebellar processes and their extensive, diverse contribution to cognitive functioning.
The Diagnosis and Treatment of Idiopathic Hydrocephalus in the Very Elderly: A Case Study
Objective: A case study of idiopathic hydrocephalus (IPH) is presented to exemplify the complexity of arriving at a differential diagnosis between IPH and secondary hydrocephalus (SH). IPH is a condition of unknown etiology, as opposed to SH in which traumatic brain injury, a tumor, a hemorrhage or an infection are examples of known causes. Variables such as arthritis and declining brain size increase the complexity of differentiating IPH from SH. Method: An 89-year-old woman sustained a mild head trauma in a fall. Brain imaging showed enlarged ventricles without gyral atrophy. She had a history of urinary tract infections and had severe arthritis. After the fall she was treated by a rheumatologist with high doses of Vitamin D. She declined a lumbar puncture to confirm the diagnosis of NPH and a need for shunting by her neurologist. Therefore, the diagnosis of idiopathol NPH was made on the basis of the CT scan. The NPH triad of symptoms (gait, mentation, and urination disorders) appeared soon thereafter. Results: After beginning high-dose vitamin D, her arthritis improved. Improvement was also seen in the triad of symptoms for idiopathic NPH as measured by the serial assessment of gait, mentation, and urination frequency. Advanced Clinical Solutions estimated premorbid function of 111 and WAIS-IV Information subtest scaled score of 10 showed current verbal information knowledge to be average. Conclusion: The serndipidous finding of improvement in NPH symptoms after vitamin D treatment supported the hypothesis that vitamin D might be an alternative treatment strategy for suspected IPH patients who decline shunting.
Cognitive Reserve Influences Neuropsychological and Everyday Functions Among Individuals Infected with Hepatitis C
Objective: Higher levels of cognitive reserve (CR) may be protective against the neuropsychological manifestation of neuropathology across a variety of clinical disorders. However, the role of CR in the expression of neurocognitive deficits among persons infected with the hepatitis C virus (HCV) is not well understood. Method: Thirty-nine HCV-infected participants were classified as having either high (n = 19) or low (n = 20) CR based on education attainment, word reading, and IQ scores. A sample of 40 demographically comparable healthy adults (HA) was also included. All participants completed the Neuropsychological Assessment Battery (NAB), Delis–Kaplan Executive Function System (D-KEFS), and Behavioral Rating Inventory of Executive Function (BRIEF). Results: Linear regression analyses, controlling for gender, depression, and lifetime substance use disorders, found significant effects of the study group (HCV High CR, HCV Low CR, and HA) on fluency, attention, executive function, memory, and everyday function T-scores (ps < .05, adjusted R2 range = .09–.18), but not in learning or the BRIEF (ps > .10). Pairwise comparisons revealed that the HCV Low CR group performed significantly below the other cohorts (ps < .05), who did not differ from one another (ps > .10). Conclusion: Although HCV infection may increase the risk of neurocognitive impairment, HCV-infected persons with high CR performed similarly to HA in the majority of cognitive domains and everyday functions. Higher levels of CR may, therefore, be protective of the neurobehavioral manifestation of neural injury associated with HCV infection. Future studies on the longitudinal protective value of CR on incident HCV-associated neurocognitive declines and everyday functioning outcomes (e.g., employment) may be warranted.
Intra-individual Variability in Prodromal Huntington's Disease: The Relationship between Dispersion Across Neuropsychological Tasks and Genetic Burden
Objective: The current study sought to examine the utility of intra-individual variability (IIV) across a neuropsychological battery for detecting cognitive decline in prodromal Huntington's Disease (HD). Method: Participants were categorized based on estimated time to diagnosis using CAG-Age-Product (CAP) scores developed by Zhang and colleagues (2010): Low (>15 years; n = 186), Medium (9–15 years; n = 246), and High (<9 years, n = 261). A control group (n = 191) of non-gene expanded individuals was also used. The coefficient of variation (CoV; intra-individual standard deviation/mean T-score) was used as a measure of dispersion across 15 tasks in the PREDICT-HD study's battery. CoV scores were compared with two individual tasks: Symbol Digit Modality Test (SDMT) and Paced Timing. Results: After adjusting for BDI-II and Motor Score using ANCOVA, there was an effect for the CAP group, F (3,877) = 11.25, p < .0001, for CoV, with significantly more dispersion within the High group compared with the Medium, Low, and Control groups. There were no significant differences among the other groups. However, Cohen's d values for comparisons with the High and Medium CAP groups were larger for SDMT (High = − 0.81; Medium = − 0.37) and Paced Timing (High = − 1.02; Medium = − 0.43) than for CoV (High = 0.56; Medium = 0.14). Conclusion: Increased dispersion in individuals closer to HD diagnosis is consistent with the dementia literature, suggesting increased IIV may be a marker of cognitive decline in prodromal HD. However, CoV was not as sensitive to cognitive decline as individual neuropsychological tasks.
Long-Term Outcomes and Adjustment Following Electrical Injury
Objective: Literature on neuropsychological effects of electrical injury (EI) has grown in recent years but due to a paucity of longitudinal investigation, it remains largely unknown what factors contribute to poorer recovery outcomes. The current investigation extends the original study by Fink and colleagues (1999) and reports on the long-term psychosocial and functional outcome following EI. We investigate adjustment to injury, return-to-work status, and potential neuropsychological predictors of later psychosocial adjustment. Method: Participants included seven male EI patients who completed an initial neuropsychological assessment and participated in the follow-up study by Fink and colleagues (1999). The follow-up protocol was re-administered via telephone interview and included a brief survey of employment and litigation status, neuropsychological symptom checklist, and Psychosocial Adjustment to Illness Scale, Self-Report (PAIS-SR). Participants had an average age of 50.4 (SD = 7.4) and were interviewed at average of 199.1 months (SD = 26.4) post-injury. Results: We found that participants showed an overall increase in self-reported psychological distress, t(6) = − 3.16, p < .05. Although the original study revealed correlations between return-to-work status to poorer adjustment in several domains of functioning, the current results show significant differences only in vocational environment functioning. Conclusion: This select subset of EI patients reveals ongoing difficulties across numerous areas of functioning as evidenced by the lack of improvement in psychosocial adjustment scores between the initial and current follow-ups. Moreover, there was an increase in psychological distress since the first evaluation. These results highlight the persistence of adjustment problems and somatic complaints in addition to worsening psychological issues across long-term outcomes of EI.
ADHD Assessed with Self-Report Does not Predict Neurocognitive Performance in Abstinent Opiate and Amphetamine Users
Objective: Impulsivity is a core feature of drug addiction and one of the main symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). The specific aim of this study was to investigate whether the presence of ADHD would predict performance on two neurocognitive measures of impulsivity and attention in currently abstinent heroin and amphetamine users. Method: A total of 173 currently abstinent heroin (n = 56) and amphetamine users (n = 40) and 77 healthy control participants completed two measures of response inhibition/”motor impulsivity”: the Stop Signal Task (SST) and the Immediate Memory Task (IMT). Participants in the drug groups met DSM-IV criteria for past heroin or amphetamine dependence, whereas control participants had no history of substance dependence. The total score of the 25-item self-report Wender Utah Rating Scale (WURS) was used to measure symptoms of ADHD. Results: Multiple regression analyses revealed no significant relationship between a self-report measure of ADHD symptoms (WURS) and performance on two measures of impulsivity and attention. The effects of ADHD symptoms on neurocognitive performance were not influenced by drug status either. Conclusion: In our sample of heroin and amphetamine users, retrospectively assessed childhood symptoms of ADHD were not related to neurocognitive performance on tasks of motor impulsivity. Research with adults with ADHD has shown that neurocognitive impulsivity tends to wane over the years, which may explain why higher scores on the WURS did not predict performance. Our sample consisted of currently abstinent individuals; thus, results may also indicate that impulsivity decreases after long periods of abstinence.
Shame and Multiple Sclerosis
Objective: This study examined basic and moral emotions in individuals diagnosed with multiple sclerosis (MS) and aimed to show that shame is uniquely related to depressive symptomatology and quality of life. Method: Nine individuals (5 male, 4 female; mean age of 45 and 11 years since diagnosis) with relapsing-remitting and secondary progressive MS from a community MS support group volunteered as participants. Measures included the Test of Self-Conscious Affect-3 (TOSCA-3), vignettes of personal scenarios for which individuals rated intensity of emotions (anger, embarrassment, guilt, sadness, and shame), Beck Depression Inventory-II (BDI-II), and subtests of the MS Quality of Life Inventory. Results: Shame was uniquely related to loss of function in several socially relevant areas (e.g., bowel control, r = .81) and had the strongest relationship of emotions studied (r = .64–.85) to depression. Interestingly, greater shame, in contrast with less guilt, appeared to be related to the perceived loss of functioning over time from initial diagnosis to present. Anger and embarrassment only related to current functioning. Finally, shame demonstrated the most consistent connection to reduced quality of life in areas of physical, cognitive, and psychosocial functioning (r = .49–.90). Conclusion: Results revealed that shame does exist in individuals with MS and highly correlates with an apparent gradual loss of functions relevant to the social domain, a loss of quality of life, and increased depressive symptomatology. These findings inform the understanding of emotional changes in the disease progression and should be considered in symptom management and psychotherapeutic treatment programs for individuals diagnosed with MS.
Self-Predictions of Prospective Memory Performance in HIV Infection: Evidence of a Meta-memory Deficit
Objective: HIV infection is associated with deficits in prospective memory (PM; remembering to remember), which confer risk of declines in everyday functioning. One potential moderating factor of such functional decline may be awareness of one's PM abilities (“meta-PM”); however, little is known regarding meta-PM in HIV. Our study examined meta-PM in HIV-infected and control participants. Method: Performance-based PM abilities (Memory for Intentions Screening Test), self-reported prediction of PM performance, and PM complaints in everyday life (Prospective-Retrospective Memory Questionnaire) were assessed in 49 individuals with HIV-associated neurocognitive disorders (HAND), 93 HIV+ without HAND (noHAND), and 121 seronegative adults (HIV−) matched on demographics and lifetime substance use disorders. Results: After controlling for depression, HAND individuals reported lower confidence in predicted PM performance, more PM complaints in everyday life, and worse actual PM performance when compared with noHAND and HIV− individuals (ps < .05). However, among HAND individuals, PM prediction and complaints were not related to actual PM performance (ps > .05). Overconfidence in PM predictions (PM performance − PM prediction) was associated with greater executive dysfunction (rho's = 0.33–0.34, ps = .02) within the HAND group, but not mood or PM complaints (ps > .05). Conclusion: HIV+ individuals with neurocognitive impairment evidenced a meta-PM deficit, such that overconfidence in PM was associated with greater objective executive dysfunction, but not affective functioning. Individuals with HAND, especially with deficits in PM and executive functions, may be at risk of overestimating their PM abilities thereby leading to errors in daily functioning (e.g., absence of compensatory strategy use when needed). Interventions to improve awareness of HIV-associated cognitive limitations are warranted in this population.
Anoxic Ischemic Encephalopathy After Prolonged Cardiac Arrest: Neuropsychological and Neuroimaging Profiles
Objective: In anoxic ischemic encephalopathy (AIE), the brain is deprived of oxygen, resulting in inadequate tissue perfusion as sequelae of cardiac arrest, asphyxiation, carbon monoxide poisoning, or traumatic brain injury. Current availability of CPR, AED equipment, and body cooling procedures (Arctic Sun) enable more patients to survive. This case study describes neuropsychological and neuroimaging profiles of two cases of AIE after prolonged cardiac arrest. Method: Two patients with AIE were seen for neuropsychological testing. Case 1 is a 54-year-old, right-handed Caucasian male whose cardiac arrest and resuscitation lasted longer than 20–30 min. Case 2 is a 41-year-old right-handed Caucasian male whose cardiac arrest and resuscitation lasted at least 45 min in addition to the “Arctic Sun” (several hours). Results: Neuropsychological testing revealed moderate to severe neuropsychological deficits of a diffuse, global nature including severe amnestic syndromes, executive dysfunction, attention, language, and processing speed impairments, personality changes, and organic mood disorders. Case 1 exhibited severe anosagnosia and Case 2 exhibited moderate anosodiaphoria. MRI findings in Case 1 indicated “global findings and hyperintensity of the left frontal/parietal lobes near the vertex and associated gyral thickening.” CT indicated “cerebral edema.” In Case 2, MRI indicated “a punctate area of signal dropout in the right basal ganglia.” This poster provides an in-depth analysis of neurocognitive and neuroimaging similarities/differences in the manifestations of AIE sequelae for both cases. Conclusion: With advanced life-sustaining techniques following cardiac arrest, AIE survival is increased. Neuropsychological evaluation is crucial in identifying and correlating deficits with neuroimaging and providing a blueprint for successful rehabilitation.
The Acute Cognitive Effects of the Z-drugs: A Systematic Review and Meta-Analysis
Objective: To investigate which domains of cognitive function are affected by the ingestion of z-drugs and whether there are certain z-drugs that produce more adverse effects on cognition than others. Data sources: MEDLINE and PsycINFO (search dates between 1 January 1980 and 3 December 2012). The cognitive tests were categorized as measuring one of six cognitive domains (speed of processing, psychomotor speed, verbal memory, verbal reasoning, working memory, and attention). Mean weighted effect sizes were calculated to determine the overall and drug-specific effect sizes for each z-drug on each domain of cognitive functioning. Data synthesis: A total of 14 studies met the inclusion criteria. Ingesting zolpidem the previous night induced small to moderate deficits in verbal memory performance in healthy adults; all other effect sizes were not statistically significant (ES = − 0.33, 95% CI spanning −0.51 to −0.14). No statistically significant mean weighted effect sizes were found for any domain of cognition following the ingestion of zopiclone. When the effect size data for cognitive performance following the ingestion of both zopiclone and zolpidem was combined, the only domain significantly impaired was verbal memory. Conclusion: The pattern of results revealed by this meta-analysis suggests that the use of zopiclone has less deleterious effects on cognition in healthy adults than does zolpidem, which appears to have specific deleterious effects on verbal memory performance only. These observations may have implications for clinicians as well as providing the foundations for more thorough investigations into the cognitive effects of z-drugs for insomnia patients.
A Longitudinal Study Evaluating Neuropsychological Function Across the First Two Months of Remission from Methamphetamine Dependence
Objective: Although cross-sectional studies reveal significant cognitive deficits during remission from methamphetamine (MA) dependence, few longitudinal studies have characterized change in cognition across remission. The purpose of the present longitudinal study, therefore, was to determine whether MA dependent adults experience significant cognitive improvements over a 2-month remission period. Method: Demographically matched (age, gender, ethnicity, estimated baseline cognitive function) groups of MA-dependent adults (MA+ group, n = 25) and non-dependent controls (CTLs, n = 15) were recruited through addiction treatment centers and the community in Portland, OR, USA. The MA+ group completed a comprehensive neuropsychological test battery following 2 weeks and 2 months of abstinence. CTLs completed testing at baseline and six months later. Results: A 2 (Group) × 2 (Visit) factorial ANOVA was calculated for each cognitive measure. Significant (p <.05) group effects indicated that the MA+ group performed significantly worse than CTLs on measures of auditory verbal memory, visual-spatial memory, visual processing speed/attention, complex working memory/divided attention, and cognitive flexibility/inhibition. Significant visit effects indicated that both groups displayed significant practice effects on several measures. Only one interaction effect was significant; this interaction indicated that the MA+ group significantly improved on one test of immediate visual-spatial memory, while CTLs did not. Conclusion: Results confirm that MA-dependent adults experience significant cognitive impairments during remission. However, except on one subtest, our MA+ group did not evidence significant cognitive improvement across the first 2 months of remission, suggesting that longer periods of abstinence are required for notable cognitive recovery.
Effects of Sleep and Fatigue on Prospective Memory in Multiple Sclerosis
Objective: Symptoms of fatigue and sleep disturbances are a major concern for the multiple sclerosis (MS) population, having been shown to relate to impaired neuropsychological functioning and reduced quality of life. However, investigations of how fatigue and sleep affect functionally relevant cognitive abilities such as prospective memory (PM) in MS are limited. PM is the ability to carry out future intentions and is particularly relevant to patients because of its effect on medical adherence. The current study explores the impact of sleep and fatigue on PM in MS. Method: Thirteen community-dwelling individuals with MS (mean age = 45.9) completed a single 2-h testing session. Measures administered included the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), and the Memory for Intentions Test (MIST). Results: Results suggest that PM (MIST Total Score) is correlated with trouble sleeping (r = − .600, p < .05), and self-rated sleep quality, r = − .737, p < .01. Analysis using stepwise multiple linear regression indicated that specific PSQI and FSS items relating to sleep quality and fatigue emerged as significant predictors of overall performance on a standardized PM task (MIST Total Score); this model was able to account for 96% of the variance in MIST performance, F(2,4) = 43.98, p = .002. Conclusion: Preliminary results suggest sleep quality and fatigue may independently predict PM in the MS population and are better predictors of PM than variables such as age, education, or disease severity. Though further study is needed, targeting sleep quality and fatigue among individuals with MS can provide guidance for rehabilitation and interventions.
Performance Trends on the Montreal Cognitive Assessment in Untreated Parkinson's Disease and Healthy Controls
Objective: As recommended by the Movement Disorder Society (MDS) taskforce guidelines, neuropsychological tests, as well as screening instruments for cognitive impairment and dementia are often used to assess Parkinson's disease (PD) with Mild Cognitive Impairment (PD-MCI). The detection of impairment and improvement or decline in cognitive function is crucial for diagnostic as well as therapeutic decisions. The aim of this study was to compare cognitive screening performance trends in participants with de novo, untreated PD and healthy controls (HCs) over time using the Montreal Cognitive Assessment (MoCA). Method: Participants who had completed the MoCA at baseline, 12 months, and 24 months were selected from the Parkinson's Progression Markers Initiative (an international, multisite, case–control clinical study conducted at 21 academic movement disorders centers). Participants were recently diagnosed (within 2 years), untreated PD patients (n = 29), and HCs (n = 20). A two-way repeated mixed analysis of variance was conducted to assess participants' MoCA performance at baseline, 12-month, and 24-month follow-up. Results: MoCA total scores were significantly different between PD and HCs across at all three time points, F (1,47) = 4.71, p ≤ .05 partial eta squared = 0.091. However, there was no significant interaction between MoCA scores and time within either group, Wilks' Lambda = 0.932, F (2,46) = 0.016, p > .05. Conclusion: MoCA scores did not significantly change over 2 yearly intervals in PD and HC participants. A clinical implication is that continued screening intervals past 2 years may be necessary to detect changes in MoCA total scores compared with baseline.
Relationship Between the CNS Penetrative Effectiveness (CPE) Index and Years of HIV Infection on Identifying Cognitive Domains of Initial Decline on the Montreal Cognitive Assessment (MOCA)
Objective: Screeners for mild neuropsychological deficits could have great utility in identifying those most at risk for cognitive decline due to HIV infection. The Central Nervous System Penetrative Effectiveness (CPE) Index classifies anti-retroviral treatments by their ability to efficiently cross the blood–brain barrier. The current study is examining the interaction between the CPE index and years of infection to determine what cognitive domains are most impacted by a lower penetrative index on the Montreal Cognitive Assessment (MOCA). Method: Subjects were 19 HIV-positive adults (73% male) who completed the MOCA. Nadir CD4+ count, CPE index, and years since diagnosis were derived from the chart review of medical records. Results: The mean total MOCA score was 23.89 (range = 16–30; SD = 2.99), which was below the standard MOCA risk cutoff. MOCA scores clustered into three factors: Concept Formation, Attention, and Executive Functioning. Regressing MOCA Concept Formation on years since diagnosis, CD4+ count, and CPE index yielded a main effect for CPE (R2 = .15). Regressing Executive Functioning on the same model plus interactions yielded a main effect for CPE (R2 = .19) and an interaction between years diagnosed and CPE (R2 = .16). Conclusion: The CPE index and its interaction with years of HIV diagnosis holds promise as an index of risk for cognitive sequelae. In addition, HIV patients show considerable variability in MOCA scores. Thus, more research is needed to understand its potential as a predictor of cognitive ability and functional decline in HIV-positive populations.
Do Patients Spontaneously Report Sleep Problems in the Clinical Interview?
Objective: This study aims to assess the incidence of patient's sleep complaints reported spontaneously during the clinical interview and through direct assessment using a questionnaire. Method: Forty patients, 40% female, referred for neuropsychological evaluation were interviewed to obtain information about relevant history and current symptoms as part of standard practice in an outpatient neuropsychological clinic. Investigators coded whether patients spontaneously reported sleep complaints during the interview. Additionally, all patients were administered the Pittsburg Sleep Quality Questionnaire (PSQI), an 18-item self-report measure commonly used to identify good and poor sleepers. Results: Patients in this sample reported mean sleep duration of 6.42 h (SD = 2.0) and a sleep onset latency mean of 32.4 min (SD = 33.8). PSQI data places 72.5% (n = 29) of the sample above the cutoff for poor sleep quality (PSQI > 5). Strikingly, only 27.5% (n = 11) of patients reported sleep difficulties in the clinical interview. An independent sample t-test suggests that those who acknowledged sleep problems during the interview have more severe sleep problems, indicated by higher PSQI scores (p = .01, 95% CI [−6.9, −9.7]). Conclusion: Consistent with past research, a high frequency of neurologic patients report a poor sleep quality when formally assessed. Nonetheless, this data suggest that only a fraction of those with poor sleep quality are reporting sleep problems in the clinical interview. This suggests if clinicians are not directly assessing sleep during the neuropsychological evaluation, they may be missing a large percentage of patients with poor sleep quality.
Relationship between Learning, Recall, and Recognition and Fornix Microstructural Integrity in Recently Detoxified Alcoholics: A 1-Year Longitudinal Study
Objective: This study examined the association between white matter integrity in fornix, a tract affected in Alcoholic Korsakoff's Syndrome, and memory/learning in recently detoxified alcoholics (RDA). Method: Fifteen male RDA (mean age = 51.4 years) from San Diego VA were examined 2 weeks and then 1 year after abstinence and compared with 15 age and education matched controls. Measures included story memory learning, delayed recall, and recognition, as well as fractional anisotropy of fornix (FAF). Results: There was a statistically significant interaction between time and group in FAF, F(1, 28) = 16.43, p < .001. Further analysis indicated that the two groups differed significantly on FAF at 2 weeks, t(28) = − 3.88, p < .001, and at 1-year post-abstinence, t(28) = − 2.01, p = .05. The RDA had lower FAF at both time points. Both groups exhibited significant change over time, with RDA FAF increasing, t(14) = 2.43, p = .03, and control decreasing, t(14) = − 3.33, p = .005. Although the two groups did not differ significantly on any measure of memory, RDA showed deficits (mean T-score < 40) on learning. A significant positive correlation, r = .65, p < .01, was observed between increases in FAF and learning performance at follow-up in RDA. Conclusion: The fornix is susceptible to the effect of alcohol and does not completely recover after 1 year of abstinence. The learning deficits observed in RDA appear to ameliorate with abstinence and are associated with increased FAF.
Assessing the Lateralization of Cingulum Bundle Injury among Recently Detoxified Alcoholics and its Relation to Visual versus Verbal Memory and Learning
Objective: The cingulum bundle (CB), a white matter tract in the Papez circuit, has been shown to be affected in recently detoxified alcoholics (RDA), with the right hemisphere more impacted than the left. The current study examined potential lateralization in CB microstructural integrity in relation to verbal versus visual memory and learning among RDA. Method: Fifteen male RDA (mean age = 51.4 years) from the San Diego VA Healthcare System were examined and compared with 15 age and education matched controls. Measures included Story and Figure Memory Learning, Delayed Recall, and Recognition from the Expanded Halstead-Reitan Battery, as well as fractional anisotropy of the CB (FACB). Results: Although FACB was found to be lower among RDA in both the right, t(28) = − 2.38, p = .02, ω2 = 0.14, and the left hemisphere, t(28) = − 2.96, p = .006, ω2 = 0.21; none of the verbal or visual memory or learning measures correlated with this white matter integrity index. Conclusion: Contrary to previous findings, both the left and the right CB are susceptible to the effect of alcohol. Although the CB is part of the Papez circuit which has recently been found to be involved in memory processes, changes in its microstructural integrity does not seem to be correlated with memory or learning in RDA (VA Merit Review SA-320).
Myotonic Dystrophy Type 1: A Case Study
Introduction: Myotonic dystrophy is a branch of muscular dystrophy that is characterized by weakness and degeneration of skeletal muscles. Primarily found in adults, myotonic dystrophy type 1 (DM1) is a progressive disease that has multisystemic impacts. DM1 is considered to be the most common form and more severe subtype. Patients diagnosed with DM1 often experience a decline in strength and evidence cognitive impairments including executive dysfunctioning; however, data related to this topic are limited. Psychological concerns most commonly associated with DM1 include: depression, anxiety, and decreased quality of life. Method: Data were collected on a right-handed, 44-year-old female who was referred for a neuropsychological evaluation in order to assess the extent and nature of cognitive impairment including short-term memory loss. Reported symptoms included the inability to look upward, poor balance, impaired fine motor skills, upper and lower extremity weakness, fatigue, and dysphasia. Cognitively, the patient reported a progressive onset of deficits including sustained attention, processing speed, expressive language, word-finding, multitasking, short-term memory, and problem-solving. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed significant weaknesses in working memory, processing speed, verbal fluency (phonemic and semantic), visual organization, visual perception, and variable performance in attention and abstract problem-solving. With regard to mood, there was evidence of significant anxiety and severe depression, with suicidal ideation. Conclusion: The patient presented with frontal, frontal-subcortical, and more right-hemisphere based deficits secondary to DM1. Neuropsychological assessment can be extremely helpful in clarifying etiology and extent of difficulties, thereby guiding intervention.
From Conversion Disorder to Creutzfeldt–Jakob Sisease: A Case Highlighting the Importance of Clinical Flexibility and Differential Diagnosis
Objective: There is considerable heterogeneity in the few documented cases of sporadic Creutzfeldt–Jakob disease (sCJD) initially presenting with rapid language deterioration. Furthermore, psychiatric symptoms and negative or non-specific studies may delay diagnosis. This case illustrates the value of a comprehensive approach and the ability to maintain healthy skepticism when confronted with anomalous, circumscribed neuropsychological findings. Method: A 62-year-old female presented with 12 weeks of anxiety, progressive speech difficulties, and right-sided numbness. Significant psychosocial stressors led to suspicion of conversion disorder given unremarkable medical findings. A thorough neuropsychological assessment was completed to characterize cognitive difficulties. Results: Testing revealed focal deficits in verbal expression and verbal working memory, including impaired fluency, spelling, repetition, and conversational expression. Digit span, but not spatial span, was impaired. Comprehension, semantic processing, and narrative writing were intact. Fluctuating and unusual speech production difficulties appeared most consistent with apraxia of speech. She endorsed mild to moderate levels of depression and anxiety. Two weeks after evaluation, she presented with worsening language dysfunction, intermittent abnormal movements (right > left), and gait disturbance. Electroencephalography showed abnormal activity, and subsequent neuroimaging and spinal fluid analysis indicated probable CJD. Language continued to rapidly decline, with ultimate involvement of other cognitive domains. Dementia progressed until death, 17 weeks after symptom onset. Biopsy confirmed CJD. Conclusion: This case contributes to understanding CJD progression, emphasizing that sCJD may first present with psychiatric symptoms and focal cognitive deficits. It also highlights the complicated interplay between personality and psychosocial variables, neuropathologic changes, and symptom profiles, with implications for early detection, differential diagnosis, and clinical decision-making.
Progressive Cognitive, Motor, and Psychiatric Impairment in a Young Patient with Antiphospholipid Antibody Syndrome
Objective: Antiphospholipid syndrome is an autoimmune condition characterized by venous and arterial thrombosis in the presence of antiphospholipid antibodies. Involvement of cerebral vessels is frequent, and patients often present with transient ischemic attacks and strokes. Although less common, other clinical features have been described including: movement disorders, seizures, psychiatric features, migraines, and cognitive impairment ranging from subtle to severe. Method: The patient is a 41-year-old female diagnosed with antiphospholipid antibody syndrome at the age of 27. She has experienced TIAs for 15 years, with approximately 2–3 per year. She had depression for 7 years and associated psychosis for 4 years. Her motor abilities have reportedly declined over the past 3 years, and she now stumbles and/or falls on a regular basis. Her cognitive abilities have progressively declined for at least 3 years as well. The patient and her husband also stated her vision seems to be worsening. Neuroimaging with MRI showed bilateral white matter disease and “significant cortical atrophy.” The patient has not been diagnosed with lupus, although recent ANA testing was positive at 1:640. Results: Neuropsychological testing was valid and revealed significant global cognitive impairment. Learning, executive functioning, and visuospatial ability were among the most profoundly impaired. Psychomotor retardation and significant spasticity were also noted, resulting in the discontinuation of motor testing. Depression and anxiety screening tests indicated moderate levels of both. Conclusion: This is a rare case associating Antiphospholipid Antibody syndrome with multiple neurologic manifestations including severe neurocognitive dysfunction. Evidence from both neuroimaging and neuropsychological testing confirmed the neurologic and neurocognitive deficits.
Internal Carotid Artery Dissection Following Chiropractic Neck Manipulation: A Case Study
Objective: Literature suggests that the sudden hyperextension and rotation of the neck during chiropractic manipulation may put stress on the internal carotid artery causing dissection. Only a handful of cases of internal carotid artery dissection occurring in close temporal relation to chiropractic manipulation have been reported in the professional literature, however. This study presents an individual who developed an internal carotid artery dissection with subsequent ischemic CVA following chiropractic neck manipulation. Method: The patient was a 44-year-old male with no medical history other than neck and back pain. He sought chiropractic manipulation therapy secondary to the pain. Ten days after chiropractic manipulation of the neck, the patient developed an abrupt headache, neck ache, slurred speech, and left-sided weakness. He was taken to a hospital where a CT study showed a hyper-acute infarct in the right MCA territory. A follow-up MRI showed the development of ischemia with thrombosis of the right internal carotid artery. A cerebral angiogram showed a right internal carotid artery occlusion secondary to dissection. The patient was started on an anticoagulant, and his functioning greatly improved. Results: A comprehensive neuropsychological evaluation was performed approximately 2 months after the CVA. Neuropsychological testing was valid and consistent with a non-dominant, right hemisphere insult. Visuospatial planning, constructional ability, and visuospatial memory were substantially below premorbid expectations. Mental processing speed was also below expectations. Conclusion: Internal carotid artery dissection is a rare occurrence after chiropractic neck manipulation. This study presents one such case where there is a close temporal relationship between the condition and chiropractic manipulation.
The Effects of Changes in Mood on the Self-Report of Neurocognitive Dysfunction in Women Treated for Cancer
Objective: Neurocognitive impairment in women with breast cancer (BC) following diagnosis and cancer treatments is an evolving area of research. A subgroup of BC survivors report considerable, persistent difficulties after treatment. However, the concordance between objectively assessed and self-reported neurocognitive functioning has been low. We hypothesized that non-treatment related factors, such as distress, may influence perceived cognitive dysfunction. Using data from an ongoing study, we investigated the impact of change in mood from pre- to post-treatment on self-reported cognitive functioning. Method: One hundred and sixty BC participants completed the Brief Symptom Inventory (BSI) and the Behavioral Rating Inventory of Executive Functioning (BRIEF) prior to any treatment, and again at 1-month post-treatment. Sample characteristics of participants were as follows: Age (M = 60.83, SD = 7.22) and Education (M = 13.98, SD = 1.93). Results: Change in mood levels were associated with changes in the BRIEF Behavior Regulation Index, r(160) = .19–.20, p = .01, and BRIEF Metacognition Index (MCI), r(157) = .23–.29, p = .001–.004, such that as distress decreased, self-report of cognitive difficulties also decreased. Repeated measures ANCOVA results (controlling for age and education) based on categorizing change in BSI depression and anxiety scores in three groups (1, decreased; 2, increased; 3, same) found that the “increased” group had significantly increased MCI scores-Depression: F(2,151) = 4.24, p = .01, 95% CI [52.24,55.49] and Anxiety: F(2,151) = 3.80, p = .02, 95% CI[52.16,55.97]. Conclusion: Pre–post changes in mood appear to be accompanied by corresponding changes in self-report of cognitive functioning, as measured by the BRIEF, among BC patients. Mood may play a contributory role in the experience of treatment-related cognitive decline, and future research should further elucidate this relationship.
Relationship of Psychosocial Factors on Perceived Cognitive Functioning in Multiple Sclerosis
Objective: Individuals with multiple sclerosis (MS) commonly have greater cognitive complaints than objective neuropsychological findings. This study examined the relationship between cognitive complaints and depression, fatigue, sleepiness, and objective neuropsychological testing in MS. Method: One hundred and three patients (age = 44.4 [11.43]) with MS were administered self-report measures of cognitive symptoms (Multiple Sclerosis Neuropsychological Questionnaire [MSNQ]), fatigue (Modified Fatigue Impact Scale [MFIS]), depression (Quick Inventory of Depressive Symptoms [QIDS]), and daytime sleepiness (Epworth Sleepiness Scale [ESS]), in addition to the Oral Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and California Verbal Learning Test-II Short Form (CVLT-II). Stepwise linear regressions were performed to examine the impact of psychosocial and cognitive variables on cognitive complaints. Results: Overall levels of fatigue, sleepiness, and depression were mild (MFIS = 44 [18.40]; ESS = 9 [5.20]; QIDS = 10 [5.79]) and cognitive performances were low average for the PASAT (T = 41 [15.50]) and average for the SDMT (T = 48 [15.53]) and CVLT-II (Total T = 49 [12.20]; Long Delay Free Recall T = 47 [10.54]). Stepwise linear regression revealed that MFIS, ESS, and QIDS accounted for 56% of the variance in MSNQ scores, F(3, 96) = 39.85, p < .001, with fatigue accounting for 44% of the variance. Of the cognitive variables, only SDMT was significant, accounting for 15% of the variance in the MSNQ, F(1, 95) = 16.75, p < .001. Conclusion: Self-report measures of fatigue, daytime sleepiness, and depression were better predictors of cognitive complaints than objective cognitive functioning, with fatigue the most significant predictor. These findings suggest that psychosocial factors, particularly fatigue, have a major influence on perception of cognitive abilities and are areas to target for treatment to reduce the cognitive burden of MS.
Relationship Between Hours of Sleep and Cognitive Performance in Individuals with Multiple Sclerosis
Objective: To examine the association between hours of sleep, fatigue, and sleepiness on cognitive performance in individuals with Multiple Sclerosis (MS). Method: Ninety-two highly educated (M = 15.41 [2.21]) MS participants (mean age = 44.77 [11.13]) were administered a neuropsychological battery and reported hours of sleep the previous night. Data were collected as part of a broader longitudinal study examining cognitive functioning in MS. Pearson's r correlations were obtained between hours of sleep the previous night and cognitive variables, including verbal fluency, Oral Symbol Digit Modalities Test (SDMT), Stroop Color and Word, California Verbal Learning Test-II, and Brief Visuospatial Memory Test-Revised (BVMT-R). Daytime sleepiness (Epworth Sleepiness Scale; ESS) and fatigue (Modified Fatigue Impact Scale; MFIS) were also examined. Subjects were stratified into low/medium/high groups based on sleep hours, ESS, and MFIS; t-tests were performed between low/high groups across measures. Results: Correlations were not significant between sleep hours and neuropsychological measures, and there were no significant differences between high/low sleep groups and neuropsychological performances that would survive a Bonferroni correction. Daytime sleepiness (ESS) did not correlate with any of the cognitive variables, but fatigue (MFIS) was associated with SDMT (r = − .33, p = .002) and BVMT-R total (r = − .32, p = .002). Significant differences were also seen between high/low MFIS groups and SDMT, t(51) = 2.95, p = .004, but there were no cognitive differences between the high/low ESS groups. Conclusion: These results suggest that self-reported hours of sleep the previous night and subjective daytime sleepiness are not associated with cognitive performance in patients with MS. However, objective fatigue may affect aspects of processing speed and memory in this clinical population.
Longitudinal Case Study of an Adolescent with Multiple Episodes of Acute Disseminated Encephalomyelitis
Objective: Acute Disseminated Encephalomyelitis (ADEM) is an inflammatory demyelinating condition of the central nervous system that is usually triggered by an infection. The few existing studies examining the cognitive effects of ADEM have shown that outcomes are variable, with some individuals continuing to show mild cognitive deficits (e.g., speeded processing, memory, visual spatial skills, and executive functioning) and emotional problems years after occurrence. There is very little to no longitudinal information on the cognitive outcomes for individuals with multiple episodes of ADEM. This is a longitudinal case study of an adolescent with two isolated episodes of ADEM. Method: Patient X is a 14-year-old Caucasian female with a history of two episodes of ADEM at ages 4 and 10 with recurrent optic neuritis. MRI brain scans revealed white matter and subcortical abnormalities. Multiple sclerosis was ruled out. Patient X underwent two neuropsychological evaluations at ages of 10 and 14. Results: Patient X's performance on follow-up neuropsychological testing was mostly consistent with her initial evaluation in that most neurocognitive skills were intact with weaknesses in visual attention and fine motor dexterity. In contrast, she demonstrated weaker visual scanning and processing speed, as well as planning, organization, and memory difficulties during follow-up evaluation. Patient X also has a history of hallucinations (occurring during episodes of ADEM or migraines), as well as suicidal ideation. Conclusion: Patient X's profile suggests that individuals with multiple episodes of ADEM may present with emerging weaknesses years after occurrence. Results are discussed within the context of ongoing development of and disruption to white matter.
Two Cases of Delusion of Inanimate Doubles, a Variant of Capgras Syndrome
Objective: The delusion of inanimate doubles (DID) is a misidentification syndrome characterized by a belief in inanimate doubles. A variant of Capgras syndrome (CS), research suggests that it occurs in 10% of cases. Typically, CS involves the delusion that a familiar person has been replaced by an imposter. Reduplicative paramnesias (RP) are delusions about a place being doubled. CS and RP are found after a variety of neurologic insults, most commonly neurodegenerative disease, and are hypothesized to involve right frontal lesions. We describe two cases (B and K) of DID also suspicious for frontal lobe pathology. Method: Both women were in their 70s and had a long (∼5 years), insidious history of decline with recent worsening. Both experienced sleeplessness and had normal blood work, with the exception of high cholesterol levels for K. MRI was unavailable. Both showed delusions of duplicated objects in the home (S, water heater; B, dishes and furniture replaced with a nearly identical one by acquaintances), whereas K also evidenced CS for her daughters, RP for cities, visual hallucinations, misperceptions, falls, and periods of confusion. Results: On exam, both women evidenced executive dysfunction, with anxiety about the delusions. K also had memory, visuospatial, and mild language impairments. K was diagnosed with Lewy Body Dementia and B with non-amnestic Mild Cognitive Impairment. Conclusion: Absent of their delusions, both women would have been able to remain living independently. These cases of DID support a relationship with frontal pathology. If diagnosed sooner, appropriate treatment may have allowed them to remain independent for longer.
Neuropsychological Profile of an 18-Year-Old Woman with Cerebellar Hypoplasia: Using Neuropsychological Strengths and Weaknesses to Guide Treatment and Vocational Planning
Objective: An 18-year-old woman with Cerebellar Hypoplasia (CH) was referred for neuropsychological evaluation to aid in treatment and vocational planning. Although the associated neuropsychological sequelae are variable depending on the etiology of the condition, patients diagnosed with CH typically present with developmental and speech delay, hypotonia, ataxia, and abnormal ocular movements. Method: Patient demonstrated that typical early development and early milestones were achieved within normal limits. Patient was diagnosed with Attention-Deficit/Hyperactivity Disorder at age 6. Psychopharmalogical interventions were initiated and continued sporadicaly for 2 years. When patient was 10-years old, an MRI head scan showed underdevelopment or hypoplasia of the cerebellum, with an unknown etiology. The following diagnoses were made: CH with developmental incoordination (stable or nonprogressive), mild mental retardation, generalized nonconvulsive epilepsy (well controlled), and progressive ataxia. Patient experienced increased sensorimotor deficits over time, required assistance with activities of daily living and adaptive behavior, and struggled with emotional regulation and social interaction. Patient's overall strengths were in visual spatial processing, phonemic awareness, verbal fluency, and concept formation abilities. Reading was an academic strength, with strong phonological decoding abilities. Patient's overall weaknesses were found in sensorimotor, attention, memory, and executive functioning domains as well as math achievement. Patient struggled on tasks requiring simultaneous storage and processing of information, likely due to working memory capacity. Visual scanning and tracking and motor dysfunction also negatively impacted math achievement and performance on tasks. Conclusion: Findings support the existing literature with this population, as her cognitve profile was commensurate with previous reports. Deficits in memory and executive function were also found, which provided additional information that helped guide treatment planning.
The Effects of Anxiety on Learning and Long-Term Memory in Depressed Patients
Objective: This study examined the relationship of anxiety in depressed patients to performance on a verbal learning and memory task, the California Verbal Learning Test, second edition (CVLT-II). Specifically, anxiety was hypothesized to have a greater effect on performance in the early stages of learning than on the later (delayed) memory tasks of the CVLT-II. Method: Using archival data, 101 depressed patients were included in this current study. The anxiety factor captured from a previous study's factor analysis of the Hamilton Depression Rating Scale (Gomez et al., unpublished) was correlated with CVLT-II Trial 1, Trial 5, Total Score 1–5, Short Delay Free Recall, Long Delay Free Recall, and Recognition Hits. Results: Preliminary results indicated significant correlations between the anxiety factor and Trial 1 of CVLT-II (r = − .283; p = .001) and the Total Score 1–5 (r = − .230; p = .005), but not with Trial 5 (r = − .112; p = .179). Anxiety does not appear to be correlated with Short Delay Free Recall (r = − .103; p = .218), Long Delay Free Recall (r = − .124; p = .135), or the Recognition task (r = .025; p = .762). Conclusion: The results suggest that anxiety may play a role in the learning or encoding of words in depressed patients. Anxiety does not appear to be related to performance to the storage or retrieval of the words based on short or long delayed free recall and recognition. This suggests that anxiety may not have a significant effect on longer termed memory.
Age and Gender Effects on the WRAML-2
Objective: This study examined the effects of age and gender on memory performance in children. Method: Participants included 73 boys and 55 girls. Individuals were grouped by age (58 participants ages 6–11; 70 participants ages 12–16) and administered the WRMAL-2. Results: A two-way MANOVA examined memory abilities between older and younger boys and girls on raw scores of all WRAML-2 subtests. There was a significant main effect of age, Λ = 0.80, F(15,110) = 1.82, p = .041, and gender, Λ = 0.80, F(15,110) = 1.84, p = .038, on memory performance. There was no significant interaction between age and gender. Bonferonni corrected pairwise comparisons were considered significant at p = .01. Results indicated females performed better than males on Verbal Learning Recognition. Older participants performed better than younger participants on Number Letter, Symbolic Working Memory, and Sentence Memory. Conclusion: There is limited research examining the effects of age and gender on memory in children. Results suggested that as children age they have an increasing memory capacity, particularly for verbal memory, regardless of gender. Results also indicate older children are better able to use effective learning strategies for auditory verbal information. It is interesting to note that there were no significant age differences on Finger Windows, which suggests that age affects performance on verbal but not on non-verbal recall. Results also show that girls are better able to recognize specific verbal information than boys and that older females have a slight advantage on verbal memory tasks compared with their male counterparts.
Age and Gender Effects on the WMS-IV
Objective: This study looks at age and gender effects on memory performance on the WMS-IV. Method: Participants included 70 males and 100 females, with an average age of 33.8 years (SD = 13.25) and an average education of 13.80 (SD = 2.05). Individuals were grouped by gender and younger (age 17–30) versus older (age 31–70) adults. A MANOVA examined memory abilities between younger and older men and women on raw scores of all WMS-IV subtests. Results: There was a significant effect of age and gender on memory performance, Λ = 0.67, F(40, 461.5) = 2.29, p < .000. A post hoc test, at α = 0.01, revealed that younger men scored 7.23 points better than older women on Verbal Paired Associates (VPA) I. Younger women scored 1.98 points more than older men on VPA II. Younger men scored 12.38 points higher than older men on Designs I. Younger women scored 9.31 points more than older women on Designs II. Younger men scored 3.42 points better than older men on Spatial Addition and 4.28 points more than older women. Conclusion: Results revealed that the effects of age on memory are in part due to gender. Younger women have better verbal and visual retention, whereas younger men perform better on immediate verbal and visual-spatial memory. It is unexpected that as men and women age, their visual-spatial working memory becomes approximately equivalent. This may indicate that men's visual-spatial working memory declines with age as women's remains the same. Future studies should examine how visual-spatial memory changes throughout life in men and women.
The Relationship between the WAIS-IV Working Memory Index and the WMS-IV Memory Indices
Objective: To investigate the relationship between the Working Memory Index (WMI) of the WAIS-IV and the memory indices inherent to the WMS-IV. Method: Participants included 69 males and 99 females, with average age of 33.96 (SD = 13.24) and average education of 13.82 (SD = 2.03). Participants were administered the WAIS-IV and WMS-IV as part of a comprehensive neuropsychological battery. The population was entirely chosen from an outpatient clinic or were volunteers for research studies; they had a wide variety of chronic psychiatric and neurological disorders but did not include individuals with severe memory problems as all clients were at least minimally functional on a day-to-day basis. Results: There were significant correlations between the WMI and Auditory Memory Index (r = .295, p = < .001), the WMI and Visual Memory Index (r = .400, p ≤ .001), the WMI and Visual Working Memory Index (r = .426, p ≤ .001), the WMI and Immediate Memory Index (r = .410, p ≤ .001), and the WMI and Delayed Memory Index (r = .383, p ≤ .001). Conclusion: Although correlations between the WMI and memory indices of the WMS-IV were significant, they were moderate at best, showing clearly that the WMI tests different constructs than the WMS and cannot be used to indicate the need for further memory testing. The lack of a strong correlation was most appealing between the WMI and the Auditory Memory Index, because both of the tasks that make up the WMI are auditory in nature. These results suggest the presence of additional mediating factors that impact performance on the WMI, which may include the individual's ability to attend to and concentrate on the stimuli.
Factorial Component Relationships of Visual Naming to Serial versus Semantic Verbal Learning Strategy and Intellectual Ability in a Mixed Neuropsychiatric Veteran Sample
Objective: We investigated the relationship of intellectual components and naming ability to use of logical versus rote verbal learning strategies on the California Verbal Learning Test (CVLT). Method: Our case sample included 240 clinically referred, diagnostically unselected inpatient and outpatient military veterans with mixed neuropsychiatric diagnoses. The 30 items of the Multilingual Aphasia Examination Visual Naming (VN) subtest were factored as a single group; two orthogonal factors were extracted. Factor scales based on those results were computed and re-factored separately with the Serial and Semantic Clustering indices of the CVLT. Results: The first Visual Naming factor (VN1) uniquely loaded on the CVLT Semantic Clustering Index. The second VN factor (VN2) uniquely loaded on the CVLT Serial Clustering Index. Factor scales were computed for these second order CVLT-VN components. Those factorial variables were refactored with Verbal Comprehension (VC), Perceptual Organization (PO), and Freedom from Distractibility (FFD) factorial components of the WAIS-R. The Semantic Clustering-VN1 factor uniquely loaded on the FFD component. Attention span and working memory features were associated with semantic processing. The Serial Clustering-VN2 component uniquely loaded on the VC component. Serial clustering was associated with use of over-learned verbal encoding strategies. Conclusion: These findings support the importance of joint interpretation of specific factorial naming, learning strategy, and Wechsler intelligence scale components when these measures are administered together in clinical evaluations.
Idaho Trail Learning Test (Idaho Trails): A Visuospatial Measure of Learning, Recall, and Retrieval
Objective: Most measures of visuospatial memory involve observing and/or copying a stimulus, with recall following a period of delay. Such approaches rely upon a presumption that learning occurred during the observation or copy condition. Further, most measures do not investigate if poor recall was a failure to learn or impaired retrieval. The present study adopted a trail learning approach first developed by Ruff and Light (1999). However, the current trail learning test (TLT) is designed to maximize learning potential and includes recall aids to assess retrieval problems. This poster presents preliminary evidence of reliability and validity for learning, recall, and aided retrieval of the TLT. Method: Ninety nine healthy adults (67% women) completed the TLT, CVLT-II, and the RCFT. Results: (a) Split half reliability was 0.898. (b) TLT learning and Trials-to-Criterion correlated .51 and −.37, respectively, with the CVLT-II learning and .46 and −.54, respectively, with the RCFT Immediate recall. (c) TLT Free Recall correlated .28 with CVLT-II Long-Delay Free Recall and .42 with RCFT Delay recall. (d) TLT Forced Choice (aided) Recall correlated .46 with CVLT LD Cued recall and .09 with RCFT Recognition. (e) Of 19 subjects who showed poor free recall, 15 subsequently improved with aided recall. Conclusion: Idaho trails have support as a visuospatial measure that establishes and distinguishes learning from recall. Evidence supports its reliability and validity. Preliminary evidence suggests that aided recall is effective. However, this component requires additional study with clinically impaired populations.
Comparing Learning Slopes of the Idaho Trail Test Across Age
Objective: The Idaho Trails Test (ITT) attempts to measure visual memory processes of encoding, storage, and retrieval. Learning slopes estimate the rate at which an individual can learn and reproduce new material over multiple trials. Learning slopes for the ITT have not yet been compared across age groups of healthy, non-clinical populations. Learning slopes were compared across three age groups (i.e., 17–35, 55–69, and 70–85) who completed the ITT. Method: Ninety-eight (66% female) primarily Caucasian adults aged 17–90 (M = 52.7) completed the ITT among a battery of executive functioning measures. To control for ceiling effects, only trials 1–10 of 15 were analyzed. Regression equations were calculated for each individual, yielding a regression slope and y-intercept for each subject. Results: Learning slopes did not differ significantly between groups, F(2, 95) = 1.919, p = .152, but there were significant differences between the y-intercepts of the three groups, F(2, 95) = 13.421, p < .001. After applying a Bonferroni adjustment, Fisher's LSD tests revealed individuals aged 17–35 started out with significantly more hits than either the 55–69 group, t(95) = 4.088, p < .001, 95% CI = 0.734 to 3.407, or the 70–85 group, t(95) = 4.701, p < .001, 95% CI = 1.182–4.108. Preliminary analyses revealed associations between learning slope and learning scores on the CVLT-II and RCFT. Conclusion: Age is not a reliable predictor of differences in learning slopes on the ITT; however, y-intercepts did vary. These findings support the use of learning slope as an indicator of learning.
Depressive Symptoms Moderate the Relationship between Subjective Memory Complaints and Objective Memory Performance in Ethnically Diverse Adults with Type 2 Diabetes Mellitus
Objective: This study examined the relationship between subjective memory complaints and objective memory performance, with depression as a potential moderator, in ethnically diverse adults with type-2-diabetes mellitus. Method: One hundred and two participants (M age = 57.3, SD = 8.6; M years of education = 13.64, SD = 3.24; 65.7% female; 59.8% Black; 24.5% Hispanic) were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Prospective and Retrospective Memory Questionnaire (PRMQ), and a semi-structured clinical interview for depression, the Montgomery Asperg Depression Rating Scale (MADRS). Pearson's correlations and multiple hierarchical linear regressions were performed. Controlling for education, the moderating effect of depression severity on the relationship between subjective and objective memory measures was also assessed. Results: Overall, participants presented with “mild” depression (M = 9.5, SD = 9.2). RBANS Immediate Memory (IM) was generally in the “low average” range (M = 87, SD = 15), and Delayed Memory (DM) was “average” (M = 90, SD = 15). Neither IM nor DM performance was significantly associated with memory complaints on the PRMQ or depression severity on the MADRS, whereas memory complaints and depression severity were significantly associated (r = .42, p < .001). As expected, the depression level moderated the relationship between memory complaints (PRMQ-Retrospective Memory) and IM (β = 0.25, p = .013). Specifically, at low levels of depression, no significant relationship was found between memory complaints and IM performance (β = − 0.18, p = .219). At high levels of depression, greater memory complaints were actually associated with better IM performance, whereas fewer complaints were associated with more memory impairment (β = 0.31, p = .024). Conclusion: Poor correlation between memory complaints and memory performance is consistent with previous reports in other patient populations. Depressed diabetes patients may over-report memory problems or may lack awareness of actual impairment.
Prediction of Ecological Memory Following Brain Damage: The Ecological Validity of Three Memory Measures
Objective: Assessing memory ability to predict patient functioning on return to work and home is a key component of any neuropsychological assessment. This study was designed to be an investigation of the ecological validity of three laboratory tests of memory: Ecological Memory Battery (EMB); Taylor Complex Figure, Tombaugh Administration; and California Verbal Learning Test (CVLT). The three tests were evaluated on their ability to predict later performance on the Memory Assessment Clinic's Self-Rating Scale (MAC-S), a subjective measure of perceived memory ability. It was also hypothesized that memory tests would predict return to work and independent living as reported by participants and informants. Method: Thirty neurologically impaired adults had been previously administered the EMB, CVLT, and Taylor during testing while receiving remediation services at a rehabilitation facility. Participants were later contacted by phone, administered the MAC-S and asked questions regarding return to work and independent living. An informant was also contacted to assess participants' current memory functioning. Results: CVLT measures of immediate memory, learning over trials, and recognition discrimination correlated significantly, although negatively, with self-report of change in memory speed (radj = .44, .45, and .47, respectively, p < .05). Trial two of the Taylor correlated (r = .54, p < .05) with self-report of perception of change in memory speed (radj = .50, p < .05). None of the CVLT, Taylor, nor EMB measures correlated significantly with independent living or return to work status. Conclusion: In general, laboratory tests of memory did not correlate significantly with the MAC-S. However, when laboratory tests did correlate significantly, the correlations tended to be negative.
The Relation between Obesity and Neuropsychological Functioning in Older Adults Is Specific to Hippocampal-Dependent Learning and Cannot be Explained by Other Vascular Risk Factors
Objective: Studies have shown mixed results regarding the relation between obesity and cognitive functioning across the lifespan, and few studies have evaluated whether this relation might be mediated by vascular risk factors. This study examined the relations between obesity (measured by body mass index; BMI) on global cognitive functioning, episodic memory, and executive functioning. Hypertension, diabetes, and hypercholesterolemia were evaluated as potential mediators of these relations. Method: Participants included 392 older adults with cardiovascular disease recruited from two urban hospitals. All completed a medical history and the following neuropsychological tests: Mini-Mental State Exam, the Hopkins Verbal Learning Test (HVLT), Mental Control, Trial-Making Test-B, Digit Symbol, and Digit Span Backward. Regression analyses were performed to determine if BMI was a significant predictor of any of the cognitive variables. Follow-up regressions exploring mediation of this pathway by hypertension, diabetes, and hypercholesterolemia were performed when appropriate. Results: After controlling for age, education, and stroke history, BMI accounted for a significant portion of the variance in two episodic memory measures: HVLT Percent Retained (B = − 0.12, t = − 2.19, p = .03) and HVLT Discriminability (B = − 0.11, t = − 2.15, p = .03). Follow-up regressions exploring relations with hypertension, diabetes, and hypercholesterolemia did not support full or partial mediation. Conclusion: In older adults with cardiovascular disease, there is a significant relation between obesity and hippocampal-dependent learning that is not explained by vascular risk factors. Longitudinal research is crucial to determine the direction of this relation: whether obesity-related cerebral pathology causes hippocampal dysfunction and episodic memory deficits or whether functional anomalies of the hippocampus affect episodic memory and metabolic pathways regulating hunger, satiation, and weight.
Order Matters: Effect of Wechsler Memory Scale-Fourth Edition Visual Working Memory Task Placement on Non-Verbal Memory Functioning
Objective: This study investigated the impact of test order on non-verbal Wechsler Memory Scale-Fourth Edition (WMS-IV) subtest performances. It was hypothesized that placement of visual working memory tasks between immediate and delayed non-verbal memory tasks would diminish delayed recall. Method: Young adults (n = 102; Mage = 18.86 [1.11]) were tested in a University setting. Group 1 (n = 61) did not have Symbol Span as an interpolated activity between Designs I and Designs II, whereas Group 2 (n = 41) did. Results: The group that did not have Symbol Span as an interpolated activity achieved higher Visual Memory Index scores (MGroup 1 = 111.51 [10.93]; MGroup 2 = 104.68 [12.642]; t(100) = 2.90, p = .01, d = 0.58). When Symbol Span was not administered between Designs I/II, participants performed more optimally on (a) Designs II (MGroup 1 = 11.97 [2.30]; MGroup 2 = 10.51 [3.00]; t(100) = 2.77, p = .01, d = 0.55) and (b) Symbol Span (MGroup 1 = 12.41 [2.54]; MGroup 2 = 10.61 [2.33]; t(100) = 3.62, p = .01, d = 0.74). Conclusion: It is widely recognized that verbal memory performances are impacted by test order. Current findings suggest that non-verbal memory functioning is similarly sensitive to the order in which tests are administered. If a clinician were to not administer Symbol Span between Designs I and II, these findings suggest that delayed recall of spatial designs and locations (Designs II) meaningfully increases. Continued research to understand relatively new and novel WMS-IV nonverbal memory and nonverbal working memory tasks is encouraged.
Early and Late Items of the Benton Visual Retention Test are Specifically Related to WAIS-III Summary Indices and Differentiable Components of Visual Naming
Objective: The early items of the Benton Visual Retention Test (BVRT) are easily named, whereas the later appearing items are relatively difficult to name. We tested the hypothesis that recall of the early BVRT items is verbally mediated, whereas late BVRT item recall is visually mediated. Method: We derived four index summary scores for the WAIS-III based on raw scores of the 13 WAIS-III subtests. The items of the Benton Visual Retention Test were factored into early item (1 – 4) and late item (5 – 10) subgroups. The items of the Multilingual Aphasia Examination Visual Naming (VN) subtest were factored into early item (VN1, items 1–21) and late item (VN2, items 22–30) subgroups. Orthogonal factor scales were calculated for all of these variables. All of the factor scales were refactored in a single analysis to determine their multivariate relationships. Results: The WAIS-III Verbal Comprehension (VC) and VN1 factors formed the first joint factor. The WAIS-III Perceptual Organization and Late BVRT factors formed the second joint factor. The WAIS-III Processing Speed, Early BVRT and VN2 factors formed the third joint factor. The WAIS-III Working Memory component identified the fourth joint factor. Simple structure was obtained for all four joint factors. Conclusion: VN1 and VC represent crystallized verbal abilities that do not influence BVRT performance. Late BVRT items and PO tasks were visually encoded, whereas Early BVRT items were rapidly visually recognized as well as verbally analyzed in a non-automatic manner (VN2). Attention and working memory were independent of these processes.
Visual but Not Verbal Memory Performance is Impaired in Veterans with Chronic Mild to Moderate TBI
Objective: Memory impairments have been documented in individuals with acute mild to moderate traumatic brain injury (TBI) and there is some evidence of faster recovery of verbal compared with visual abilities post-injury. However, few studies have examined differences between material-specific memory in a chronic TBI sample of military veterans. We thus investigated potential differences in performance on both verbal and visual material-specific memory tasks in individuals with chronic TBI compared with demographically comparable normal control participants. Method: Thirty veterans with a history of TBI (mean age = 32.2, mean months since injury = 78.33) and 26 demographically matched normal controls (NCs; mean age = 33.3) were administered the Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale, version 4. Results: A one-way MANOVA revealed a significant multivariate main effect between the groups, Wilks' λ = 0.798, F(4,51) = 3.23, p = .019, ηp2 = 0.202, with the TBI group performing worse on all memory tasks than NCs. Significant univariate main effects were found in immediate visual memory, F(1,54) = 8.51, p = .005, ηp2 = 0.136, and marginally significant effects were found in delayed visual memory, F(1,54) = 3.782, p = .057, ηp2 = 0.065. Performance in verbal memory did not significantly differ between groups (all p > .05). Conclusion: Findings revealed that in a chronic mild-moderate TBI sample of military veterans, visual memory but not verbal memory was significantly compromised compared with control participants. Results indicate that memory impairments in chronic TBI may be material-specific, and they underscore a need for comprehensive systematic neuropsychological screening and modality-specific treatment in this vulnerable population.
WRAML-2: Discriminatory Ability Between Clinical Groups
Objective: The purpose of this study was to determine if the core subtests of the Wide Range Assessment of Memory and Learning, Second Edition (WRAML-2) accurately discriminate between the clinical groups of Learning Disability, Neurological Impairment, Attention-Deficit/Hyperactivity Disorder, and Autism. Method: This study incorporated archival data from the School Neuropsychology Post-Graduate Certification Program. Participants included 442 children ages 6–18 previously identified with one of the aforementioned diagnoses. Six WRAML-2 subtests were utilized: Story Memory, Verbal Learning, Design Memory, Picture Memory, Number/ Letter, and Finger Windows. To determine if significant differences existed between groups, a multivariate analysis of variance was computed. Results: Results confirmed a significant main effect for the subtests; Pillai's Trace was 0.147, F(39, 1,284), p = .005, partial eta squared = 0.049. Univariate tests indicated significant differences existed for Picture Memory, F(3, 438) = 3.592, p = .014, partial eta squared = 0.024m and Design Memory, F(3, 438) = 3.659, p = .013, partial eta squared = 0.024. Tukey's post hoc analysis showed children with Neurological Impairment performed significantly lower than those with a Learning Disability on Picture Memory. For Design Memory, children with a Learning Disability performed significantly lower than children with an Autism Spectrum Disorder. Conclusion: Children from different clinical groups performed similarly on most WRAML-2 subtests; however, Picture Memory and Design Memory may be more sensitive, which may aid in differential diagnosis.
Benton Visual Retention Test Recall and Recognition Components are Selectively Related to Each Other, Age and Educational Level
Objective: Principal component dimensions of the Benton Visual Retention Test (BVRT), Multiple Choice BVRT (MCBVRT), and the WAIS-III were derived independently. Factor scales were computed for each component extracted. Factorial relationships among these variables were then examined to investigate their associations to each other. Method: The initial sample consisted of 246 veterans with mixed neuropsychiatric diagnoses who completed the BVRT and MCBVRT as clinical evaluation procedures. A subset of 115 patients who also completed the WAIS-III were studied in the analyses of BVRT, MCBVRT, and WAIS-III variables. There were no exclusion criteria. Two factors were extracted from analysis of the 10 BVRT items; five factors were extracted from analysis of the 16 MCBVRT items; and four factors were extracted from analysis of raw scores of the 13 WAIS-III subtest scores. Results: The early BVRT (trials 1–4) and the MCBVRT first factor were positively associated with the educational level. The late BVRT factor (trials 5–10) was related to the MCBVRT third and fourth factors; all of these components were inversely related to age. The first and fifth MCBVRT components were not related to age or educational. Conclusion: There is a systematic relationship of visual recall (BVRT) and recognition (MCBVRT) components to each other and to the WAIS-III indices, age and educational level. When these non-verbal memory measures are administered together in clinical evaluations the analysis of their component relationships to each other and to intellectual and demographic variables will increase the information that can be obtained from analysis of the individual component scores.
Development of an Executive Index in the Repeatable Battery for Assessment of Neuropsychological Status (RBANS)
Objective: The RBANS includes Attention, Language, Visuospatial, and Memory indices, but no explicit index of executive skills. This study determined whether an Executive Index can be derived from the 10 RBANS subtests. Method: Sixty-eight veterans and military in our outpatient Polytrauma Clinic, who screened positive for Traumatic Brain Injury, completed comprehensive neuropsychological tests. Our Executive Criterion was the average of 12 z-scores: Trails B, Numbers and Letters B, Letter-Number Sequencing, Digit Span Backward, Spatial Span Backward, Inhibition-Switching, Category Switching, Letter Fluency, Word Generation, Mazes, Abstraction, and Wisconsin Card Sort (internal-consistency reliability a = 0.7). We estimated premorbid IQ from Vocabulary and Word Reading, emotional distress from Beck Depression and Anxiety Inventories, and test effort from RBANS Effort Index. We created the RBANS Executive Index by averaging the two RBANS subtests that correlated most strongly with the Executive Criterion. Results: RBANS Coding and Semantic Fluency had the highest correlations with the Executive Criterion (r > .6). Their mean correlated strongly with the Executive Criterion (r = .8) and had acceptable internal reliability for a two-item scale (a = 0.68). Further analyses indicated this index taps executive organization, cognitive flexibility, and working memory. These correlations all remained significant after controlling for Processing Speed, Premorbid IQ, Depression, Anxiety, and Effort (partial r > .5). Conclusion: RBANS Coding and Fluency can serve as a brief Executive Index that has high correlation with standard executive tasks, acceptable reliability, and is relatively unaffected by non-specific cognitive and emotional factors. Cross-validation studies are needed to confirm sensitivity and specificity to executive deficits in other clinical populations.
Using a GPS Device While Driving Affects the Formation of Cognitive Maps
Objective: Using a global positioning system (GPS) device to navigate while driving has rapidly gained popularity. There are numerous cognitive mapping studies derived from controlled laboratory environments yet few studies have examined the impact of using a GPS device. The purpose of this study was to examine the effect of using a GPS on the formation of cognitive maps in a real world driving environment. Method: In a metropolitan area, 54 individuals were solicited for participation in two ways: either upon arriving at a new destination or at job sites that require employees to drive to new destinations regularly, for example, satellite installers or plumbers. Upon arrival at an unfamiliar destination, participants were asked to open an envelope, which included a cognitive mapping test. Participants were instructed to recall and execute a drawing of the route they had just taken. Cognitive mapping accuracy was determined by participants' ability to correctly identify the direction of each turn and street name. Accuracy of maps drawn by GPS users when compared with all other navigation tools. Other navigation tools included verbal directions, hand drawn maps, and computer printed maps and/or directions. Results: Independent-samples t-test results demonstrated that there was a significant difference in the scores for 34 GPS users (M = 54.68, SD = 22.00) and 20 users of all other navigation tools (M = 90.35, SD = 12.28) conditions; t(52) = − 6.65, p < .001. Conclusion: Using a GPS device to navigate significantly impairs the formation of cognitive maps.
Effects of Previous MMPI-2 Completion and Enhanced PAI Instructions in the Detection of Altered Self-Presentation
Objective: The Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) and Personality Assessment Inventory (PAI) are personality measures frequently used in Child Protective Services (CPS) evaluations, wherein such individuals may try to present themselves as extremely well-adjusted. As such, the purpose of the present study was to examine the effects of previous MMPI-2 completion and standard versus enhanced (i.e., warning of validity scales) instructions on the PAI in CPS evaluations. Method: Data were obtained via archival review of 748 individuals referred for CPS evaluations. Results: The groups differed significantly in level of education, F(4, 738) = 2.71, p = .03, which was also significantly correlated with the outcome measure (p < .01). Using education as a covariate, ANCOVAs yielded a significant main effect for previous MMPI-2 completion on one PAI clinical scale, drug: F(2, 738) = 3.03, p < .05. A significant main effect was found for instruction type on all PAI validity and clinical scales (p < 0.05) with enhanced instruction groups demonstrating greater response inconsistency, negative impression management and psychopathology. Additionally, significant gender differences were observed on several PAI validity and clinical scales (p < .01). Conclusion: Results suggest that instruction method and previous MMPI-2 completion can alter self-presentation on the PAI in CPS evaluations. Gender also appears to be a variable influencing PAI performance.
Comparison of Cognitive and Behavioral Phenotypes Associated with Three Different Genetic Deletion Syndromes
Objective: A genetic deletion occurs when a part of a chromosome or sequence of DNA is missing due to a mutation. Although deletion syndromes such as 22q have been garnering more research recently, many genes that affect cognition and behavior continue to be difficult to locate within the human genome. There is a need for more information regarding behavioral and cognitive phenotypes of specific genes. This poster explores three different genetic deletion syndromes: 22p, 18q, and 14q. Method: We administered neuropsychological assessments to three children with genetic deletion syndromes. Participant #1 was a 7:6 female with Xp22.31 deletion and diagnoses of developmental delay and hypoplasia of the corpus callosum, brainstem, and possibly frontal lobes. Participant #2 was a 12:8 male with 18q deletion in conjunction with leukodystrophy, intellectual disability, autism, and seizure disorder. Participant #3 was a 9:10 male with 14q13.2 deletion, partial agenesis of the corpus callosum, dyspraxia, and developmental delay. All were administered measures of cognition, adaptive skills, attention, executive function, visual-motor integration, and language. Participants #1 and #3 were also administered academic measures. Results: Results indicated severe cognitive and adaptive deficits across all three deletions, with the 18q and 14q deletions resulting in greater impairments than 22p. All showed strengths in social and emotional status. Strengths also included single-word receptive language in Participants #1 and #3. Conclusion: Results offer preliminary data on similarities across three relatively rare genetic deletion syndromes. Further research would help to provide more information to families and schools regarding cognitive and behavioral expectations.
MMPI-2 Clinical and Validity Scales Associated with Poorer Reading Performance for Highly Educated Clinical and Nonclinical Patients
Objective: Although the MMPI manual suggests that a sixth grade reading level is sufficient to produce a valid profile, there is evidence that this may be questionable. The purpose of this study was to examine how MMPI results relate to performance on the NDRT, a measure of vocabulary recognition and reading comprehension. Method: Participants from clinical (n = 187, education = 13.33, SD = 2.25, age = 32.08, SD = 12.49, 55% female) and non-clinical (n = 52, education = 15.00, SD = 2.60, age = 32.91, SD = 12.49, 54% female) populations were recruited from a University-based clinic. Individuals diagnosed with a Reading Disorder were excluded from the analysis. All participants had ninth grade education or higher. Results: All reported correlations were significant at p < .01. For the clinical sample, NDRT Vocabulary (VOC) was related to: L (r = − .22), F (r = − .19), Mf (r = − .19), Pa (r = − .17), and Ma (r = − .19), and for non-clinical: Hs (r = − .28) and Ma (r = − .28). For the clinical sample, NDRT Passage Comprehension (PC) was related to F (r = − .28), D (r = − .17), Pa (r = − .23), and Sc (r = − .24), and for non-clinical, Hs (r = − .47) and Ma (r = − .29). Conclusion: These results suggest that reading ability is significantly associated with performance on the MMPI in individuals with a greater than eighth grade education. All of the observed relationships were negative, suggesting that greater pathology elevations are associated with decreased reading ability. These results suggest that methods commonly used to measure test “readability” may underestimate the actual reading level of self-report instruments such as the MMPI. It is recommended that caution be taken when using the MMPI to inform clinical decisions with individuals who have less than a tenth grade reading level.
Prorating Verbal Comprehension and Perceptual Reasoning Indices on the WISC-IV
Objective: This paper examined relationships between prorated and full scoring methods on Verbal Comprehension and Perceptual Reasoning Indices (VCI/PRI) of the WISC-IV. Method: Participants included 25 youth (M age = 9.76, SD = 2.95). Diagnoses were primarily psychiatric (60%). Participants were administered WISC-IV core subtests, which were scored using standard scoring methods, and re-scored using each two-subtest VCI/PRI proration combination. Results: Results of a one-way repeated-measures ANOVA indicated no significant differences between VCI scoring methods, F(1.918, 72) = 0.958, p = .388. Proration combinations were highly correlated with the full VCI (r > .89); standard error for estimates did not exceed 2.93. Significant differences between PRI scoring methods emerged, F(1.311, 72) = 0.820, p = .015. Post hoc pairwise comparisons indicated that Block Design + Matrix Reasoning produced significantly lower scores than full PRI and other estimates and exhibited the highest standard error. Matrix Reasoning + Picture Concepts produced significantly higher scores than full PRI. Block Design + Picture Concepts correlated the highest with full PRI and had the lowest standard error. Conclusion: No significant differences between full and prorated VCI scores emerged. Block Design + Matrix Reasoning produced the lowest PRI estimates, correlated least with full PRI, and produced the highest standard error. Block Design + Picture Concepts did not differ significantly from full PRI, correlated highest with full PRI, and produced the lowest standard error rate. Therefore, although the WISC-IV may be shortened, subtest omissions should be carefully chosen. Omitting Vocabulary from VCI appears to produces estimates highly correlated with full VCI without increasing standard error. Omitting Matrix Reasoning from PRI produces estimates highly correlated with full PRI with only slight increases in error.
Prorating Full-Scale IQ Scores on the WAIS-IV
Objective: This paper examined the relationship between prorated and full scoring methods on Full-Scale IQ scores (FSIQ) of the WAIS-IV as a result of removing Working Memory and Processing Speed Index (WMI, PSI) subtests. Method: Participants included 25 adults (M age = 31.64, SD = 14.01), mostly Caucasian (56%). Diagnoses were primarily neuropsychological (72%). Participants were administered the WAIS-IV core battery, which was scored using the standard scoring methods outlined in the manual and re-scored by removing WMI/PSI subtests to obtain prorated FSIQ scores. Results: Results of a one-way repeated-measures ANOVA indicated no significant differences between FSIQ scoring methods, F(3.415, 192) = 2.24, p = .082. Prorated scores were highly correlated with full FSIQ scores (r > .95); standard error for all estimates did not exceed 2.95. Conclusion: There were no significant differences between full and prorated FSIQ scores obtained by omission of either one WMI or PSI subtest or omission of one WMI and one PSI subtest. These data suggest that the WAIS-IV core battery may be shortened by the removal of up to two subtests without damaging the reliability or validity of the resulting FSIQ score or significantly increasing standard error. All prorated scores were highly correlated with FSIQ scores. This study was limited, however, because of the small sample size; perhaps significant differences between prorated and full FSIQ scores would appear in larger or more specific diagnostic samples, such as neurological and acute impairment conditions, which may cause decreased WMI and PSI scores. In such cases, removing subtests sensitive to impairment may cause artificially inflated FSIQ estimates.
Wechsler Adult Intelligence Scale-IV Non-Dominant Hand Corrections
Objective: There is a lack of formal evidence to correct for the presence of dysmobility of the dominant hand in patients who are administered the Wechsler Adult Intelligence Scale-IV (WAIS-IV). This study attempts to provide a psychometrically valid procedure for implementing such a correction. Method: The WAIS-IV Block Design, Symbol Search, Coding, and Cancellation subtests were administered to 58 right-hand dominant non-impaired adults. Twenty-nine subjects were administered the subtests with standrad adminisministration procedures (SA group) and 29 used their non-dominant had to complete the subtests (NDA group). The mean age of the SA group was 31.52 and 36.14 for the NDA group. No IQ differences between the groups was present. The mean raw and scaled scores for each subtest were compared between the groups in order to determine the impact of of non-dominant hand use on performance. NDA correction scores were then generated for each of the four subtests. Results: For the Block Design and Cancellation subtests, there were no significant differences in scores between groups, although all four subtest mean scores were lower for the NDA group. For Symbol Search and Coding, both raw and scaled scores were significantly different between groups (p < .001), with reductions in scaled scores of 3.24 and 3.03, respectively. Conclusion: Non-dominant hand use resulted in significantly lower performance for Symbol Search and Coding. Correction factors that would remove the significance of the lowered performance are proposed for use when administering the WAIS-IV to patients who are physically unable to use their dominant hand. A discussion concerning future research needs in this area is presented.
Differentiation of Left and Right Hemisphere Forms of Intelligence in Children
Objective: Previously we found that a purported right-hemisphere task, the Street Completion, showed effectively no relationship with index scores on a purported left-hemisphere task, the WAIS intellectual evaluation. None of the subtests accounted for more than 10% of the variance. We decided to investigate this relationship among children to look at the development of this isolation of function between the hemispheres. Method: Performance on the Street Completion Test was correlated with the index and subtest scores on the WISC-IV from 107 children aged 6–16 and then again for subgroups aged 6–7, 8, and 9–16. Results: Street performance again turned out to be orthogonal to cognitive performance, in most cases with less than 3% of the variance accounted for. However, a small but significant inverse relationship was found between the Street and Processing Speed (r2 = .05) and the component subtests Coding and Symbol Search (both r2 = .04). It was only 8-year olds who contributed to this inverse relationship, with Coding r2 = .27 and Symbol Search r2 = .11. When only data from children 9–16 were looked at, none of the relationships were even close to significant (all r2 < .03), and the same was true for those aged 6–7 (all r2 < .04 but Picture Concepts, .11). Conclusion: For older and younger children the same orthogonal relationship observed for adults was found, but, for some reason, there is an inverse relationship between processing speed and gestaltic functioning for 8-year-old children.
Intraindividual Variability within the Domain of Processing Speed
Introduction: Conceptualizing abnormal performance on neuropsychological testing remains to be an important issue, as the definition is essential in guiding clinical diagnoses, prognoses, and recommendations. However, to better understand atypical patterns of performance, healthy-normal patterns must also be well established. Interestingly, current research indicates that some abnormal scores are actually normal for the average healthy adult when given a battery of neuropsychological tests. Understanding intaindividual variability appears to be a beneficial approach to forming a clearer definition of what is considered abnormal performance. The purpose of this study was to look at the intraindividual variability amongst healthy adults on a 16 measure test battery comprised of formal and ecological processing speed tasks. Method: Fifty healthy individuals completed eight formal processing speed measures (e.g., Trails A and B) and eight ecological measures created to represent everyday paced activities. Two age groups were formed young (18–35) and older (60–85). Results: The average correlation across processing speed tasks was 0.51. The average individual difference between maximum and minimum z-scores across tasks was 2.5. The average number of z-scores achieved by a participant that fell less than −1 SD below the mean was 1.4. The average number of z-scores achieved by a participant that fell less than −1.5 SD below the mean was 0.6. Discussion: Comparable with other research, the results from this study demonstrate intraindividual variability within healthy adults. Interestingly, this research also suggests that there is likely to be less variability within a battery that measures a single construct (i.e., processing speed).
The WAIS-III Factor Indices Are Related to Specific Components of Benton's Serial Digit Learning Test
Objective: We investigated the relationship of verbal and non-verbal cognitive components of the WAIS-III in relationship with the performance on the initial, middle, and late trial portions of the nine-digit Benton Serial Digit Learning Test (SDL-9) to investigate whether the rote auditory learning process changes over trials. Method: A sample of 125 Veterans who received neuropsychological evaluations and completed both WAIS-III and SDL-9 composed this study sample. They presented a wide variety of mixed neuropsychiatric diagnoses. There were no exclusion criteria. A four factor solution was derived from principal component analysis of the raw scores for the 13 subtests of the WAIS-III. These factors represented the Verbal Comprehension (VC), Perceptual Organization (PO), Working Memory (WM), and Processing Speed (PS) indices. The 12 trails of the SDL-9 also were factored and a three orthogonal factor solution representing the early, middle, and the late phase trials resulted. The WAIS-III and SDL-9 factors were jointly factored and a four orthogonal factor solution resulted. Results: The late trial SDL-9 factor loaded .Seven hundred and eighty-two on the WAIS-III PS component. The early trial SDL-9 factor loaded 0.691 on the WM component. The middle trial SDL-9 factor loaded 0.806 on the WAIS-III PO Component. No SDL-9 factor loaded on the WAIS-III VC component. Conclusion: There are specific components of verbal and nonverbal intellectual ability that are related to auditory learning and memory on SDL-9. Analysis of complementary cognitive components of each measure enhances their interpretability beyond an analysis that is based on either measure alone.
Comparisons of the PASAT and the SDMT as Cognitive Screens in Multiple Sclerosis
Objective: The Paced Auditory Serial Addition Test (PASAT) and the Symbol Digit Modalities Test (SDMT) are neuropsychological measures commonly used to screen for cognitive impairment in patients with multiple sclerosis (MS). This study aimed to evaluate these tests in predicting overall cognitive functioning in MS. Method: Participants (n = 208) were referred for clinical evaluation at an MS Center in NJ and signed consent for research. The Minimal Assessment of Cognitive Functioning in MS (MACFIMS) battery was administered. Pearson's correlations and hierarchical linear regressions were run. Results: Both the PASAT (r = .58, p < .01) and SDMT (r = .69, p < .01) z-scores were significantly correlated with the composite z-score representing overall performance on the MACFIMS. Both the PASAT and the SDMT remained significant predictors of overall cognitive function after controlling for age, gender, education, duration of illness, MS course, and disability ratings in separate regression models. The PASAT and SDMT total scores were highly correlated with each other (r = .56, p < .01), and each was significantly correlated with every other test in the battery. The PASAT was most strongly correlated with an executive measure (DKEFS Card Sort, r = .58, p < .01) and overall intelligence (WASI FSIQ, r = .59, p < .01). The SDMT was most highly correlated with visual memory (BVMT, r = .55, p < .01). Conclusion: Although both the PASAT and the SDMT were found to be predictive of overall cognitive functioning in MS, the SDMT was found to have a higher correlation with the composite score. The SDMT was more highly correlated with visual memory, whereas the PASAT was more highly correlated with overall intelligence and executive functioning.
Age, Educational Level, Verbal, and Non-Verbal Intelligence Mediate Performance on the Early and Late Item Components of the Benton Visual Retention Test
Objective: The construct validity of the early items (1–4) and late items (5–10) of the Benton Visual Retention Test (BVRT) relative to the performance level variables of age, educational level, and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) factorial constructs of Verbal Comprehension (VC), Perceptual Organization (PO), and Freedom from Distractibility (FFD) as performance pattern variables was investigated. Method: The sample consisted of 664 inpatient and outpatient veterans at a large VA Medical Center who had completed the BVRT and the WAIS-R as part of their clinical neuropsychological evaluations. They presented a wide variety of complex medical, psychiatric, and neurological diagnoses. There were no exclusion criteria. Factor scales for the early and late BVRT item subgroups were factored with age and educational level. Second order factor scales were computed and refactored with the VC, PO, and FFD variables. Results: Age was associated with the late BVRT Item factor only; educational level was associated with the early BVRT item factor only. This analysis explained 60.53% of the total variance. In the second factor analysis, the Age and Late BVRT factor was associated only with WAIS-R PO. The Education and Early BVRT factor was associated only with WAIS-R VC. This analysis explained 81.28% of the total variance. Discussion: Early BVRT items are easily named and verbally mediated, suggesting that Early BVRT items are related to repetition and simple naming. Late BVRT items are visually processed and related to visual memory, auditory memory, and repetition. Component item subgroup analysis of BVRT protocols is recommended.
The Impact of Executive Function and Language Dominance on Health Literacy in Bilingual HIV+ Latino Adults
Objective: Although living with HIV requires frequent communication with health-care professionals, many adults lack adequate health literacy. This is particularly concerning for HIV+ Latinos who are disproportionately impacted by HIV/AIDS. This study investigated the degree to which executive functioning (EF) and English language dominance were related to health literacy in a bilingual HIV+ Latino population. Method: Sixty-two HIV+ English/Spanish bilingual Latino adults (68% male; M age = 46 (6) years; M education = 12 (2) years; 17% AIDS) completed the Controlled Oral Word Association Task (COWAT; English [F-A-S], Spanish [P-M-R]), Wisconsin Card Sorting Task-64 (WCST-64), Trail Making Test (TMT-B), and Test of Functional Health Literacy in Adults (TOFHLA). Language dominance was operationalized as the COWAT language difference score (CLDS; P-M-R T-score minus F-A-S T-score; lower scores = greater English dominance). EF was the average of the WCST-64 and TMT-B T-scores. Results: EF and CLDS correlated with the TOFHLA Total Score (r = .29, p < .05; r = − .28, p < .05, respectively). Within the TOFHLA subscales, EF correlated with Numeracy (r = .29, p < .05) and CLDS with Reading Comprehension (r = ;−.44, p < .05). A regression model (with both EF and CLDS) significantly predicted the TOFHLA Total Score, R2 = .13; F (2,51) = 3.58, p < .05, with only EF providing a trend-level contribution (p = .07). Conclusion: Lower levels of EF and higher levels of Spanish language dominance were associated with lower levels of health literacy. Subscale analyses revealed, however, that EF was only related to Numeracy, whereas the CLDS was only related to Reading Comprehension. These findings help explain poor health literacy among HIV+ Latino adults who may be disadvantaged by both compromised EF and lower English language proficiency.
Estimating WAIS-IV FSIQ Using the Barona and Ward 7 Short Form
Objective: The purpose of this study was to evaluate accuracy of the Barona and Ward 7 Short Form (Ward 7) estimates of the Wechsler Intelligence Scale-IV (WAIS-IV) Full-Scale Intelligence Quotient (FSIQ) using a neurologicallyintact sample. Method: Fifty-three volunteers completed the WAIS-IV (including the Picture Completion Subtest). Assumptions regarding homogeneity and linearity were evaluated for descriptive statistics and relationships between samples. Mean differences were tested. ANOVA was calculated comparing the Standard Error of Estimate (SEE) for each proxy model. Accuracy rates were converted to proportions using two separate paradigms: SEE target criteria interval (TCI) and IQ Classification Range as TCI. A multiple comparisons analysis was conducted to evaluate models of accuracy for respective proxies. Results: A significant difference (−2.7, df = 52; p < .009) between FSIQ and Ward 7 means was detected. An effect size (d = 0.44) for these samples revealed the samples were homogeneous. The Barona correlated (r = .31) with the FSIQ and (r = .27) with the Ward 7. The Ward 7 correlated (r = .96) with FSIQ. The Barona predictions of FSIQ and the Ward 7 yielded significantly larger SEEs (F = 5.76, p < .00001; F = 8.45, p < .00001) than the Ward estimates of FSIQ. Post hoc multiple comparisons showed no difference in accuracy paradigms evaluated. The Barona and Ward 7 yielded modestly high accuracy rates in estimating FSIQ for scores in the Average Range of Intelligence. When total sample accuracy rates were compared for the Barona and Ward 7 FSIQ estimates, no significant differences were appreciated. Conclusion: Despite the remarkably high correlation between the Ward 7 and FSIQ compared with low correlation between the Barona and FSIQ, the Ward 7 was no more accurate in estimating FSIQ in a neurologically intact sample of individuals with Average or better intelligence. Using the Barona to predict FSIQ outside the Average range of intelligence was cautioned. Confidence Intervals were recommended for any proxy of the WAIS-IV FSIQ.
Parsing Working Memory Processes: The Impact of Eye Movement Strategy on Neurocognitive Test Performance
Objective: Spatial Working Memory (SWM) is a key brain system that provides temporary storage and manipulation of information pertaining to locations. SWM impairment has been linked to genetic susceptibility to schizophrenia, bipolar disorder, and substance dependence (e.g., methamphetamine). The cognitive processes underlying SWM are complex but have not been adequately distinguished in classic SWM assessments, thus compromising interpretation of impaired test performance. The present study brings a novel perspective to identifying SWM processes by examining eye movement strategies conducive to successful SWM performance. Method: Cognitively healthy adult volunteers (n = 25) recruited to participate in a larger neuropsychological study were tested in a computerized version of the Corsi Block Tapping-Task coupled with eye tracking. In this task, examinees were asked to remember a series of locations presented in a specific order. Stimuli were varied in target number and delay duration. Eye movement strategies were characterized using descriptive modeling. Results: Significant associations were found between performance and eye movement strategy during the retention interval, but only in cases of capacity overload (eight targets) and long delay (20 s). In those cases, better performance was associated with a central gaze maintenance pattern (r = .52, p = .007) versus overt eye movements to target locations. Conclusion: These results suggest that, in capacity overload, central gaze maintenance is a more efficient strategy than overt eye movement for the retention of a series of locations. This finding underscores the important role played by processes such as covert attention shifts and higher cognitive function (e.g., integrating spatial information into virtual shapes) during SWM assessment.
Neurocognitive Profile of a Child Identified with a Chromosome 12p Microdeletion Syndrome
Objective: Referral was made for a neuropsychological reevaluation of a child with interstital microdeletion of 12p12.1-p12.1. Neurocognitive data linked to many of the microdeletion syndromes are limited; very few case report studies are documented. Literature indicates that individuals with 12p12 deletions often have features, including prominent speech delay, intellectual disability, behavioral abnormalities, dysmorphic features, and other health complications. The objective of this single-case study is to explore the neurocognitive impact of a microdeletion of 12p12.1-p12.1. Method: This case describes an 8-year-old male with interstital microdeletion of 12p12.1-p12.1 and previous diagnoses of cerebral palsy, attention problems, hypotonia, and vision problems. Based on results of this neuropsychological battery, we compare test findings from his initial evaluation (5 years, 6 months) to his current evaluation (8 years). Results: Intellectual functioning was identified as average (FSIQ = 90, WISC-IV). Academic functioning scores range between borderline and average (WJ-III). Performance was consistent with specific reading and math learning disabilities. Executive functioning was most compromised, scores ranging between mildly impaired and average, confirming a diagnosis of ADHD. Conclusion: This case study's aim was to identify cognitive implications associated with chromosome 12p microdeletion. This assessment indicates that executive functions and academics were most impaired; however, strengths were noted in language and intellectual functioning. This child's case is unique as he is not as globally compromised as described in the literature. It is believed, therefore that as many more of the microdeletion syndromes become better identified by new microarray techniques that the phenotypic impact of the deletions will be best appreciated.
Is Diagnosis of Asymptomatic Neurocognitive Impairment (ANI) a Predictor of Death?
Objective: Recent questions have arisen regarding the clinical importance of the mildest form of HIV-associated Neurocognitive Disorders (HAND), Asymptomatic Neurocognitive Impairment (ANI). The objective of the present study was to determine whether persons diagnosed with ANI are at greater risk for death when compared with neurocognitively normal individuals. Method: Participants included 543 HIV-infected individuals at increased risk of death due to advanced HIV characteristics enrolled in the National NeuroAIDS Tissue Consortium. Participants completed a comprehensive neuropsychological assessment covering seven domains and self-report questionnaires of mood and daily functioning allowing for a HAND diagnosis (Antinori et al., 2007). Using HAND criteria, participants were classified as neurocognitively normal (NC Normal), ANI, mild neurocognitive disorder (MND), or HIV-associated dementia (HAD) at the last in-life study visit prior to death for those participants who died or the last available visit if still living. Results: There was a stair-step effect, with 42.1% of normal individuals classified as deceased, 65.2% of ANI, 70.2% MND, and 80.4% of HAD individuals (p < .0001). Participants with ANI did not differ their current CD4 count from the other three groups; however, the normal group differed from both MND (p = .003) and HAD (p = .02) group in that they had higher CD4 counts. Conclusion: Neurocognitive diagnosis significantly predicts mortality in a cohort of HIV-infected individuals. Even mild neurocognitive impairment without evidence of daily functioning impairment (i.e., ANI) results in a significant increase in mortality risk compared with NC Normal individuals. The present study argues for the importance of ANI as a meaningful diagnostic category.
Cognition and Driving in Young Adults: Does Risk Taking Propensity Matter?
Objective: Risk taking behavior is one contributor to hazardous driving situations and crash in young adults. The present study investigated driving behavior and its relationships with risk taking propensity and cognition. Method: Participants completed a driving task on a virtual reality driving simulator and a battery of neurocognitive tests. Risk taking propensity was measured using the Balloon Analog Risk Task (BART). The Wisconsin Card Sorting Test (WCST) was used to measure problem solving, the Stroop Color Word Test was used to measure response inhibition, and Symbol Digit Modalities Test (SDMT) was used to measure processing speed. Results: Participants (n = 44) were divided evenly into high- and low-risk-taking propensity groups based on their BART performance. No significant differences existed between the groups on age (M = 20.18, SD = 2.06), gender (22 males, 22 females), and driving experience (M = 3.30, SD = 1.81). Multiple linear regressions were used to test the interaction between group and WCST, Stroop, and SDMT variables in predicting driving variables. Results showed that in a curved road segment, as processing speed increased, average speed increased to a greater degree in the high-risk group than in the low risk group. On a straight road segment, variability in lane position decreased as processing speed increased to a greater degree in the low-risk group than in the high-risk group. Conclusion: These data provide preliminary evidence that risk-taking propensity and processing speed interact to produce differing driving behaviors. Risk-taking propensity is rarely addressed in assessment settings, but may be an important moderator when considering driving ability and cognition.
Neuropsychological Predictors of WAIS-IV Visual Puzzles Performance
Objective: To date, little information has been published regarding cognitive functions underlying the Visual Puzzles (VP) subtest of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). The present study investigated the amount of variance in VP performance accounted for by performance on verbal, visual-spatial, and executive functioning neuropsychological tests. Method: Participants were 80 subjects (gender: 40% male; mean/SD: Age = 29.30/10.52; education = 13.93/2.24) referred to a university clinical psychology research and training clinic for neuropsychological academic evaluation. Individuals had a primary diagnosis of ADHD (n = 36), cognitive disorder (n = 12), learning disorder (n = 18), no diagnosis (n = 6), and mood/anxiety/adjustment disorder (n = 8). Multiple regression analysis predictor variables included education; WAIS-IV Similarities, Vocabulary, Block Design, and Matrix Reasoning subtests; Rey Complex Figure Test (RCFT) Copy, Immediate Recall, and Delayed Recall; as well as Wisconsin Card Sorting Task (WCST) Percent Conceptual Responses. Results: Together, these predictors accounted for 55% of the variance in VP performance, F(9, 70) = 11.58, p < .001. Block Design was the only significant predictor of VP performance, b = 0.59, t(80) = 6.57, p < .001, 95% CI = 0.41 to 0.76. Conclusion: These results are consistent with a previous study (Fallows & Hilsabeck, 2012), indicating that Block Design is a significant predictor of VP performance and suggesting that VP requires visual-spatial integration skills to a greater extent than verbal or executive skills.
Age, Educational Level, and WAIS-III Factorial Components are related to Specific Performance Components on the Benton Visual Retention Test and the Benton Serial Digit Learning Test
Objective: The higher order factorial relationships of age, educational level, and WAIS-III index scores to performance on early, middle, and late phase performance on the Serial Digit Learning Test (SDL) and the Benton Visual Retention Test (BVRT) were examined. Method: Factor scales were computed to model the relationship of age with the WAIS-III Perceptual Organization (PO) and Processing Speed (PS) components and of educational level to the Verbal Comprehension (VC) component. Those combined variables were used as markers to analyze their relationships with early, middle, and late trials of SDL 8 and 9 and the early and late item factors of BVRT. Results: The WAIS-III WMI factor was related to the early trials of SDL 8 and 9 only. WAIS-III VC and educational level were related to the late trial SDL 8 and early trial BVRT variables only. WAIS-III PO and age were related to the SDL 9 middle trials only. WAIS-III PS was related to SDL 8 middle trials, SDL 9 late trials, and late trial BVRT performance only. Conclusion: Initial performance on SDL 8 and 9 and WMI are associated with attention span, working memory, and rote learning. Late trial SDL 8 and early BVRT item performance are verbally mediated. Age is inversely related to performance on SDL 9 middle (learning phase) trials and the PO level. Speed of mental processing is directly related to SDL 8 middle trial (learning) performance, late SDL 9 trial information consolidation, and late BVRT (complex figure) BVRT performance.
Neurocognitive Deficits Predict Performance-Based Functional Impairment in Methamphetamine-Dependent Individuals with HIV Infection
Objective: Preliminary evidence suggests that methamphetamine (MA)-dependent individuals with HIV infection (HIV + /MA+) may be at increased risk for problems with essential daily activities (e.g., medication adherence). However, these studies have relied on self-report measures, which can be highly influenced by mood and/or social desirability factors. Given the clinical and diagnostic significance of functional impairment in this high-risk population, we aimed to identify underlying neurobehavioral predictors of functional impairment in HIV + /MA+ individuals using the UCSD Performance-Based Skills Assessment (UPSA), an objective, performance-based measure designed to simulate, and assess the skills required for the successful completion of important real-world activities. Method: Participants included 29 HIV + /MA+ and 41 demographically comparable HIV − /MA− individuals who were administered the UPSA alongside a comprehensive neuromedical and neuropsychological evaluation. Results: Relative to controls, HIV + /MA+ individuals performed significantly worse overall (p < .05; Cohen's d = 0.71) and within the comprehension/planning and communication domains (ps < .05; Cohen's ds = 0.62 and 0.54). HIV + /MA+ individuals also demonstrated relative difficulties within the financial and medication management domains (ps < .10; Cohen's ds = 0.44 and 0.48). Within the HIV + /MA+ group, global neurocognitive impairment (NCI) was a strong independent predictor of overall functional impairment (p = .013), even while accounting for potentially confounding characteristics (e.g., depression, HIV plasma viral load, duration of MA use). This association between NCI and overall functional impairment was driven primarily by deficits in learning, executive functions, and working memory. Conclusion: Results demonstrate significant performance-based functional difficulties in HIV + /MA+ individuals that are strongly linked to NCI. Neurocognitive rehabilitation strategies targeting learning, working memory, and executive functions may be particularly helpful in the remediation of functional impairment in HIV + /MA+ individuals.
An Investigation of Early Gender Differences in Mental Rotation Ability
Objective: Research indicates robust gender differences in mental rotation tasks (MRTs) using variations of Shepard and Metzler's (1971) geometric figures. This task is too difficult for children under the age of 13 years and other measures of mental rotation have yielded inconsistent gender results for preadolescent children. Notably, the child tasks have not been similar to the classic block rotation task of the MRT. An analog computerized version of the MRT designed for younger children using fewer blocks in the design was constructed. Preadolescent gender differences in spatial ability were investigated on an MRT experimental measure. Method: Typically developing children (35) aged 6–12 (21 female) were recruited. The experimental MRT was computer administered via ePrime. Group differences in the number of items correct, adjusted for age, were examined. Results: Gender groups did not significantly differ in WASI-2 Vocabulary or Matrix Reasoning. Analysis of variance indicates that gender did not significantly predict spatial ability when controlling for intelligence, F(3,30) = 0.043, p > .05, ηp2 = 0.002. Matrix Reasoning accounted for a significant amount of variance, F(3,30) = 6.91, p < .05, ηp2 = 0.187, in MRT performance. Conclusion: Gender differences in spatial ability may manifest in later childhood and might be related to puberty or non-biological influences. More research is needed to identify when mental rotation gender differences first appear and if early prevention can help eliminate later disparities. Mental rotation has been related to mathematics learning and engineering expertise, for which efforts to improve female participation is a national priority.
Effort During Neuropsychological Assessment in Heavy and Light Cannabis Users
Objective: Research has identified neuropsychological deficits associated with chronic cannabis use and suggests that deficits may worsen with increased frequency of use. However, none of these studies utilized effort tests to ensure that assessment results are valid. We examined light (4 days/week) and heavy (7 days/week) chronic cannabis users to determine whether group differences in performance persisted after removing participants with suspect effort. Method: Examiners administered a brief battery of neuropsychological tests to 48 chronic cannabis users (30 light use, 18 heavy). Tests included the Digit Span subtest of the WAIS-III, California Verbal Learning Test-II, Rey–Osterreith Complex Figure, and Trail Making Test, as well as a measure of effort, the Word Memory Test (WMT). Results: There was a significant difference in performance on one of the four cognitive tests, the Trail Making Test (measuring processing speed and executive function), such that light cannabis users (mean = 46.22 s, SD = 16.83) performed better than heavy users (mean = 57.62 s, SD = 20.97; p = .044, Cohen's d = 0.60). However, 12.5% of participants exhibited performance on the Word Memory Test, suggesting suspect effort (based upon the 90% cutoff recommended by Green, 2001). Following the removal of these participants, the two groups (28 light use, 14 heavy) exhibited no differences in performance on any of the four cognitive tasks (Trail Making Test p = .161, Cohen's d = 0.46). Conclusion: Results suggest over 10% of research participants who use cannabis may put forth suboptimal effort during neuropsychological assessment. Further, removing those participants eliminated the group differences in cognitive performance between light and heavy cannabis users. Implications will be discussed.
Comparison of MMPI-2 Profiles with Standard Versus Enhanced Instructions in Individuals with External Incentives to Either “Fake Good” or “Fake Bad”
Background: The Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) is a personality assessment frequently used in Child Protective Services (CPS) and competency to stand trial (CST) evaluations, wherein individuals may have incentive to alter their self-presentation. As such, the purpose of the present study was to examine the effects of standard versus enhanced (i.e., warning of validity scales) instructions on the MMPI-2 in CPS and CST evaluations. Method: Data were obtained via archival review of 575 CPS and CST evaluations. Results: Gender, χ2(3) = 86.1, p < .001, and education, F(3, 569) = 5.31, p = .001, differed significantly between groups, were significantly related to the outcome measure (p < .05), and thus employed as covariates. A significant main effect was observed for the evaluation group on all clinical and validity scales (except TRIN)—with CST participants demonstrating greater response infrequency and psychopathology. A significant main effect was observed for instruction group on Scale 1, F(1, 566) = 12.0, p = .001, Scale 3, F(1, 566) = 12.3, p =.001, and Scale 7, F(1, 566) = 4.44, p = .04, all which yielded higher scores for those receiving standard instructions. Additionally, a significant interaction was found on Scale 1, F(1, 566) = 6.17, p = .01. Conclusion: Results suggest unique response patterns and differing effects of the instruction method in CPS and CST evaluations.
Exploring the Experiences of Maori Who Have Undergone Neuropsychological Assessment
Objective: The aim of this study was to examine the impact of the cultural identity of indigenous New Zealand (Maori) clients with Traumatic Brain Injury (TBI) on their experience of neuropsychological assessment. Method: This qualitative study used semi-structured interviews within a framework that utilized research practises from a Maori world view. The sample comprised of 16 Māori and was balanced for gender and urban/rural demographic variables. The age range was 16–64 years. All participants had experienced a TBI ranging from mild to severe. The study was conducted in three regions of the north island of New Zealand. Participants were eligible for the study if they self-identified as Maori, had been assessed within the previous 5 years, and could remember the assessment. Individuals were excluded if they did not have a clear memory of the assessment. All participants had been referred for their assessment through a New Zealand Crown entity. Results: Two themes encompassed the significance of the data. Positive Experiences refer to affirmative aspects of the assessment which participants thought facilitated their performance. Cultural Invisibility refers to the failure to acknowledge Maori culture in any aspect of the assessment process. Conclusion: Overall, Maori clients commented positively on the therapeutic relationship with the neuropsychologists; however, there was an almost total absence of the acknowledgement of culture as part of the assessment process. They expressed an overwhelming wish to include aspects of a Maori world view, including a preference for a Maori neuropsychologist, in future assessments which participants believed would facilitate a better performance.
Replication of the Use of Number of Impaired Scores as a Measure of Performance Invalidity
Objective: Previous research has examined the classification accuracy of using the number of impaired neuropsychological test scores to identify performance invalidity. This study attempted to replicate this procedure using a different criterion for performance validity in a new sample that was administered an alternate battery. Method: Fifty examinees, the majority of whom had sustained a mild traumatic brain injury, were administered the Halstead–Reitan Neuropsychological Battery (HRNB). Failing >2 free-standing performance validity tests (PVTs) was used as the criterion. The number of impaired scores was evaluated to determine their ability to accurately classify performance invalidity. Impairment was defined at three cutoffs: 1, 1.5, and 2 SD below the mean. Results: Area under the curve (AUC) analyses were examined while maintaining a specificity (SP) of 0.90 or above. A cutoff of 19 scores at least 1 SD below the mean yielded sensitivity (SN) of 0.57 and AUC of 0.79. A cutoff of 10 scores at least 1.5 SD below the mean yielded SN of 0.67 and AUC of 0.82. A cutoff of 4 scores at least 2 SD below the mean yielded SN of 0.67 and AUC of 0.82. Conclusion: Using 10 scores at least 1.5 SD below the mean or 4 scores at least 2 SD below the mean provided the best classification accuracy. SN and SP were comparable with previous research; however, the number of impaired scores used to achieve a similar classification accuracy differed slightly with this different sample, battery, and criterion.
Processing Speed Deficits in a Gifted Child Post ADEM: Should Students in Gifted Education Be Permitted Modifications?
Objective: Acute Disseminated Encephalomyelits (ADEM) is a rare neuroimmununologic disorder that usually presents as an acute inflammatory demyelinating disease. The case of a gifted boy with a history of developmental delay and confirmed ADEM will be examined as to whether children in a gifted educational setting should be afforded special modifications for deficits in their rate of output. Method: Acute onset of ataxia at age six followed by MRI that showed numerous subcortical foci in the frontal and parietal lobes was confirmed to be consistent with ADEM. Serial WISC-IV administrations at age 7 and nine demonstrated a consistently superior General Ability Index (GAI; SS = 135 vs. 130), with a decline in the Processing Speed Index (PSI; SS = 97 vs. 75) as he transitioned from the “younger child” to the “older child” subtests. Memory decreases on serial assessments were thought to be evident for possible neurological decline. Results: Neuropsychological evaluation at 10.5 years of age observed similar WISC-IV findings (i.e., GAI = 123; PSI = 73), while memory reassessment was consistent with initial performance levels such that prior declines were likely due to motivational factors. Repeat MRI 6 years post-ADEM observed no interval change, whereas repeat WISC-IV at age 13 was similar in trend (i.e., GAI = 124; PSI = 83), with evidence of variable executive difficulties. Conclusion: Recommendations to modify the volume (not the difficulty level) of class and homework assignments to “half-load” to address the disparity in his ability versus output were rejected for a 504 Plan previously, with renewed efforts underway to address this issue.3
Pediatric Thalamic Brain Tumor: The Neuropsychological Profile of an 8-Year-Old Boy following Resection
Objective: Thalamic tumors are rare in pediatric populations. Accordingly, limited information is known about their neuropsychological correlates. The current case study contributes to existing knowledge. Method: An 8-year, 8-month-old left-handed boy who underwent surgical resection of a left thalamic cavernous hemangioma at age 3.5 years and has a post-surgical history of seizures presented for neuropsychological evaluation. Results: Testing revealed average to high average intellectual functioning with significant difficulties with learning and memory, sustained attention, and processing speed. Verbal and nonverbal abilities fell at the high end of the average range (WISC-IV VCI = 110; PRI = 104). In this context, his performances on learning and memory measures indicated significant difficulties with memory encoding but there was no material-specific encoding effect. Storage of nonverbal material appeared intact but there was evidence of mild forgetting of new verbal information. His encoding difficulties are at least in part related to additional difficulties with aspects of attention and executive function. He had marked difficulties with sustained attention (e.g., CPT-II Omissions 99th percentile), processing speed, (WISC-IV PSI = 78), and graphomotor skills with greater right-handed weakness. He also exhibited qualitative pragmatic language weaknesses consistent with a history of social difficulties. Conclusion: Taken together, the patient presents with a complex neuropsychological profile that implicates disruption within brain systems involving the frontal lobes and possibly the left medial temporal lobe, likely reflecting the functional role of the thalamus in connecting these regions.
Effects of Aging Non-Crystalline, Fluid, and Other Forms of Intelligence
Objective: The Cattell–Horn–Carroll theory of intelligence is best assessed through the Stanford-Binet. In the fourth edition, three intellectual abilities, or second level factors, were evaluated: crystallized abilities (verbal reasoning and quantitative reasoning), fluid/analytic abilities (abstract and visual reasoning), and short-term memory, and all of these were subsumed under general ability or g. With the newest, fifth edition, the crystalline abilities are now called knowledge, and the four other areas include fluid reasoning, quantitative reasoning, visual-spatial reasoning, and working memory. We decided to see how these five areas change over time, expecting little change in crystalline ability (knowledge), substantial in fluid reasoning and working memory, and little in visual-spatial reasoning. Method: Average performance on each of these areas was computed for each age group for verbal and non-verbal tasks from 25:0–29:11 to 85:0–89:11 and the resultant performances compared with those who are 20:0–24:11 years old. Results: Verbal crystalline held through all the ages observed, whereas verbal fluid abilities dropped in the eighth and ninth decades to the ninth percentile. Non-verbal crystalline also held well through the eighth decade, but non-verbal fluid dropped after the sixth decade to the second percentile by the end of the ninth decade. Quantitative and spatial processing and working memory also showed declines. Conclusion: Overall cognitive abilities held pretty well through the 60s, but by retirement age there were slippages in most areas. Several explanations are possible, from a use-it-or-lose-it phenomenon to an organic deterioration. Clinical evidence strongly suggests a non-organic basis for the observed trajectories.
Comparison of Cross-Sectional and Longitudinal Data on Animal Fluency in Older Adults
Objective: To compare the findings from our cross-sectional and longitudinal studies on the effects of age on Animal Fluency. Method: There were 1045 “normal” older adults (age 50–89) in the cross-sectional analysis and 618, 315, 267, and 197 participants with at least 2, 4, 5, and 6 annual visits in the longitudinal study were. There were 239 subjects in whom the first and last testing were at least 6 years apart and 124 that were at least 10 years apart. Results: The magnitude of the Animal Fluency decline was considerably greater in the cross-sectional study. There was a 1.48-word decline (7.3%) when comparing the 50s and 60s age groups, a 1.40-word decline (7.5%) when comparing the 60s and 70s, and a 1.34-word decline (7.7%) when comparing the 70s and 80s. In our longitudinal study, we found no change (0.02 words, 0.1%) in the 50s age group when projected over 10 years, a small decline in the 60s (−0.78 words, 4.0%), a small decline in the 70s (−1.05 words, 5.7%), and a very small decline in the 80s age group (−0.16 words, 1.0%). Conclusion: There was a 1.65-word decline in the longitudinal study between the 50s and 80s age groups and a 4.22-word decline in the cross-sectional study. There were likely cohort effects in our cross-sectional study, whereas there likely was a selective attrition bias in our longitudinal study. Thus, an estimate of the “true” mean animal fluency decline is 2–3 words from the fifth to eighth age decade with the clearest declines in the sixth and seventh decades.
Cohort (i.e., Generational) Effects on Animal Fluency in Older Adults
Objective: To determine if there were “cohort” (i.e., generational) effects in a cross-sectional and normative study of the effects of age on Animal Fuency in normal older adults. Method: There were 1,045 “normal” older adults (age 55–89) in this cross-sectional study of the effects of age on Animal Fluency. The data in this study were collected over a 23.5-year period. Subgroups of participants whose year of birth (YOB) was in the earliest and latest ∼33% of the distribution for each of the seven age half-decades (55–59 to 85–89) were compared on Animal Fluency (e.g., YOB for the early vs. late cohort for the 60–64 age group were 1926–1931 vs. 1937–1984). Results: Five of seven half-decade age group comparisons examing the effect of YOB were statistically significant (all but the 75–79 and 85–89 age groups) such that the early cohort scored significantly lower on the Animal Fluency than the late cohort. The mean Animal Fluency difference score was −2.7 words for the five comparisons in which the early cohort scored significantly lower than the late cohort. There were no significant age or education differences between the early and late cohorts except that in the 60-64 age group the late cohort was significantly better educated by 1 year. Conclusion: There was evidence that year/decade of birth (independent of age) affected Animal Fluency performance such that the late cohort scored significantly better than the early cohort for five of seven half-decade age groups. Previously, we did not find cohort effects on confrontation naming as measured by the Boston Naming Test.
Current and Cumulative Groundwater Metal Exposure Impacts Risk for Diagnosis of Mild Cognitive Impairment
Objective: Millions of Americans are exposed to metals through groundwater exposure, which places them at an increased risk for associated negative health effects, such as cognitive dysfunction. The aim of this study was to examine the impact of current and cumulative groundwater metal exposure on the risk for mild cognitive impairment. Method: Data were analyzed on 444 participants (359 Normal Cognition and 85 Mild Cognitive Impairment [MCI]) from Project FRONTIER, an epidemiological study of rural cognitive aging. Geographic information systems (GIS) analyses were utilized to estimate regional groundwater metal concentrations using the Environmental Systems Research Institute Arc GIS program and metal concentrations from the Texas Water Development Board (TWDB). Cumulative exposure was derived by multiplying the average metal exposure by number of years at location. Results: Within the total sample, higher levels of current groundwater arsenic (B [SE] = 0.11 [0.04], p = .013), mercury (B [SE] = 9.91 [4.65], p = .03), and vanadium (B [SE] = 0.01 [0.00], p = .007) exposure were associated with an increased risk of MCI diagnosis. Additionally, lower levels of current groundwater Cadmium (B [SE] = − 5.48 [1.63], p = .001) exposure was also found to be associated with an increased risk of MCI diagnosis. When broken down to examine the impact of cumulative metal exposure on the risk of MCI diagnosis, only arsenic (B [SE] = 0.00 [0.00], p = .04) and vanadium (B [SE] = 0.00 [0.00], p = .01) were shown to be impactful, no other metals analyzed were shown to have a significant impact on cognitive diagnosis. Conclusion: Current and cumulative exposure to groundwater metals (Arsenic, Vanadium, Mercury, and Cadmium) were shown to impact the risk of MCI diagnosis while covarying for age, education, gender, albumin, and APOE4 presence.
Role of a Computerized Brain Fitness Program in Managing Mood Among Older Adults
Introduction: Distressed mood is commonly endorsed by older adults experiencing memory difficulties. Computerized cognitive training programs are effective in improving memory in older adults. The current study examined whether participation in a brain fitness program also results in improved mood by reducing self-reported anxiety. Method: A sample of 34 participants was recruited from independent retirement communities (M = 82.26, SD = 6.68). Individuals completed computerized brain fitness sessions utilizing Dakim Brain Fitness and were divided into two groups: Group 1 (n = 25) completed >40 sessions; Group 2 (n = 9) completed <39 sessions. All participants completed the Geriatric Depression Scale (GDS) and anxiety subscale from the Depression Anxiety Stress Scale (DASS Anxiety) at baseline (Time 1) and after a 6-month period (Time 2). Only individuals with mild depressed symptoms (GDS > 5) were included in the analyses. Results: An independent t-test compared self-reported anxiety between groups. There were no differences at baseline (Group 1: M = 4.76, SD = 5.46; Group 2: M = 3.89, SD = 2.93), t(32) = − 0.476, p = .65; however, differences were noted at the end of 6 months (Group 1: M = 3.80, SD = 3.12; Group 2: M = 6.56, SD = 4.67), t(32) = 1.985, p< .06, with Group 1 reporting less anxiety than Group 2, including a decrease in anxiety from Time 1 to Time 2 (Group 1: M = − 0.96, SD = 4.75; Group 2: M = 2.67, SD = 3.24), t(32) = 2.11, p < .05. Conclusion: Participants who completed more computerized brain fitness sessions reported less symptoms of anxiety after completing 40 sessions or more in comparison to participants who completed fewer sessions. Computerized cognitive training programs may serve as a therapeutic instrument to promote cognitive and psychological health.
Occupational Complexity as a Predictor of Cognitive Reserve
Objective: This study sought to determine the significance of occupational complexity toward predicting levels of cognitive reserve of a local older-adult population. Method: Ninety-two participants were extracted from two separate study populations performed in conjunction with the UGA Neuropsychology and Memory Assessment Laboratory: 57 participants from a 2010–2011 study, and 35 participants from a 2010 study. Variables of interest included: age, gender, years education, occupation, and Wechsler Test of Adult Reading (WTAR) raw word reading scores. The WTAR has proven to be a valid proxy for cognitive reserve in older adults, successfully predicting premorbid IQ in patients with minimal to mild Alzheimer's disease. Occupational data were codified by scores of substantive complexity as defined in Roos and Treiman (1980). Results: Using a hierarchical regression model created in SPSS, gender, age, years education, and occupational complexity (independent variables) was used to account for WTAR scores (dependent variable). It was found that occupational complexity accounted for 16% of additional variance in WTAR scores after controlling for the effects of gender, age, and years education. Conclusion: Occupational complexity significantly contributes to the effects of cognitive reserve. This finding supports the notion that long-term occupational complexity contributes to cognitive reserve throughout ones life. While further research is needed, this link between occupation and cognitive reserve could contain valuable implications for the public health struggle against the rising global epidemic of neurological degenerative disorders such as Alzheimer's disease.
(Lack of) Association between a Marker of Cholinergic Activity and Intra-Individual Variability in Reaction Times in Normal Aging
The central cholinergic system is thought to support memory, attention, and executive functions, and its deterioration in aging is hypothesized to underlie declines in these domains. Greater intra-individual variability (IIV) in reaction times (RTs) has also been found consistently in normal aging and is associated with poorer cognitive performance. Objective: Our goal was to investigate whether short-latency afferent inhibition (SAI), which is a transcranial magnetic stimulation (TMS) marker of central cholinergic function, might predict age-related increases in RT IIV. Method: We used TMS to assess in vivo cholinergic activity in a cohort of young (age range 18–30; n = 54) and healthy older adults (age 65 + n = 49). SAI was assessed by examining modulation of TMS-induced motor evoked potentials in response to median nerve conditioning at 20 ms inter stimulus interval. Timed performances on complex RT (CRT) and go/no-go tasks were obtained for each participant. Mean RT, IIV, and coefficients of variation (CoV) were derived for each participant. Results: As expected, we found clear age differences in SAI levels and in IIV and CoV on our RT tasks. Although individual variability in CRT CoV was correlated with SAI levels in the overall sample (r = .29, p < .01), this correlation was weaker when we examined each age group separately, suggesting that the correlation in the overall sample was driven by age. Conclusion: SAI levels are only a weak predictor of age-related differences in RT variability. Other neurotransmitters (e.g., dopamine) may be more influential than acetylcholine.
Education, as a Proxy of Cognitive Reserve, Moderates Cognitive Ability and Functional Performance
Objective: Examine the influence of cognitive reserve on the relationship between cognitive performance and instrumental activities of daily living (IADLs) in a sample of older adults. We hypothesized education, as a moderator, would attenuate the relationship between cognitive ability and IADLs. Method: Fifty-seven community-dwelling, healthy older adults (65–85 years, 65% female, mean age = 74.8 years, mean educ = 15.8 years ) were recruited locally. Exclusion criteria included the absence of a reliable informant, dementia, or history of neurological disorder. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Score (TS) represented each participant's cognitive ability. Functional performance was assessed via the Direct Assessment of Functional Status-Revised (DAFS-R). A total raw score was calculated from all IADL domains. Multiple regression investigated: (a) the association between RBANS and IADLs and (b) the moderating effect of education. Simple slope tests were conducted to compare high and low levels of education. Results: In regression analysis, RBANS TS explained 59% variance in IADLs (ΔR2 = .52, B = 0.357, p < .001). Then, the RBANS × education interaction explained a significant increase in variance in IADL performance (ΔR2 = .038, B = 0.357, p = .024). Simple slopes revealed a significant association between RBANS and IADLs, with RBANS more strongly related to IADLs for low levels of education (B = 0.438, p < .001) than for higher levels (B = 0.249, p < .001). Conclusion: Results suggest that higher cognitive reserve may buffer the influence of cognitive decline on functional performance in older adults.
The Relationship Among Arachidonic Acid, Executive Functioning, and Alzheimer's Disease
Objective: The present study aimed to investigate the relationship between the omega-6 fatty acid, arachidonic acid (AA), and executive functioning in cognitively healthy (CH) older adults with and without Alzheimer's disease (AD) pathology. The purpose of the study was to explore early indicators of preclinical AD in this population and, specifically, to test the hypotheses that those with AD pathology would have higher levels of AA and worse executive functioning. Method: Participants were 70 cognitively healthy older adults whose cerebrospinal fluid ration of Amyloid-beta (42) to tau was either consistent (CH-AD, n = 34) or inconsistent (CH-healthy or CH-H, n = 36) with that of individuals with confirmed AD. Neuropsychological and biomarker data collected for each of the 70 participants was used to affirm their cognitively healthy status. Results: As expected, results indicated that individuals with AD pathology had significantly higher levels of AA levels and worse executive function compared with the CH-H group, t(68) = − 2.07, p = .04, 95% CI (−2.32, −0.04). Similarly, individuals in the CH-AD group had significantly lower domain scores compared with the CHH group, t(67) = 3.25, p = .002, though both fell in the average range. The interaction between AA and executive function and regression was non-significant. Conclusion: Results indicate that Omega-6 fatty-acid and executive functioning are important predictors of the presence of AD neuropathology in cognitively healthy individuals. Thus, they could be considered indicators of pre-clinical Alzheimer's disease used in diagnostic- or treatment-based intervention. However, they are uniquely related suggesting a more complex interplay between cognition and Omega-6 in this population.
Regression-Based Norms for a Bi-Factor Model for Scoring the Brief Test of Adult Cognition by Telephone (BTACT)
Objective: The Brief Test of Adult Cognition by Telephone (BTACT) is a telephone-administered battery that provides a psychometrically sound measure of global cognition. The current study developed regression-based norms for a bi-factor model for scoring the BTACT. Normative adjustments for age, education, occupation, and gender were explored. Method: The sample consisted of 3,096 28–84-year-old (Mage = 55.90, SDage = 12.20) volunteers who participated in the National Survey of Midlife Development in the United States Cognitive Project. Eight separate linear regression models, accounting for age, education, gender, and occupation, alone and in combination, were used to predict the bi-factor BTACT scores. The residuals from these models were used to develop normative data for the bi-factor BTACT. Results: The sample consisted of nine occupation groups, was predominantly female (55.5%), and highly educated (6.1% had less than 12 years of education). The regression model with age, education, gender, and occupation as predictors accounted for 33.4% of the variance in the bi-factor BTACT global cognition score, F(22, 3,015) = 68.7, p < .001. All demographic variables, alone and combined with other covariates, significantly predicted bi-factor BTACT scores, p < .05. Conclusion: The bi-factor BTACT scores provide a psychometrically sound estimate of global cognitive functioning, but in clinical use, normative adjustments may be desirable. Even when simultaneously accounting for age, gender, and education, occupation was a significant predictor of BTACT scores. The ability to apply occupation-based norms makes the BTACT unique as a screening measure of global cognition.
Aging and Perceptual Ambiguity: Volitional Control and the Perception of Bistable Images
Objective: Neuroimaging studies with young adults show the activation of fronto-parietal attentional networks during volitional control of bistable images. Fronto-parietal circuits are known to change with aging, but the effect on bistable perception is unknown and was examined here. Method: Ten older adults (mean age 63.6) and eight younger adults (mean age 19.0) viewed a Necker cube, which can be perceived as having the upper-left face or lower-right face at the front at any one time. The experiment consisted of a passive viewing condition and two volitional control tasks, each with five 60s trials: hold one percept in front and expedite the switch between the two percepts. Participants verbally reported their percept (“right,” “left” face in front). Results: Mean dominance durations (time spent on each percept) were calculated. Relative to passive viewing, younger adults were able to increase dominance durations by 117% in the hold condition (SD 59%), compared with 59% by older adults (SD 69%). The groups did not differ on the switch condition, for which younger adults decreased dominance duration by 48% (SD 27%) and older adults by 30% (SD 53%). Conclusion: We found that older adults were less able than younger adults to voluntarily inhibit ambiguous perception by focusing on one interpretation, but were as likely to covertly alternate their attention to bring both percepts into awareness. These results suggest that aging affects selective attentional components while leaving others unaffected and able to support the control of bistable perception.
Neurocognition and Protective Factors in HIV: Implications for Cognitive Reserve
Objective: Studies of healthy adults show a relationship between engagement in mental, physical, and social activities and better cognitive outcomes, suggesting that these activities may increase cognitive reserve, or the threshold of neurological insults one can withstand before the manifestation of cognitive impairment. Given that individuals with HIV have a higher prevalence of risk factors to cognitive impairment, the present study examined the potential protective effect of physical exercise, employment, and social activity on cognitive performance among HIV+ adults. Method: HIV+ (n = 174) participants completed a neuromedical and neuropsychological battery. Participants were classified on a summative scale of protective factors (0–3) based on physical exercise, social engagement, and current employment. ANCOVA was used to examine differences on demographically adjusted neuropsychological T-scores between the four protective factor classification groups after adjusting for age, education, mood, current, and nadir CD4 counts. Results: A stair-step effect across the groups was observed, such that an increasing number of protective factors was associated with better overall neuropsychological performance (p <.001). There were no significant covariates, although current CD4 (p = .07), nadir CD4 (p = .06), and BDI (p = .09) approached significance. Conclusion: These findings demonstrate only cross-sectional associations, but support the cognitive reserve hypothesis of the protective effect of mental, physical, and social activities on expression of underlying neuropathology among HIV+ persons. Future studies should utilize longitudinal observational or intervention approaches to establish cause–effect relationships and uncover the diverse neural mechanisms whereby physical, mental, and social stimulation may protect cognition.
Exploring the Relationship Between Cognitive Reserve and Functional Ability: The Role of Executive Functioning
Objective: A limited literature suggests cognitive reserve (CR) is positively associated with functional ability (FA) in independent community dwelling older adults (OAs). However, possible mechanisms of action explaining this relationship have yet to be examined. One potential related variable that consistently predicts FA in OAs is executive functioning (EF). This investigation examines the relationship between CR and FA and determines if it is mediated by EF. Method: Fifty-four independent community dwelling OAs ages 65–85 without history of learning disabilities, self-reported dementia diagnosis, self-reported illiteracy, or gross sensory impairment completed a semi-structured interview, the Wechsler Test of Adult Reading (WTAR), four tests from the D-KEFS: Trail Making Test Condition-4, Verbal Fluency, Design Fluency and Tower Test, and the Direct Assessment of Functional Status-Revised (DAFS-R). CR was operationalized as years of formal education, income, occupation and premorbid-IQ, and FA as total score on the DAFS-R. Results: All measures of CR were found to be positively related and predictive of FA except occupation (p = .114). WTAR was the most correlated (r = .450) and the predictive CR measure of FA, accounting for 17% of the variance (p < .001). Therefore, this measure was used for the mediation analyses which followed the guidelines specified by Baron and Kenny (1986). An internally consistent (α = .77) D-KEFS EF composite score mediated the relationship between CR and FA (p < .001). Conclusion: These results further the few findings that CR is positively related and predictive of FA in community dwelling OAs. The mediation result also adds to our understanding that the mechanism of action between CR and FA is EF.
Non-Verbal Learning Disability: A Neuropsychological Case Review
Objective: To add to the existing literature regarding the neuropsychological profile of a 13-year-old female who was diagnosed with Non-verbal Learning Disability (NLD). The current case illustrates the differential neurocognitive profile of NLD versus Attention-Deficit/Hyperactivity Disorder (ADHD) and Asperger's syndrome. Method: This adolescent completed comprehensive neuropsychological testing. In addition to common psychometric, achievement and memory/learning measures, she was administered the complete Halstead–Reitan Neuropsychological Battery (HRB). Results: The neuropsychological evaluation revealed findings unique to NLD, not ADHD or Asperger's syndrome. Specifically, all four inferential approaches to the HRB were significant. Lateralizing indicators revealed right cerebral hemisphere more impaired than left. Level of performance and pattern analysis revealed consistent impairments across measures. Diffuse and focal deficits revealed difficulties with novel problem-solving, visual memory and spatial analysis, mathematics, and sensory-perceptual discrimination. Conclusion: Though there is significant overlap between NLD, ADHD, and Asperger's, the unique pattern of NLD through neuropsychological testing has been well documented. Despite ongoing neuropsychological evidence, NLD is not yet recognized by the major diagnostic instruments, DSM-IV-TR or ICD-10. This case example emphasizes the importance of diagnostic clarity and further awareness of the NLD profile.
Relationship Between Woodcock–Johnson Test of Cognitive Abilities-Third Edition Clusters and the Wechsler Intelligence Scale for Children-Fourth Edition Index Scores
Objective: This paper examined the relationships between WJ-COG Standard Cognitive Performance and Working Memory Clusters and WISC-IV Index scores. Method: Participants were 206 clinically referred children with mixed clinical diagnoses (psychiatric [51.5%], neurological [24.3%], combination [17.0%], no diagnosis [7.3%]). The sample was predominantly male (63.6%), right-handed (89.8%), ranged in age from 6 to 16 years old (M = 9.80, SD = 2.78), with an average education of 3.86 years (SD = 2.61). Participants were predominantly Caucasian (54.4%) . Results: Paired samples t-tests were used to evaluate the relationship between the WJ-COG and WISC-IV. Paired samples correlations revealed significant correlations for WISC-IV FSIQ and WJ-COG GIA (r = .86), WISC-IV VCI and WJ-COG Verbal Ability (r = .63), WISC-IV WMI and WJ-COG WM (r = .60), WISC-IV PRI and WJ-COG Thinking Ability (.72), and WISC-IV PSI and WJ-COG Cognitive Efficiency (r = .59). Paired t-tests revealed significant group differences for the relationship between the two working memory measures, t(205) = −4.207, p < .000, and for the WISC-IV PSI and WJ-COG Cognitive Efficiency, t(205) = − 2.247 p = .026. Conclusion: Results revealed similar relationships between WISC-IV Index scores and the WJ-COG clusters. However, the Working Memory measures for both tests, while correlated, had significant mean differences and may measure different abilities. In addition, the PSI and WJ-COG Cognitive Efficiency, while correlated, do not appear to be corresponding measures. Despite the differences in several of the measures that make up the scales, the WISC-IV FSIQ and WJ-COG GIA were shown to assess similar domains of functioning. Thus, although GIA may be appropriate for comparison with WISC-IV FSIQ, working memory and processing measures should be compared and substituted with greater caution.
Reading Abilities in School-Aged Children and Adolescents with High Functioning Autism
Objective: This study examined differences in specific reading skills among school-aged individuals with High Functioning Autism (HFA). Measures of comprehension and decoding, including word identification and nonword decoding, were selected to evaluate these specific reading skills during the school years. It is expected that typically developing children maintain predictable abilities in decoding and reading comprehension as they progress through school. Researchers hypothesized that individuals with HFA are likely to show greater variance in reading abilities than their typically developing peers. Method: In this study, reading assessment data were collected for a group of individuals with HFA (n = 47), ranging from 6 to 18 years old, to examine this sample's capacity to maintain comparable skills in these areas of reading ability. Results: An analysis of collected data confirmed and further informed the researchers hypothesis, showing that individuals with HFA evidenced a significant difference between abilities in reading comprehension and both non-word reading, t(47) = 2.65, p < .011, and word identification, t(47) = 3.53, p < .001. Conclusion: This suggests while school-aged individuals with HFA possess and are able to maintain a strong ability to decode words, they exhibit a weakness in comprehension, perhaps due to impairments in working memory and high-order language skills. These findings indicate that interventions and support services provided to students with HFA should place a strong emphasis on the development of strategies to build reading comprehension skills.
Mathematics Weakness and Comorbidity: Learning and Attention Deficits
Introduction: The presence of one diagnosable developmental disorder increases the likelihood of being diagnosed with others which is consistent with the conceptualization of the brain as multiple interacting functional systems. An understanding of the occurrence of comorbidities is necessary for case conceptualization and effective treatment implementation. Research suggests that up to 7% of school-age children have difficulties in mathematics, and up to 25% of children with ADHD have a math disorder. There is a growing body of research suggesting high comorbidity in children with mathematic disabilities. The hypothesis of this study was that children with math weaknesses (defined as a 10+ point discrepancy between math achievement scores and Full-Scale IQ) would also exhibit a high percentage of attention or learning deficits. Method: Participants included 101 children (boys = 75%; ages 5–17 years; mean age of 9.35 years) who were referred for neuropsychological evaluations due to academic and/or behavioral problems. Children with neurologic conditions were excluded. Mean FSIQ was 88.18(15.28). Descriptive and chi squares analysis were performed. Results: Children with math weakness had an exceptionally high percentage of comorbidity (as assessed by DSM-IV-TR criteria) of ADHD inattentive (31%), ADHD combined (25%), and ADHD combined with behavioral/emotional symptoms (12%). Children also had a high percentage of comorbidity of dyslexia (13%), dysgraphia (10%), and a combination of both (22%). Conclusion: Results support that children with math weaknesses have a higher than the average rate of comorbidities with attention, reading, and writing deficits. These results suggest that children with math weaknesses may also have other confounding deficits needing intervention.
The Importance of Auditory Sustained Attention for Emerging Readers' Skill Development
Objective: The current study examined the influence of auditory and visual sustained attention on decoding, fluency, and comprehension in emerging readers. It was hypothesized that auditory sustained attention would predict decoding and fluency scores and that visual sustained attention would predict comprehension. Method: Participants included 31 typically developing children between the ages of 6 and 8 years old in kindergarten, first, or second grade. Children's reading skills were assessed using the Test of Word Reading Efficiency-Second Edition (TOWRE-2) and the Gray Oral Reading Test-Fifth Edition (GORT-5). Sustained attention was examined with the auditory and visual conditions of the Test of Variables of Attention (TOVA). Results: The findings suggest that auditory sustained attention, but not visual sustained attention, significantly contributed to the variance observed in decoding, R2 = .138, F(1, 29) = 4.468, p < .05, and fluency, R2 = .184, F(1, 29) = 6.303, p < .05, scores. Neither auditory nor visual sustained attention significantly predicted comprehension scores. Conclusion: Auditory sustained attention appears to be important for decoding and fluency skill development in emerging readers. Children who are learning to read may benefit from early interventions targeting auditory sustained attention skills. For struggling readers, it may be important to ascertain whether sustained attention to auditory stimuli is a contributing factor. Further research is needed to examine whether this aspect of attention is a critical variable in developmental dyslexia.
Neuropsychological Profile of an Adolescent Female with Ectodermal Dysplasia: A Case Study
Objective: The ectodermal dysplasias (ED) are a group of heritable disorders resulting in abnormalities of the ectoderm (e.g., sweat glands, hair, teeth, and nails). There has been speculation that ED has neuropsychological implications, but a recent study failed to find such a relationship (Maxim et al., 2012). The goal of this case study was to describe the neuropsychological profile of a 16-year-old, Caucasian female with ED. Method: In addition to ED, the patient's medical history is significant for febrile seizures, clinodactyly, headaches, and muscle pain. An MRI at age 2 revealed structural brain abnormalities consistent with cortical dysplasia (i.e., ventricular asymmetry with multiple heterotopias in the right hemisphere, macrogyria in the right frontal temporal region). The patient was diagnosed with a Learning Disorder Not Otherwise Specified in the past. Results: Results from neuropsychological testing revealed low average verbal and non-verbal abilities and severe deficits in information processing (i.e., working memory and processing speed). Additionally, results indicated a pattern of cognitive impairment associated with right hemispheric dysfunction including deficits in visual memory, spatial processing, visual-motor integration, and nondominant (left-hand) fine motor dexterity. Lastly, results were consistent with specific learning disabilities in math, reading, and writing, with the most pronounced weaknesses in math. Conclusion: Results from neuropsychological testing and MRI both indicated abnormal brain development. This suggests that a subset of individuals with ED may have neuropsychological impairment. Nonverbal learning disability may be a useful heuristic to guide educational and treatment planning. Further investigation is warranted to understand the neuropsychological profile of ED.
Metformin Does Not Reduce Risk of HIV-Association Neurocognitive Impairment
Objective: Metformin (Glucophage®) is a drug popularly used for patients with Type 2 Diabetes, but recently, studies have shown that Metformin has several neurobiological benefits. For example, metformin reduces total tau and maintains synaptophysin levels in a mouse model of Alzheimer's disease. The drug also stimulates neurogenesis by activating aPKCs in neural stem cells and increases the number of neurons generated from neural stem cells in the dentate gyrus of the hippocampus of mice. HIV results in a variety of neurocognitive impairments caused by underlying neuronal loss and decrease in synaptophysin levels. We hypothesize that metformin may help prevent HAND or reduce its severity. Method: Fifty-two HIV+ individuals with Diabetes Mellitus enrolled in the National Neurological AIDS Bank were included, 20 of whom were taking metformin. Groups did not differ with regards to demographic or virologic variables. ANOVA and chi-square analysis were used to compare neurocognitive functioning and frequency of HAND diagnosis, respectively. Results: The groups did not differ with regards to global neurocognitive functioning (F = 0.614, p = .44) or HAND severity (χ2 = 3.06, p = .22). Conclusion: In this small convenience sample of HIV+ adults with Diabetes Mellitus, metformin was not associated with better neurocognitive functioning or reduced risk of HAND.
Math Performance and Cognitive Correlates in Children with Duchenne Muscular Dystrophy
Objective: To further explore math performance in children with Duchenne Muscular Dystrophy (DMD), and the relationship between math and possible cognitive correlates. Cognitive skills examined include behavioral and cognitive attention, verbal working memory, and non-verbal problem-solving. Method: Children with DMD between the ages of 6 and 16 years (n = 17) and a sibling comparison group (n = 8) were recruited from the Muscular Dystrophy Association Clinic at Texas Children's Hospital/Baylor College of Medicine. Children were administered measures of math and cognitive measures having established correlations with math performance. Given the small sample size, comparisons were made between the entire group with DMD and a smaller sibling comparison group using descriptive statistics and effect sizes. Because of the dependence that may occur when using siblings as a comparison group, DMD-sibling pairs were also analyzed. The contribution of cognitive correlates to math performance was also examined in children with DMD. Results: Children with DMD were found to have specific difficulties in math. Children with DMD performed significantly worse than the comparison group and matched siblings on a measure of verbal working memory and a measure of non-verbal problem-solving (p ≤ .5). Math calculation skills were found to significantly correlate with measures of verbal working memory, with working memory for numerical information correlating slightly higher (r = .69). Conclusion: Findings suggest that children with DMD display specific math difficulties. These difficulties may be due to poorly developed verbal working memory skills. A lower distribution of dystrophin in cerebral areas may lead to limited verbal working memory, which in turn contributes to deficits in math.
Speeded Eye Tracking Is Associated with Visual and Non-Visual Neuropsychological Test Performance in Multiple Sclerosis
Objective: Few studies have examined visual biomarkers of disease burden in multiple sclerosis (MS). Recent research indicates a correlation between visual acuity and performance on both visual and non-visual neuropsychological tests in MS. The current study examined oculomotor speed in relation to performance on cognitive tests that do and do not require visual scanning in a sample of participants with MS. Method: MS participants (n = 76) were recruited from the Mid-America Neuroscience Institute as part of a larger study examining the association between cognition and visual acuity. Participants were given the Speeded Eye Tracking Test and a neuropsychological battery that assessed executive function, attention, and speed of information processing. Two composite z-scores were created, one for visual and one for non-visual neuropsychological tests. Results: Slower eye movements were associated with greater disease burden (r = − .44, p < .01), longer disease duration (r = .26, p < .05), and older age (r = .45, p < .01). As expected, partial correlations controlling for age and education revealed that slower eye movements were associated with poorer performance on visual neuropsychological tests (r = − .42, p < .01). However, slower eye movements were also significantly associated with worse performance on non-visual neuropsychological tests (r = − .32, p < .01). Conclusion: Findings suggest that slowed oculomotor functioning may be indicative of impaired visual and non-visual neuropsychological test performance in MS. Future studies should attempt to develop a more sensitive measure of speeded eye tracking to determine if oculomotor speed may serve as a visual biomarker for disease progression in MS.
Practice Effects with Repeated Neurocognitive Assessment in Multiple Sclerosis. Which Measures are Most Susceptible?
Objective: Repeated neurocognitive assessment is common in treatment trials and longitudinal studies, but may introduce practice effects on re-test performance. This study examined which tests commonly used with multiple sclerosis (MS) are most susceptible to practice at 6-month follow-up. Method: Twenty-seven MS subjects (Mage = 45.2 [±12.6]; Meducation = 15.7 [±1.9]) were seen at baseline and 6 months as part of a longitudinal study of cognition in MS. The neurocognitive battery consisted of verbal fluency (FAS; Animals), Stroop Color and Word Test (Stroop), Oral Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and California Verbal Learning Test-II (CVLT-II). Repeated-measures analysis of variance (ANOVA) was conducted to assess for practice effects, and reliable change indices (RCIs) were calculated for all variables. Results: Repeated-measures ANOVA showed minimal practice effects at 6 months for FAS, Animals, Stroop, and SDMT (p > .05), whereas significant improvement was seen on memory variables BVMT-R Total (p = .029) and CVLT-II Total (p = .004) and Long Delay Free Recall (p = .021). Over 30% of subjects improved by ≥1 SD on repeat memory testing. RCIs were largest for BVMT-R and CVLT-II and smallest for SDMT. Conclusion: Memory measures were most susceptible to practice effects at 6 months in a stable and mostly average cognitive functioning MS sample, whereas verbal fluency, attention, and processing speed measures were more resilient. RCIs indicate that ≥1–2 SD of change are necessary to identify meaningful variation in memory performance. These findings suggest that caution should be used when interpreting memory changes over short intervals in high functioning MS patients.
The Course of Central Nervous System Insults in the Dually Diagnosed Multiple Sclerosis and Human Immunodeficiency Virus: A Case Study
Objective: The objective of this study was to explore the utility of neuropsychological assessment in determining the presence and progression of CNS Insultsin persons with a dual diagnosis of Multiple Sclerosis (MS) and Human Immunodeficiency Virus (HIV) infection. MS and HIV-associated Central Nervous System (CNS) insults in the brain include the fronto-straital areas, basal ganglia, white matter lesions and occasional gray matter insults, the hippocampal regions, corpus callosum, and cerebral cortex. It is often characterized by a range of complex neuropsychological disturbances including memory impairments, slowed information processing speed or bradyphrenia, impaired executive function, and visuospatial processing. Method: A 42-year-old, right-handed, single, Caucasian man was assessed in a medical clinic setting following concerns of short-term memory loss and a slowness of thinking. The patient reported changes in cognitive abilities 2 years ago, after his HIV diagnosis and further cognitive decline after his MS diagnosis 1 year ago. Complaints included word-finding problems, unmanageable short-term memory difficulties, and lowered frustration tolerance. Personality changes were denied. Archival neuropsychological data, de-identified history, and neurologist report will be organized and presented in a single case study. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Neuropsychological assessment revealed deficits in divided attention, working and delayed memory, and executive functioning deficits including problems with organization, planning, and slowed simultaneous sequencing processing. Conclusion: Neuropsychological assessment is an effective tool in determining CNS insults unique to the neuropsychological profiles, as the literature suggests, of the dually diagnosed MS and HIV population.
Depressed Adults Demonstrate Impaired Performance on Computerized Version of WCST Compared with Controls
Objective: Although significant differences have been found in depressed versus non-depressed individuals on the Wisconsin Card Sorting Test (WCST), these findings have yet to be replicated on the computer-administrated version of the WCST. This study compared a sample of adults diagnosed with Major Depressive Disorder (MDD) to a sample of healthy normal participants. Method: Depressed participants (n = 38, ed. = 13.11, SD = 2.56, age = = 32.87, SD = 10.93, 55% female) and healthy controls (n = 44, ed. = 16.09, SD = 2.11, age = 27.70, SD = 8.29, 48% female) were recruited from a University-based clinic. Results: Data were analyzed using independent samples T-tests. All group mean differences were significant at the p < .01 level unless noted. Depressed participants were significantly older, t(80) = − 2.43, p = .017, and less educated than normal participants. Depressed participants completed significantly less categories (M = 3.69 vs. 6.0). Depressed participants also required more trials to finish the test (M = 114.85 vs. 79.07), made more errors (M = 45.74 vs. 12.23), and had more perseverative responses (M = 29.36 vs. 6.07) and errors (M = 22.31 vs. 5.89) than non-depressed participants. Depressed patients failed to maintain set more often than nondepressed patients (FTMS = 1.45 vs. 0.364) and demonstrated negative change in conceptual efficiency across stages (LTL = − 2.10 vs. 0.806). Conclusion: These results suggest depressed individuals are likely to perform significantly worse on the WCST than non-depressed individuals. This provides further support that depressive disorders such as MDD disrupt processes mediated by the frontal lobes. Specifically, depressed individuals seem to make more perseverative responses and benefit less well from feedback. Further research might examine the effects of differential feedback on depressed individuals' performance on tasks of executive functioning.
Limitations in the Assessment of Functional Capacity in Cognitively Unimpaired Outpatients Diagnosed with Schizophrenia and Bipolar Disorder
Objective: Deficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used to assess functional disabilities for cognitive remediation programs, and significant linear relationships between functional capacity and cognitive deficits are frequently observed. The aim of this study was to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity. Method: Two independent samples were obtained. Study 1: 829 participants with schizophrenia (n = 438) and bipolar disorder (n = 391) aged 16–83 completed a neuropsychological battery, the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), and Advanced Finances Test. An adaptive functioning composite was created. Study 2: 192 participants with schizophrenia (age range = 39–72) completed the RBANS and UPSA-B. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores. Results: Significant linear and quadratic trends were observed for both studies. Study 1: Examining bipolar and schizophrenia participants together, R = .657 (adjusted R2 = .431) for the linear model and R = .693, adjusted R2 = .479 for the quadratic model. When z-scores on cognitive composite were >0, cognition was not significantly related to the UPSA-B. Study 2: For the linear model R = .672, adjusted R2 = .449, with the quadratic trend improving overall model fit (R = .719, adjusted R2 = .512). When RBANS standard score >80, cognition was not related to the UPSA-B. Conclusion: These results illustrate as cognitive function improves, its relation to functional capacity weakens. These findings may aid clinicians in determining the functional benefits of cognitive remediation, whereby greater benefit may occur for those with severe versus mild cognitive deficits.
Neuropsychological, Psychological, and Injury Variables Associated with Post-Traumatic Stress Disorer in Individuals Who Suffered an Elecrical Injury
Objective: Electrical injury (EI) represents a major form of trauma that can greatly impact the individual cognitively, physically, and emotionally. EI can lead to a variety of cognitive impairments affecting attention, processing speed, and memory. Furthermore, and it can lead to a variety of physical impairments from burns to cardiac injury. In addition to other psychiatric disorders, individuals who suffer an EI can eventually develop Post-Traumatic Stress Disorder (PTSD). Method: This study examined a clinical sample of 143 individuals (86.0% male, 85.3% Caucasian, 44.1% diagnosed with PTSD) who experienced an EI to determine the factors associated with the development of PTSD after EI. By using a clinical sample, this study offered greater generalizability compared with previous research on EI which primarily used electricians. Results: This study applied a unique statistical approach that allows for the creation of subgroups within the context of the model. Classification tree analysis via Optimal Data Analysis determined the demographic and injury parameters, psychological, and neuropsychological factors associated with the development of PTSD in individuals post-EI. The strongest predictor of classification into the PTSD group for this sample was depressive symptoms (p = .002) with a cut score of 11.5 on the Beck Depression Inventory-Second Edition. Conclusion: Mood symptoms may be utilized in clinical settings to determine individuals more likely to develop PTSD post-EI. Several causal pathways have been theorized to explain the association between PTSD and depression following exposure to a traumatic event. Given that PTSD and depression increase susceptibility for each other, there may be a shared vulnerability for both disorders.
Decision-Making in Individuals with Bipolar Disorder
Objective: Bipolar disorder (BD) is characterized by cognitive and behavioral disinhibition, which manifests as a propensity to make risky decisions and an increase in novelty seeking and motor hyperactivity. The current study aims to assess the relationship between aspects of disinhibition and risky decision-making using the human Behavioral Pattern Monitor (hBPM) and the Iowa Gambling Task (IGT) among people with BD. We hypothesized that increased risk-taking on the IGT would be related to increased disinihibiton in the hBPM. Method: Twenty-four euthymic BD outpatients were assessed in the hBPM, an unfamiliar room containing novel objects. Participants were asked to wait in the hBPM for 15 min, but given no other explicit instructions. Their behavior was recorded and scored for motor activity and perseverative responding, measures thought to reflect behavioral disinhibition. Following the hBPM, all subjects were assessed with the computerized version of the IGT. Results: Greater preference for risky choices during the last two IGT blocks was significantly associated with increased motor activity in the hBPM (r = − .45, p <.05), and a trend toward more perseverative object interactions (r = − .37, p = .08). hBPM measures were not correlated with IGT performance during the first 60 trials. Conclusion: These findings suggest that impairments in cognitive inhibition as manifested by risky decision-making correspond with “real-world” disinhibited behavior that may lead to engagement in risky activities with adverse consequences. The hBPM could be utilized as a tool to determine the potential for high-risk or impulsive behaviors in individuals with this illness.
Impact of Depression Level on Prospective Memory Performance in Multiple Sclerosis
Objective: Prospective memory (PM) has emerged as an important everyday functional ability. Investigations of PM among individuals with Multiple Sclerosis (MS) have demonstrated impaired PM performance relative to control participants. Depression symptoms are a major concern in this population and are associated with impaired neuropsychological functioning. Depression has also been shown to be related to poor PM performance. The current investigation set out to determine whether the depression level accounts for patterns of PM performance in MS. Method: Twenty-seven community-dwelling individuals with MS (mean age = 47.7) participated. Groups were formed based on traditional BDI-II cutoff scores: 0–13 (MIN, n = 13), 14–19 (MILD, n = 8), and >20 (MOD-SEV, n = 6). Measures administered included the MIST, the Complex Prospective Memory (CPM) task, the MS Functional Composite (MSFC), and a self-report measure of PM. Results: No group differences were identified on symptom severity or self-reported PM difficulties. Omnibus results demonstrated that MIST score differed significantly between the groups, F(2,23) = 6.780, p = .005, as did CPM Initiation score, F(2,24) = 5.249, p = .013. Post hoc comparisons (Tukey's HSD) revealed that the MIN group performed significantly better than the other two groups on the MIST; the MOD-SEV performed significantly worse that the other two groups on CPM Initiation. Conclusion: These preliminary results suggest depression may be related to PM impairment in the MS population. This conclusion was supported by results from two separate measures of PM. These differences did not emerge on a self-report measure of PM ability, indicating that depression symptoms may be related to PM impairment regardless of subjective perception of PM abilities.
Neuropsychological Correlates of Functional Disability in Patients with Borderline Personality Disorder
Objective: Patients with borderline personality disorder (BPD) report severe functional impairments in their interpersonal relationships, life activities, and participation in society. Neuropsychological deficits underlie BPD and may contribute to these functional impairments. The purpose of the present study was to examine the relationship between neuropsychological deficits and functional disability in BPD. Method: Twenty-eight patients with BPD (93% female) with a mean age of 30.3 years without a history of serious medical or neurologic illness were included in this study. They were recruited from outpatient psychiatric clinics and online postings and tested in a University setting. Neuropsychological tests of visuospatial construction, episodic memory, cognitive flexibility, response inhibition, working memory, planning/problem-solving, and symptom validity were completed by patients. The World Health Organization Disability Assessment Schedule 2.0 measured the functional domains of cognition, mobility, self-care, interpersonal relationships, life activities, and participation in society. Results: On average, patients with BPD reported functional disability that scored above the 90th percentile according to population based normative data. Self-reported problems with understanding and communication were associated with cognitive flexibility deficits, whereas difficulties with self-care were linked to deficits in visuospatial construction and visual episodic memory. Functional difficulties with participating in society were associated with problems in response inhibition. Conclusion: Functional disability in patients with BPD may be underpinned by difficulties in the cognitive domains of cognitive flexibility, visuospatial construction, visual episodic memory, and response inhibition. These cognitive deficits may serve as important targets in interventions for this disorder.
A Pilot Study Examining the Effects of a Computerized Cognitive Training Program on Perceived Cognitive and Psychosocial Functioning in Veterans with Bipolar Disorder
Objective: This pilot study examined the effects of a web-based cognitive training program on perceived cognitive and functional outcomes in eight veterans with bipolar disorder (BP). Self-report ratings were collected pre- and post-intervention in a variety of cognitive and psychosocial domains including depression, sleep, memory, and impulsivity. Method: Eight veterans with BP were recruited from the VA Palo Alto Health Care System and completed 8 weeks of a Posit Science web-based cognitive training program. Participants completed an average of 46 1-h sessions. Assessments were administered at baseline (T1) and again after the completion of the training program (T2) and included the Barratt Impulsivity Scale (BIS), Cognitive Self-Report Questionnaire-64 (CSRQ-64), Bipolar Functional Status Questionnaire (BFSQ), and Beck Depression Inventory-II (BDI-II). Results: Given the small sample size, data were examined descriptively. Group means (SD) for all participants are presented. Post-intervention, five participants reported increased psychosocial functioning on the BFSQ (T1 = 90.01 [24.79], T2 = 98.25 [27.34]), four reported decreased depression symptoms on the BDI-II (T1 = 12.38 [9.05], T2 = 9.13 [8.99]), and seven reported decreased impulsivity on the BIS (T1 = 67.25 [12.57], T2 = 59.13 [7.49]). On the CSRQ-64, a post-intervention rating of perceived changes in functioning, improvements were noted across all domains including attention, memory, and language. Conclusion: Following a web-based cognitive training intervention, veterans with BP reported an improvement in perceived functioning across a variety of cognitive and psychosocial domains including depression, attention, language, memory, and impulsivity. These pilot data are promising and provide the basis for future studies.
Web-Based Cognitive Training in Veterans with Bipolar Disorder: A Pilot Study
Objective: Bipolar disorder (BP) is associated with cognitive impairments that can have significant real-world consequences. The goal of this pilot study was to demonstrate the feasibility of implementing a computerized cognitive training program in veterans with BP and explore its effects on neuropsychological performance. Method: Eight veterans with BP (ages 42–63) were recruited from the VA Palo Alto Health Care System. Participants completed a baseline assessment of neuropsychological measures including tasks of memory, attention, and executive functioning. They were then asked to complete 40 1-h sessions of the Posit Science Brain Fitness program from home before returning for a repeated neuropsychological assessment after 8 weeks. Results: Data were examined descriptively. On average, participants completed 46.16 (27.03) sessions with six participants completing approximately 40 sessions as requested. Participants' performance improved on assessments within the training program (0.77 SD on average). On neuropsychological measures, group averages increased on measures of working memory and attention including WMS-III Spatial Span, Digit Vigilance Test, Auditory Consonant Trigrams, and D-KEFS Color Word. Average group performance on D-KEFS Verbal Fluency, NAB Memory Module, and NAB Mazes either decreased or remained unchanged. Conclusion: This pilot study demonstrated the feasibility of implementing a web-based computerized cognitive training program in veterans with BP. Not surprisingly, participants demonstrated improvements on training-based tasks. Performance on neuropsychological measures was more variable with the most promising improvements on the measures of working memory and attention. These preliminary data are encouraging and provide a basis for future research in this area.
Basic Auditory Perception Deficits Are Related to Impaired Perception of Sarcasm
Objective: Deficits in theory of mind (ToM) have been identified in schizophrenia (SZ) and bipolar disorder (BP). Studies examining sarcasm perception as an index of ToM suggest variations in fundamental frequency and prosody distinguish sarcasm from sincere remarks. Given findings that individuals with SZ and BP exhibit difficulty discriminating tones of differing frequencies, it may be that these deficits are related. The current study examined this matter by investigating the relationship between frequency discrimination, cognitive and affective ToM ability, and sarcasm recognition in a psychiatric sample. Method: Participants included 11 individuals with SZ or BP (55% female; mean age = 45.1, mean education = 13.2) were assessed on their ability to identify tones of differing frequency, as well as to answer cognitive and affective ToM questions from the Assessment of Interpersonal Problem-Solving Skills (AIPSS) and The Awareness of Social Inference Test (TASIT), the latter requesting participants to identify sincere and sarcastic remarks. Results: Results indicated that performance on frequency discrimination was positively correlated with identifying TASIT ToM-based sarcastic remarks (r = .67, p < .05), but not with identifying ToM-based sincere remarks. Performance on frequency discrimination did not correlate with similar cognitive or affective ToM questions from the AIPSS. Conclusion: These findings suggest difficulties with basic auditory perception serve as a component in recognizing sarcasm, as sarcasm detection relies heavily on an individual's ability to effectively perceive frequency changes in tone of voice. Further research should be conducted to ascertain underlying neural mechanisms and additional cognitive processes associated with sarcasm recognition.
Impaired Higher-Order Social Perception Skills in Psychotic and Affective Disorders
Objective: Social perception impairments are common in schizophrenia (SZ) and bipolar disorder (BP). The Awareness of Social Inference Test (TASIT) was designed to evaluate social perception. Conversational inference has demonstrated association with linguistic prosody, emotion perception, and theory of mind (ToM). The present study used TASIT to evaluate sincere, lying, and sarcastic remarks, in a psychiatric sample. We hypothesized impaired recognition of sarcasm to be associated with psychotic symptomatology. Method: Participants included 27 BP, 12 with psychotic symptoms during mood episodes (BP+) and 15 who never experience psychotic symptoms (BP−), as well as 9 SZ and 16 healthy controls (HC). Clinical participants were recruited from community outpatient mental health clinics. There were no group differences for age, gender, ethnicity, or education. TASIT scores were evaluated for group differences. Results: Results indicated significant differences in TASIT scores among groups. There were no group differences with respect to sincere remarks. The SZ group performed worse than all groups on recognition of lies. As hypothesized, the BP+ and SZ groups performed significantly worse than the BP− and HC groups in their ability to correctly interpret sarcastic remarks. The BP− and HC groups did not differ in performance. Conclusion: Social perceptual dysfunction reflects numerous overlapping neural systems, such as affective cortical networks and those involving auditory processing and high-order ToM. These findings suggest that BP+ are impaired in recognition of sarcasm, which has been associated with right superior temporal and right frontal gyrus dysfunction. The results support continued investigation into mechanisms underlying sarcasm recognition in affective psychosis.
Inadequate Screening of Acquired Brain Injury in Psychiatric Settings
Objective: Acquired brain injury (ABI) is a common comorbidity of psychiatric disorders. However, there are no systems in place for routine clinical screening of ABI in psychiatric services, and no clinical practice guidelines. This study aims to evaluate current practice in detection of ABI in an inner-city psychiatric inpatient service in Melbourne, Australia. Method: In adult psychiatric inpatient setting (17–64 age group), a retrospective file audit was conducted for 100 inpatients with at least 3-day admission (in days: males, X = 25.5, SD = 23; females, X = 16.3, SD = 17). Files were reviewed for admission interviews, standard initial assessment, and final discharge summary documents. Further information was collected on patient demographics, DSM-IV-R diagnoses, medical and substance use, and ABI screening. Results: The audit revealed that the patients in general had chronic psychiatric conditions and history of multiple admissions. The presentations were often complex with a broad range of axis I disorders (55% psychotic disorders; 31% mood disorders), axis II personality disorder or traits (41%), medical and polysubstance use comorbidity (65%). Although medical and substance use comorbidity information was regularly collected, only 18% of files had evidence that ABI was considered. The remainder of files had no reference to any form of ABI screening. Conclusion: The study provides evidence for inadequate screening of ABI in psychiatric inpatient settings. The findings highlight the need to put systems in place for routine and systematic screening of ABI patients in mental health settings, for optimizing management of psychiatric patients with ABI comorbidity.
Effort Expenditure Is Related to Every Day Functioning and Psychiatric Symptomatology
Objective: The allocation of effort is an adaptive mechanism and involves cost/benefit considerations. Some psychiatric populations have been found to exert less effort for a given reward. However, it is unclear whether effort expenditure is associated with every day functioning. In order to address this, the current study examined whether effort is significantly different between patients and controls and whether effort is significantly related to every day functioning. Method: Forty-six individuals were evaluated in the current study. Thirty had a history of schizophrenia or bipolar disorder and 16 had no history of psychiatric illness. All participants were interviewed and clinician-rated measures of current symptomatology were completed. Participants also completed the Effort Expenditure for Reward Task (EEfRT), Birchwood social functioning scale (BSFS), and UCSD performance-based skills assessment (UPSA). Results: Results indicated effort was significantly different between the patient and control groups with the patients choosing the easy task significantly more than the control group. Effort was significantly correlated with the Recreation and Prosocial subscales of the BSFS and the UPSA total score. Effort was also significantly correlated with ratings of negative, positive, and general psychiatric symptomatology. Findings suggest that effort is related to every day functioning and psychiatric symptomatology. Conclusion: Pharmacological treatments targeting dysregulation in brain areas associated with effort as well as behavioral interventions aimed at improving effort may also benefit functional ability. Future research examining specific aspects of effort, psychiatric symptoms, and functioning are warranted in order to clarify and expand on current results.
Social Perception Skills Predict Functional Outcome in Bipolar Disorder and Schizophrenia
Objective: Theory of mind (ToM) impairments predict decreased functional outcome in schizophrenia (SZ), although it is unclear whether this is true for bipolar disorder (BP). To our knowledge, conversational inference, a putative ToM subdomain, has not been investigated as a predictor of functional outcome. The Awareness of Social Inference Test (TASIT) was used to ascertain whether correct interpretation of conversational inference would predict functional outcome, as measured by the University of California, San Diego Performance-based Skills Assessment (UPSA) and Social Functioning Scale (SFS). Method: Participants included 9 SZ and 27 BP who combine to yield a serious mental illness group. Multiple regression analyses were utilized and TASIT subscales were simultaneously entered as predictors of UPSA and SFS scores. Results: Sections of TASIT which purport to assess conversational inference were significant for predicting functional outcome. TASIT explained 56.0% of UPSA summary score variance. The Social Inference-Minimal section of TASIT (Part II) was the strongest predictor of overall UPSA performance. TASIT predicted Planning, Finance, and Communication domains. Separately, TASIT explained 18.1% of SFS summary score variance. The Social Inference-Enriched section of TASIT (Part III) was the strongest predictor of the SFS summary scores. TASIT predicted Independent Performance and Recreation. Conclusion: The ToM subdomain reflecting persons' ability to correctly interpret conversational inference is predictive of social functioning across a multitude of functional domains. The reasons for differential impairment on one domain versus another remains unclear. Future research could continue to elucidate unique associations between ToM subdomain impairments and diminished social functioning.
Neuropsychological Profiles Following Electrical Injury for Individuals With and Without PTSD: A Preliminary Investigation
Objective: Electrical injury (EI) is a debilitating and often fatal occupational hazard and post-traumatic stress disorder (PTSD) is a common sequelae of the injury. However, at present, it is unclear how the etiology and symptomatology of PTSD following EI is similar to, or distinct from, other forms of trauma. Additionally, while neuropsychological performance has been examined in a variety of trauma survivor cohorts, few studies have examined the neuropsychological profiles of EI survivors with PTSD. In this study, we conducted a systematic examination of PTSD symptomatology and cognitive performance in EI survivors with and without PTSD. Method: Two hundred and thirty-two EI survivors with and without PTSD (with PTSD n = 63; without PTSD n = 169) participated in this study. Because nothing is presently known about the neuropsychological outcomes of EI survivors with PTSD, a priori hypotheses were not generated in this preliminary study. Instead, a systematic examination of cognitive domains was undertaken; specific domains examined included: attention, verbal memory, visual memory, and executive functioning. Premorbid intelligence was also examined. Results: No differences were found between EI survivors with and without PTSD in any of the domains sampled. These results represent a diversion from earlier studies with other trauma survivors (e.g., veterans, sexual assault survivors) with PTSD. Results are discussed in the context of neurobiological theory and the nature of electrical injury. Conclusion: Using neurobiological theory and information about the pathophysiology of EI, reasons why a distinct PTSD neurocognitive pattern may have emerged are discussed. Implications and suggestions for treating EI patients are also offered.
PAI Scores and Neuropsychological Test Performance
Objective: The purpose of this study was to determine the relationship between elevations on Personality Assessment Inventory (PAI) clinical scales and neuropsychological test performance. Method: Subjects were 155 patients referred to a Neurology/Neuropsychology clinic who underwent neuropsychological evaluation including measures of visual-spatial ability, language, attention, memory, and executive functions. Only patients who obtained valid PAI profiles and failed no symptom validity tests were included. Participants were assigned to one of two groups based on PAI scores: (a) >70 t on one or more PAI clinical scales (n = 90; gender: 70% female; mean/SD: Age = 43.9/12.9; education = 13.6/2.2) or (b) all PAI scales <70 t (n = 65; gender: 55% female; mean/SD: Age = 48.1/13.2; education = 14.7/2.4). Results: There were no significant differences in neuropsychological test scores for subjects with and without PAI scale elevations. Only two statistically significant correlations (both r < .3) were found between some PAI scales and neuropsychological measures, and these correlations were not clinically meaningful. Conclusion: For patients similar to the one in this study, elevated PAI clinical scales are not associated with, and thus do not account for, impaired neuropsychological performance. A limitation of this study is combining patients with an elevation on any PAI clinical scale into a single group. Future research should employ groups with more specific PAI elevations.
Variations in Verbal and Visual Memory Abilities Between Clinical Anxiety and ADHD
Objective: Clinical anxiety can oftentimes manifest in similar ways to ADHD. Both may be associated with restlessness, inattention, and various neurocognitive complaints. Although current diagnostic practices remain focused on DSM-IV criteria, objective measures are commonly utilized to support diagnoses. The current study sought to determine if any significant difference existed between groups in aspects of verbal and visual memory. Method: The performances of 341 patients diagnosed with anxiety and 3,325 patients diagnosed with ADHD, both using the DSM-IV-TR criteria, were compared. Neurocognitive data were obtained by way of the verbal memory and visual memory subtests of the CNS Vital Signs. Group means and standard deviations were available for comparison. Two independent sample t-tests were used. A Bonferroni correction was utilized to avoid inflation of the family-wise error rate. Results: No significant difference existed between groups in regards to visual memory. However, ADHD was associated with significantly lower outcomes within the realm of verbal memory. Conclusion: Results demonstrate that although similarities are found between ADHD and clinical anxiety on the behavioral surface, differences can be found on objective assessment. Group differences in verbal memory may be explained by greater impediment of attentional capacity and cognitive efficiency in ADHD compared with anxiety.
Differences in the Neurocognitive Burden of Bipolar Disorder Compared to Major Depression
Objective: Disturbances in mood such as depression and bipolar disorder are often associated with neurocognitive impairments. Although emphasis is commonly placed on the behavioral differences between these groups, owning to their differential diagnosis, there is growing interest in the neurocognitive effects of such psychiatric manifestations. The current study sought to determine what similarities and differences would emerge when comparing a sample of patients with major depression to those with bipolar disorder on CNS Vital Signs. Method: The performances of 1,056 patients diagnosed with depression and 447 patients diagnosed with bipolar disorder using the DSM-IV-TR criteria were compared in patients that completed the core tests of the CNS Vital Signs computer-based assessment system. Group means and standard deviations were compared. Multiple independent sample t-tests were ran utilizing a Bonferroni correction to avoid inflation of the family-wise error rate. Results: Statistical analysis revealed patients diagnosed with bipolar disorder performed significantly worse in both verbal memory and visual memory. In addition, bipolar disorder was associated with significantly lower performance on the Stroop task, a continuous performance test, and a test of reaction. No significant difference was found between groups in finger tapping. Conclusion: Overall, results suggest that bipolar disorder may correspond to greater neurocognitive burden compared with major depression.
Impact of Posttraumatic Stress Disorder, Alcohol, and Mild Traumatic Brain Injury on Anxiety and Depression: Preliminary Findings
Objective: The purpose of the study was to investigate differences between veterans (n = 51) with PTSD, PTSD and mTBI, PTSD and alcohol dependence, and mTBI on measures of anxiety and depression. It was hypothesized that the presence of comorbid conditions with PTSD would result in higher depression and anxiety. Method: All subjects were administered the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) as part of the evaluation process at a Midwestern VA Medical Center. Subjects were excluded if they had previously been diagnosed with major depressive disorder. Multiple analyses of variance (MANOVA) and univariate statistics (e.g., ANOVAs) were conducted to examine differences between groups on BDI-II and BAI scores. Results: A MANOVA revealed an overall main effect between groups (Wilks' λ = 0.571), F(6,92) = 4.96, p < .001, η2 = 0.244]. ANOVAs revealed significant differences between groups on BAI scores, F(3,47) = 7.32, p < .001, η2 = ;0.318, and BDI scores, F(3,47) = 8.22, p < .001, η2 = ;0.344. The PTSD and alcohol dependence group had the highest scores of the four groups on BAI (M = 35.44, SD = 8.28) and BDI-II (M = 24.67, SD = 10.75) scores; and the group scored significantly higher than groups diagnosed only with PTSD or only mTBI, but not those subjects with combined diagnoses of PTSD and mTBI. Conclusion: Findings suggest the need for ongoing screening of depression and anxiety in clinical settings, particularly when comorbid conditions exist with PTSD (e.g., mTBI).
Neurocognitive Predictors of Non-verbal Memory in Depression: Testing the Cognitive Speed Hypothesis
Objective: We investigated predictors of nonverbal memory in depression examining psychomotor speed, visual-spatial attention, visual-spatial working memory, depression severity, and age. We wished to determine if psychomotor speed is an underlying source of non-verbal memory performance, as the cognitive speed hypothesis suggests, or if alternative cognitive factors underlie non-verbal memory functions. Method: Archival data of 37 depressed adults from a larger study were analyzed. Measures of visual memory (Wechsler Memory Scale-III Visual Reproduction) served as the dependent variables. The predictors were: non-verbal attention (Spatial Span Forward), working memory (Spatial Span Backwards), psychomotor speed (Trails A), and depression severity (Hamilton Depression Scale- 24). Results: Significant correlations were found between immediate recall and working memory (r = .372, p = .025) and between recognition and working memory (r = .403, p = .015). Delayed recall was not significantly correlated with any predictors. Depression severity, age, and psychomotor speed were not correlated with visual memory measures. Visual-spatial working memory significantly predicted 13.8% of the variance for immediate recall and 16.2% of the variance for visual memory recognition. Conclusion: Psychomotor speed had no significant influence on non-verbal memory in depressed adults; rather, visual-spatial working memory was the strongest predictor. Results challenge the cognitive speed hypothesis, suggesting that visual-spatial working memory may be an independent deficit found in major depression.
Protective Effects of Premorbid Cognitive Reserve on Neuropsychological Performance after Brain Injury
Objective: Research has found that cognitive reserve, as indicated by premorbid intelligence estimates, serves as a protective factor against cognitive decline in several neuropsychiatric conditions including schizophrenia, depression, and bipolar disorders. We investigated whether the phenomenon of cognitive reserve as a protective factor against neurocognitive dysfunction extends to traumatic brain injury (TBI), even with the occurrence of posttraumatic amnesia (PTA), a strong indicator of TBI severity. Method: Clinical records of 120 adults screening positive for TBI were analyzed. Neuropsychological measures included: Repeatable Battery for the Assessment of Neuropsychological Status, Grooved Pegboard, Trails, WAIS-IV Digit Span, Numbers and Letters Test, and Delis–Kaplan Verbal Fluency and Interference Tests. Predictors included PTA per structured clinical interview and premorbid intelligence as estimated by the Wechsler Test of Adult Reading and Shipley Vocabulary tests. Results: Occurrence of PTA was significantly associated with lower premorbid intelligence. Further analysis indicated an interaction effect of PTA and premorbid intelligence for several measures of attention, verbal fluency, and affect recognition (p < .05), such that in the lower IQ group, PTA was associated with lower scores on these neurocognitive measures. However, PTA was not associated with lower cognitive performances in the higher IQ group. Significant interactions were not found for measures of fine motor functions and processing speed. Conclusion: Present analysis indicates that premorbid intelligence likely does serve to protect neuropsychological functioning following TBI even with the occurrence of PTA. This expands the range in which this phenomenon of cognitive reserve has been demonstrated and highlights the importance of accessible education.
Attentional State Training in Traumatic Brain Injury
Objective: Patients with traumatic brain injury (TBI) often have difficulties regulating fundamental aspects of attention and may exhibit hypo or hyper states of alertness. Attention deficits may underlie or exacerbate higher order executive dysfunction. Recent studies indicate that computerized cognitive training, focused on attentional control and alertness, can ameliorate poor intrinsic regulation of alertness (i.e., attentional state) evident in patients with TBI or acquired brain injury. Method: The current study examined effects of training in seven patients with a history of mild-to-moderate TBI. Patients engaged in several hours of Tonic and Phasic Alertness Training (TAPAT), a program previously shown to improve attention regulation in individuals with acquired brain injury. To evaluate potential consistencies in the training effect, individual's progress in training as well as performance on standard neuropsychological measures of attention, executive functions, and mood were evaluated pre- and post-training. Results: On the computerized cognitive training program, patients demonstrated increased response inhibition, as well as decreased omission errors and overall variability in reaction time across sessions over time. Associated with improvements on TAPAT, improvements were also seen on neuropsychological outcome mesaures, including higher-order executive functions and overall emotion regulation. In particular, results suggested improvements in areas of attention, working memory, set-shifting, verbal fluency, and processing speed, as well as responses to emotinonal stressors. Conclusion: Patients' performances on TAPAT and neuropsychological outcome measures suggest that improvements in attention regulation facilitate improvements in higher-order executive functions. Results from the current study offer promising insight into the development of treatments for attentional deficits among patients with TBI.
Trail Making Test Performance in OEF/OIF Veterans: Identification of Subgroups Based on Cluster Analysis
Objective: The current study examined Trail Making Test (TMT) cluster profiles in a sample of veterans referred for mild TBI and compared profiles on relevant neuropsychological and psychiatric variables to determine subgroups of neuropsychological functioning within this population. Method: Participants were included in this study if they sustained at least one head injury in combat and completed both TMT trials and were excluded if they demonstrated low effort on any of three symptom validity measures (TOMM Trial 2 < 45; WMT IR, DR, CNS < 85%; Rey 15 < 12). The final sample consisted of 78 veterans (mean age 30.1 years, SD = 7.0; 93.6% men). Results: Two clusters were characterized by level of performance and a third cluster had a unique pattern of performance characterized by significantly slow performance on Trail B (Below B). Clusters did not differ on age, education, gender, previous injuries, months since injury, psychiatric distress, or estimated pre-morbid functioning. The Above Average cluster had superior performance on measures of processing speed, working memory, and phonemic fluency compared with the Below B cluster, whereas no differences emerged on other neurocognitive measures. Conclusion: A subset of patients with a history of mTBI performs particularly poorly on TMT B, which in turn predicts poorer cognitive functioning on several other neuropsychological measures. In addition, this subset may be vulnerable to cognitive changes in the context of mTBI and multiple co-morbidities, whereas there are a number of other patients who under the same circumstances remain largely unaffected cognitively.
Sports Concussion Assessment Tool - 2: Normative Values in College-Aged Athletes
Objective: The updated Sports Concussion Assessment Tool-2 (SCAT2) is a comprehensive screening instrument for the immediate post-trauma evaluation of injured athletes. The present study aimed to develop normative values of the SCAT2 for college athletes participating in both contact and non-contact sports. Method: In preseason, 477 college athletes aged 18–23 (male = 332; female = 145) completed the SCAT2 according to standard instructions during baseline assessment. The SCAT2 includes a 22-item self-report symptom scale, the Standardized Assessment of Concussion (SAC), and a hard-surface only version of the Balance Error Scoring System (BESS). A perfect SCAT2 score is 100. Results: The average SCAT2 score was 91.08 (SD = 5.60). The average number of symptoms endorsed was 1.75. Average performance on the cognitive and balance portions of the SCAT2 were 27.17 (SD = 2.01) and 25.64 (SD = 4.07), respectively. No significant differences were found in overall performance due to sex, collision risk, or concussion history. Females reported greater sensitivity to noise and being more emotional than males. Those reporting a history of concussion endorsed feeling foggy and being more emotional than did non-concussed individuals. Conclusion: Since many sideline and/or post-trauma assessments with the SCAT2 will be conducted in the absence of baseline measurement, comparison to norms must be used in evaluating the likelihood of concussion. The SCAT2 delivered average scores that were little influenced by sex, sport type, or concussion history. When baseline measurement is lacking, these normative data can provide a good benchmark for interpreting SCAT2 performance following trauma.
Unremitting Symptoms following MTBI: Correlations with Somatization, Depression, and Exaggeration. A Dissertation
Objective: A minority of individuals who sustain a mild traumatic brain injury (MTBI) fail to recover within 3 months of injury. This study predicted positive relationships between time since injury and somatization (MMPI-2 Scale 1) and depression (MMPI-2 Scale 2), and a negative relationship between time and test effort (performance on symptom validity tests, SVTs). Method: Archival data were collected from an outpatient neuropsychology clinic. Of 92 cases referred for assessment following MTBI who completed the MMPI-2 and a minimum of two SVTs within the context of evaluation, 62 cases met exclusionary criteria. An Effort Failure Index score was created by dividing the number of failed SVTs by the number of SVTs administered. Three Spearman's rank-order correlation coefficients were calculated for each of the variables. Results: There was a significant positive relationship between time since TBI and depression, with a small effect size, r(60) = .231, p (one-tailed) = .035. The correlations between time since TBI and somatization, r(60) = .13, p (one-tailed) = .154, as well as time since TBI and the failure index, were statistically insignificant, r(60) = .181, p (one-tailed) = .080. Although there was not a strong linear relationship with time since injury, 87% of participants beyond 3 months post-injury had clinically elevated T-scores on MMPI-2 Scale 1, 81% had clinically elevated T-scores on MMPI-2 Scale 2, and 55% failed at least one SVT. Conclusion: Factors of depression, somatization, and cognitive effort remain relevant in the assessment of functioning status-post MTBI. Time since injury is less relevant.
Clinical Utility of the WMT as a Measure of Memory after Traumatic Brain Injury
Objective: The purpose of this investigation was to determine the sensitivity of the “memory” subtests of Green's Word Memory Test (WMT) to traumatic brain injury (TBI). Method: Participants included 107 persons with TBI (median age 30, 55% male, 91% Caucasian, 49% with positive neuroimaging findings, 30% with coma >24 h) who had passed the conventional effort criteria on the WMT Immediate Recognition, Delayed Recognition, and Consistency indices when they were evaluated within 1 year after injury (median interval 4 months). Spearman's correlations were computed between psychometric variables and length of coma, and group differences on psychometric variables were evaluated with analyses of variance. Results: None of the WMT memory subtests (Multiple Choice, Paired Associates, Free Recall, or Long Delay Free Recall) demonstrated a statistically significant correlation with length of coma (p > .10 on all variables). In addition, these WMT memory subtests were not able to distinguish between groups with, respectively, uncomplicated mild TBI, complicated mild or moderate TBI, and severe TBI (p > .10). In contrast, the composite T-score on the California Verbal Learning Test-Second Edition demonstrated a statistically significant correlation with length of coma (p < .007) as well a statistically significant mean group difference (p < .03). Conclusion: It is concluded that, although the WMT is an excellent instrument for the evaluation of effort and performance validity, it lacks criterion validity as a measure of memory in persons with TBI.
Hyperbaric Oxygen Therapy and SPECT Imaging in Treating Military Veterans with Traumatic Brain Injury: A Case Study
Objective: Research on the utility of Hyperbaric Oxygen Therapy (HBOT) to treat traumatic brain injury (TBI) has been shown to be effective. The current study proposes to show the association between HBOT and improved memory. Method: The patient is a 53-year-old veteran diagnosed with Posttraumatic Stress Disorder and TBI. He initially had TBI in the 1980s while in active duty. One event resulted in unconsciousness for more than 24 h, 2 months of hospitalization, and 3 months of physical therapy. He also had 4–6 occasions following this event where he was in close proximity to bomb blasts. He presented in 2009 with complaints of sleep disturbance, poor attention and concentration, memory loss, headaches, and mood changes. The patient was administered Single Photon Emission Computed Tomography (SPECT) brain imaging and the Rivermead Behavioral Memory Test-Third Edition (RBMT-III) before and after 40 HBOT sessions at 1.5 atmospheres for 60 min. Results: SPECT scan results suggested improvement in the apico-mesial temporal area, compatible with memory and impulse control behaviors. Scores on the General Memory Index (RBMT-III) improved from a moderately impaired range to average. Conclusion: This case is unique in that it showed an association between HBOT and memory improvement approximately 30 years following TBI and supports current literature demonstrating the efficacy of using HBOT to treat veterans with TBI.
Anger as a Neurobehavioral Consequence of Mild Traumatic Brain Injury: The Impact of Time from Injury
Objective: This cross-sectional study investigated the association between recovery time from a mild Traumatic Brain Injury (mTBI) and anger. Method: The sample included 363 soldiers who had a mTBI within 3 years; age ranged from 18 to 47 (M = 26.68, SD = 5.94). Time since injury was categorized: 0–3 months (n = 81), 4–6 months (n = 102), 7–12 months (n = 113), and 13–36 months (n = 67). Anger was measured by the State Anger scale of the State-Trait Anger Expression Inventory-2 using age and gender adjusted t-scores. An ANOVA was calculated with a measure of anxiety and depression as covariants. Results: Time was significant (F = 3.07, p = .03, η2 = 0.03). The 0–3 months group (M = 58.69, SD = 12.81) and the 4–6 months group (M = 58.88, SD = 12.98) had higher scores than the 12–36 months group (M = 54.72, SD = 10.95). The 7–12 months (M = 56.69, SD = 12.29) group did not differ from the other groups. There was also a decline in the frequency of clinically significant elevations (>75th percentile) over time: 0–3 months = 54.3%, 4–6 months = 52.0%, 7–12 months = 46.9%, and 13–36 months = 38.8%. Conclusion: The results suggest anger following TBI is stable within the first year of injury with a statistically significant decrease between 1 and 3 years of injury. The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Navy, Department of the Army, Department of Defense, or the U.S. Government.
Neurobehavioral and Cognitive Impact of Mild Traumatic Brain Injury: Potential Recruitment Bias
Objective: Recruitment strategies have varied across studies investigating mild traumatic brain injury (mTBI). Common methods include recruitment from community samples (e.g., samples of veterans), whereas other studies have recruited participants from medical clinics targeting individuals who have sought medical treatment for a head injury. The aim of this study was to investigate the impact of this methodological practice on post-concussive symptoms and neuropsychological functioning. Method: All participants were active duty military service members who were less than 3 months from a mTBI. The Community sample included 79 participants recruited from the general population at a military institution. The Clinical sample included 110 participants recruited from military medical treatment facilities. In both samples, a diagnosis of mTBI was based on self-reported loss of consciousness, alteration of consciousness, and/or post-traumatic amnesia. Results: A MANOVA revealed a significant effect of recruitment site (p < .001, ηp2 = 0.27). The Clinical sample performed worse than the self-report on three of the seven subtests of Automated Neuropsychological Assessment Metrics TBI Military battery (ANAM4): Code Substitution-Learning, Procedural Reaction Time, and Simple Reaction Time Trial 2. There was no difference on the other ANAM4 tests or in self-reported neurobehavioral symptoms (Neurobehavioral Symptom Inventory). Conclusion: The results highlight the potentially confounding influence of study recruitment strategies on research in mTBI. The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Navy, Department of the Army, Department of Defense, or the U.S. Government.
Right Hemisphere Brain Injury by Penetrating Spear
Objective: Penetrating brain injuries (PBI) are rare and carry a poor prognosis. Neuropsychological functioning of a 17-year-old bilingual male with a premorbid diagnosis of ADHD who suffered a PBI resulting in Impaired scores in effortful attention, short-/long-term recall, and executive functioning shortly after incident are presented. Findings reveal positive outcomes of intensive cognitive rehabilitation. Method: Patient presented to ER conscious, agitated, with left hemiparesis after a fishing spear entered right frontal lobe near eye exiting on right occipital region. Craniotomy to remove spear was performed. Multiple CT scans showed right frontal/parietal lobe sulci subarachnoid hemorrhage, subsequent 0.5 cm right to left midline shift, and 8 mm of downward cerebellar tonsillar herniation. EEG showed severe right hemisphere encephalopathy without seizures. Once stable, intensive inpatient/outpatient cognitive rehabilitation followed for 4 months. Comprehensive bilingual neuropsychological testing of intellectual, memory, perceptual/spatial, executive, language, attention, academic, motor, processing speed, and behavioral/emotional functioning followed. Results: Bilingual test selection sensitive to measured Spanish/English language dominance revealed low average intelligence (BateriaIII GIA 81; UNIT FSIQ 80), borderline academics (WJ-III Total Ach 73), average to borderline perceptual/spatial (BateriaIII spatial relations 90; VMI Visual Perception 73), impaired processing speed (WAIS-IV PSI 68), average to low average memory (BateriaIII story recall 95-delayed recall 73), low average to impaired attention (Bat III NumbersReversed 83; CCPT 99.9% clinical), average to borderline executive functioning (Bat III Concept Formation 93, WAIS-IV Matrix reasoning 5), and impaired cognitive flexibility (D-KEFS TMT N/L Switching 1). Conclusion: Location of focal brain lesions and intensive cognitive rehabilitation can mitigate the negative prognosis of PBIs.
A Novel Approach to Symptom Classification in Sports-Related Concussion
Objective: Self-report measures such as the Post-Concussion Symptoms Scale (PCSS) are frequently used during baseline and post-concussion testing to evaluate athletes' symptom profiles. Although past research has primarily utilized the PCSS Total Score (PCSS-TS) as the main outcome variable, more recent efforts have evaluated symptom clusters derived from factor analyses of the PCSS. However, these approaches do not allow for an understanding of the severity or specificity of athletes' symptom reports. To further evaluate the meaning of symptom profiles, the Symptom Checklist 90-Revised (SCL-90-R) “global indices of distress” methodology was applied to the PCSS at baseline to better characterize athletes' symptom profiles, and profiles were compared by gender. Method: Participants included 702 college athletes (74.5% male). The average age of athletes was 18.44, with the majority being Caucasian (74.5%). Athletes completed neurocognitive testing and the PCSS. Results: Individual responses on the PCSS were transformed into the following scales: Global Severity Index (GSI), Positive Symptom Total (PST), and Positive Symptom Distress Index (PSDI). The GSI was calculated by dividing the PCSS-TS by 22 (total symptoms that could be endorsed), the PST by counting the number of positively endorsed symptoms, and the PSDI by dividing the PCSS-TS by the PST. T-tests revealed significantly higher scores for females compared with males on the PCSS-TS, t(700) = − 2.20, p < .05, the GSI, t(700) = − 2.20, p < .05, and an Affective symptom cluster derived from a previous factor analysis, t(253) = − 3.19, p < .05. Conclusion: Applying the SCL-90-R symptom framework to the PCSS may reveal additional information about athletes' symptom profiles and may be useful in evaluating symptoms post-concussion.
A Factor Analytic Approach to the Validation of the Word Memory Test and Test of Memory Malingering as Measures of Effort and Not Memory
Objective: The purpose of the current study is to provide statistically sound evidence for Symptom Validity Tests (SVTs) as measures of effort, and not memory, using exploratory factor analysis (EFA). We hypothesized that when the shared variance between factors (i.e., effort) is controlled for, the variables will load onto distinct factors of interest, providing evidence that SVTs and memory tests measure separate constructs. Method: An EFA was conducted on data collected from Operation Enduring Freedom/Operation Iraqi Freedom veterans with reported mild TBI as part of a multi-center VAMC study. The EFA utilized raw scores from the TOMM (Trial 1 and 2), the CVLT-II (Total, SDFR, LDFR), and percentage correct on the WMT (IR, DR, CONS). Data from 162 participants were analyzed with a principal axis factor analysis (PFA) with oblique rotation. Results: A two-factor solution emerged. All SVT variables loaded on Factor 1 and all CVLT-II variables loaded on Factor 2. Moderate correlational cross-loadings were evident. The pattern matrix, which controlled for the putative confounding variable (i.e., poor effort) attributing to this shared variance, provided clearer support of two highly distinct factors without cross-loadings. Conclusion: Results supported the hypothesis that SVTs and memory tests are separate constructs and support the unique contribution of SVTs. Although other studies have sought to support this position using correlational analyses, this study expanded on the literature through a more statistically sophisticated method that eliminated the impact of poor effort, which was not controlled for in previous studies.
An Exploration of the Automated Neuropsychological Assessment Metrics Mood Scales in Military Veterans and Civilians with Post-Acute Traumatic Brain Injury
Objective: The present study explored the Automated Neuropsychological Assessment Metrics (ANAM) Mood Scales and self-report measures of depression and post-traumatic stress disorder (PTSD) in a sample of military veterans and civilians with post-acute traumatic brain injury (TBI). ANAM is a computerized neurocognitive screening battery often used in military populations. ANAM includes the Mood Scales (AMS), a brief self-report measure of mood states, consisting of rating scales for Vigor, Restlessness, Depression, Anger, Fatigue, Anxiety, and Happiness. Two common psychiatric disorders associated with TBI are depression and PTSD. Therefore, the utility of the AMS to predict elevated levels of these symptoms was investigated. Method: As a part of a larger study, 69 veterans and 57 civilians with post-acute TBI completed several self-report measures of psychological functioning: AMS, Beck Depression Inventory-2 (BDI-2), Patient Health Questionnaire-9 (PHQ-9), and PTSD Checklist (PCL-C). Correlational and regression analyses identified relationships between the self-report measures and determined how well the AMS scores predicted scores on the BDI-2, PHQ-9, and PCL-C. Results: The veteran group reported significantly greater psychological symptomatology on every self-report measure. Correlations between AMS scales and the other self-report measures ranged from .31 to .65 (p < .001). Standardized regression weights for the AMS scales varied across the other self-report measures. The AMS explained significant portions of variance in BDI-2 (54%), PHQ-9 (52%), and PCL-C scores (48%; p < .001). Conclusion: Overall, these findings revealed strong relationships between the AMS and self-report measures of depression and PTSD. Additional research is warranted to validate the AMS as a psychological screening tool for persons with post-acute TBI.
A Meta-Analysis: Siblings' Psychosocial Outcome After Traumatic Brain Injury
Objective: Only a few studies examined the effects of traumatic brain injury (TBI) on the family. Studies looking at TBI's psychosocial effects on the non-injured siblings are far less, and information gathered were mostly from parents/caregivers not from the siblings themselves. The current meta-analysis sought to analyze the literature examining the psychosocial effects reported solely by uninjured siblings. A meta-analysis was chosen to understand the degree to which a TBI impacts an uninjured sibling and to improve the accuracy of conclusions drawn from this literature base. Method: Thirty articles were gathered from PsychArticles, PsychINFO, and Google Scholar using the search terms: “family,” “sibling,” “traumatic brain injury,” “head injury,” “psychosocial,” and “effects.” Only five met the criteria and were used in this study. Results: Measures were divided into meaningful groups/constructs to better understand the psychosocial impact of TBI. Hedges' g was used to determine the effect sizes of each of the constructs. Results found varying effects: Family Disruption ES = 0.46, Positive Impact ES = − 0.16, Negative Impact ES = − 0.01, Internalizing ES = 0.15, and Behavioral Symptoms ES = 0.16. Conclusion: It appears that the effect of TBI on siblings is reflected in behavioral symptoms, internalizing and especially in family disruption. Therefore, it is important to include non-injured siblings in the treatment process as they are also affected by their sibling's injury. It is important to note that studies available for this meta-analysis were limited and outdated; therefore, further research should be done.
Determinants of Inpatient Rehabilitation Functional Outcomes
Objective: To determine factors that predict differences in patient outcomes across rehabilitation centers. Method: Participants: 6,975 patients with traumatic brain injury (TBI) admitted to 21 Traumatic Brain Injury Model System (TBIMS) rehabilitation centers between 1999 and 2008. Patients were aged ≥16. Retrospective analysis of prospectively collected data. Functional outcomes were measured using the Functional Independence Measure (FIM) and Disability Rating Scale (DRS) at discharge and 1 year. Potential predictors were elicited from content experts and review of the literature. Data of consecutive patients with completed measures for both time points were analyzed. Results: A regression model was formulated, correcting for demographics and injury severity. Patients who were female, married, Caucasian, and younger in age obtained stronger outcomes at discharge and 1 year (FIM/DRS, p = < .0001–.01). Patients whose TBI was due to gunshot wound had poorer overall outcomes (p = .005), whereas those suffering a motor vehicle crash had stronger outcomes at 1 year (FIM/DRS, p = .01). Increased chronicity post-injury was correlated with poor overall outcomes (FIM/DRS, p ≤ .0001). Longer LOS was associated with stronger outcomes initially, but poorer outcomes at 1 year (p = .01 and p ≤ .0001, respectively). Insured patients fared better at 1 year (FIM/DRS, p ≤ .0001), with no significant differences in outcomes when compared with their uninsured counterparts during inpatient rehabilitation (FIM, p = .77; DRS, p = .37). Conclusion: Patient characteristics, injury severity, onset and duration of rehabilitation intervention, and insurance status significantly influence differences in functional outcomes across TBIMS rehabilitation centers. Rehabilitation institutions have greatest control over processes of care such as initiation and duration of rehabilitation intervention.
Depression and Mania Symptoms Predict Neuropsychological Test Performance
Objective: Several studies have found relationships between emotional factors such as depression and anxiety and performance on neuropsychological tests, whereas others have not. The goal of the current study was to clarify the previous conflicting findings by determining if specific facets of mood (e.g., depressive cognitions) predict memory functioning. Method: Participants were 102 university students (71% female, 29% male; 67% Caucasian, 28% African American) aged 17–30. The Personality Assessment Inventory (PAI), Rey Complex Figure Test (RCFT), and Wechsler Memory Scale-Third Edition were administered. Results: Correlations and regression analyses examined the relationships between the PAI depression and mania subscales and neuropsychological test scores. Cognitive depression was associated with poorer auditory working memory, r = − .25, p = .02. One facet of mania, grandiosity, was associated with poorer visual memory, both immediate, r = − .28, p = .01, and delayed, r = − .30, p = .01. The association between grandiosity and other forms of memory and learning approached significance (p values of .07–.09). No facets of depression and no other facets of mania were related to verbal memory, verbal learning, or visual or auditory working memory. Conclusion: These results support the theory that emotional factors predict performance in some areas of neuropsychological performance. Specifically, the results indicate that an individual's mood (as measured by the PAI) can impact performance on tests of auditory working memory and visuographic memory.
Non-Medical Users of Prescription Psychostimulants May Use Due to Perceived ADHD Symptoms
Objective: We hypothesized that college students who use prescription psychostimulants without a prescription (non-medical users) would report similar levels of memory and attention complaints as medical users (those with a prescription) and more complaints than those who have never used prescription psychostimulants (non-users). Method: College students (n = 615; 62% female, 38% male) completed a survey assessing substance use. Neuropsychological symptoms were assessed with the Clinical Assessment of Attention Deficit-Adult (CAT-A, Bracken & Boatwright, 2005) and Neuropsychological Impairment Scale (NIS, O'Donnell et al., 1994). The majority (64%) of participants were Caucasian and 29% were African American, with an average age of 20 years. MANOVA was used to test our hypothesis, with user group as the IV and CAT-A and NIS scale scores as DVs. Results: A significant multivariate main effect was found, F(14, 710) = 4.70, p < .0001, partial eta squared = 0.09. Univariate analyses showed significant main effects for the attention, hyperactivity, and impulsivity scales of the CAT-A, p < .0001, and for most NIS scales, p < .0001. Specifically, on the CAT-A impulsivity, hyperactivity, and attention scales, and on the NIS attention, cognitive efficiency, memory, learning-verbal, and academic scales, medical and non-medical users reported significantly more symptoms than non-users. With the exception of the CAT-A hyperactivity scale and the NIS attention scale, non-medical users and medical users did not differ. Conclusion: The results suggest that non-medical users may use prescription psychostimulants due to perceived symptoms of ADHD.
Relationshp Between Self-Reported Depression Scores with Attention/Concentration Variables
Objective: The purpose of this study was to examine the relationship between self-reported depression scores on the MMPI-2 and attention/concentration measures on the CPT-II. Method: Participants included 71 males and 100 females 40-years-old or younger, with an average age of 26.32 years (SD = 5.85) and an average education of 13.87 (SD = 2.11). Individuals were grouped into non-elevated (T-score <70) and elevated (T-score ≥70) Scale 2 on the MMPI-2. An independent samples t-test was conducted to compare all CPT-II T-scores such as omissions, neurological percent, ADHD percent, and hit rate in individuals with non-elevated and elevated depression. Subjects with VRIN and TRIN T-scores ≥70 were excluded. Results: An independent samples t-test revealed a significant difference in CPT-II Neurological Confidence Index Scores for individuals with non-elevated (M = 37.34, SD = 17.52) and elevated (M = 45.60, SD = 20.91) depression; t(169) = − 2.594, p = .01. Conclusion: Results revealed that self-reported depression has an effect on attention and concentration measures. A person's subjective perception of experiencing depressive symptoms decreases their cognitive performance on neuropsychological tests. Other variables on the CPT such as the ADHD percent, omissions, and hit rate showed an insignificant correlation. Therefore, future research should address the specific mechanism by which cognitive performance is affected. Some possibilities are motivation to perform, lethargy, self-esteem, and levels of reported depression. This finding also offers significant implications for clinicians when testing subjects with high self-reported depression scores. Once depression is addressed in a therapeutic manner, additional assessments should be conducted to get the most efficacious measure of cognitive functioning.
A Longitudinal Study of Sustained Attention in Patients with Bipolar Disorder
Objective: This study investigated the relationship between sustained attention and affective symptoms over time in patients with Bipolar Disorder (BD), as well as whether or not global differences in attentional capacity differ as a function of the diagnostic group. Method: One hundred and six patients with BD and 66 demographically comparable normal comparison (NC) subjects were administered symptom rating scales and the Identical Pairs Continuous Performance Test, a measure of sustained attention. Attentional indicators included the number of hit rates, false alarms, and d′, an index of discriminability. Measures were repeated 6, 12, and 26 weeks post-baseline. Mixed model analyses were performed to compare mean sustained attention scores of the BD and NC groups across time. Results: Compared with NCs, participants with BD showed impairment in discriminability across time (p = .028) and had a significantly higher rate of false alarms (p = .017) after controlling for age and education. Within the BD group, and adjusting for age and education, participants who exhibited more severe manic symptoms produced a higher rate of false alarms (p = .022); both manic and depressive symptom severity were associated with poorer discrimination d′ (p = .038 and p = .018, respectively). Neither manic nor depressive symptom severity were related to hit rates. Conclusion: Our results indicate that an inability to inhibit responding to near target versus target stimuli is globally impaired in BD compared with normal comparisons, as well as state-dependent, covarying with affective symptoms. Psychosocial interventions requiring high levels of attentional capacity may need to be adapted according to a patient's current symptomatology.
Rising to the Challenge: Longer Backwards than Forward Digit Span Profile is Associated with Better Cognitive Performance
Objective: Clinical lore postulates an abnormal and infrequent performance pattern on Digit Span of longer backward span than forward span may reflect possible pathology. We examined this profile in regard to how these individuals performed on neuropsychological tests. Method: Data from 770 individuals who completed psychoeducational evaluations including the WAIS-III, WMS-III, WJ-III, and PAI were utilized. Demographics: mean age 22.7 years (SD = 6.12), mean education 13.7 years (SD 2.0); 85% white, 9% African American, 3% Latino, and 1% Asian; 50.6% female. Ninety-one percent of the sample had a longer forward span than backward span Digit Span profile (n = 698), 5.3% had a longer backwards span than forward span (n = 41) and 4% had equal span lengths (n = 31). Results: Mann–Whitney U non-parametric analysis for the whole sample revealed significant differences (p < .05) between span groups for WAIS-III VIQ (110.0 vs. 104.7), PIQ (105.3 vs. 101.6), full-scale IQ (108.3 vs. 103.8), Perceptual Organization Index (109.1 vs. 104.5), and Working Memory Index (108.3 vs. 99.3) as well as WMS-III Immediate Memory (105.1 vs. 98.5). The longer backwards span than forward span group always performed better than the longer forward span than backward span group. No signficiant differences were observed on measures of academic achievement or personality/emotional functioning. Conclusion: Our results suggest that the atypical longer backward span than the forward span Digit Span profile does not indicate pathology. We believe this profile may result from individuals who fail to engage in simple tasks like forward span but fully engage in more challenging tasks such as backward span.
The Relation of Direct and Indirect Measures of Attention to Math Performance in Typically Developing Children
Objective: Inattention has been related to reading problems and hypothesized to be involved in at least one subtype of mathematics disability. This study examined the utility of indirect and direct observation of inattention and impulsivity on mathematics performance in typically developing children. Method: A community sample of 43 typically developing children (18 male), aged 6–14 years, completed the Test of Variables of Attention-Visual, Woodcock–Johnson III Normative Update Tests of Achievement Math Calculation and Fluency subtests, and two subtest Wechsler Abbreviated Scale of Intelligence Full-Scale IQ estimation. Parents completed the Swanson, Nolan, and Pelham-IV Parent Rating Scale for inattention/hyperactivity. Children with neurodevelopmental disorders and an estimated IQ <80 were excluded. Results: No significant differences in gender were observed. Inattention: TOVA omission errors accounted for about 10% of variance in math calculation with verbal IQ and age controlled, β = 0.326, t(39) = 2.21, p = .033, R2 = .257, chR2 = .096, whereas SNAP-IV inattention scores were non-significant (p = .626, chR2 = .002). Impulsivity: TOVA commission errors accounted for about 13% of variance in math calculation with verbal IQ and age controlled, β = 0.409, t(39) = 2.65, p = .011, R2 = .306, chR2 = .129, whereas SNAP-IV hyperactivity/impulsivity was non-significant (p = .104, chR2 = .017). Conclusion: The findings indicate that sustained visual attention is related to math calculation in typically developing children; however, parent-reported behavioral attention was not. Direct neuropsychological observation of inattention and impulsivity are important in understanding a child's mathematical skill functioning and may provide a point of intervention for lower functioning children.
Sex Differences on Shape Matching and Phoneme Matching Mental Control Tasks
Objective: There have been a considerable number of studies examining sex differences in various modalities of attention, working memory, and mental set. There is some evidence to suggest that there are sex differences in these modalities. The purpose of this study was to investigate sex differences in ability to retrieve information from memory based on specific auditory or visual physical characteristics. Method: Participants were chosen from a large heterogeneous group (n = 350) that underwent outpatient neuropsychological assessment at Kaiser Permanente Hospital in Oakland, CA, from 2000 to 2010. Data were analyzed for those participants who had completed a measure of two timed mental control tasks: Shape matching and phoneme matching (e.g., participants were asked to name aloud all the letters of the alphabet that contain a curve when printed as capital letters and later name all the letters of the alphabet that rhyme with the word “key”). Two analyses of covariance (ANCOVAs) were conducted to investigate the relationship between sex and the two mental control tasks, controlling for age. Results: There was a significant relationship between sex and phoneme matching, controlling for age, F(1,347) = 23.80, p < .001 (sex accounting for 6.4% of the variance in phoneme matching). Additionally, there was a significant relationship between sex and shape matching, controlling for age, F(1,347) = 17.38, p < .001 (sex accounting for 4.8% of variance in shape matching). Conclusion: In sum, results support the notion that men perform better on a visual task of mental control; likewise, women outperform men on a task of verbal mental control.
Factor Structure of the CPT-II in a Pediatric TBI Sample
Objective: Conners' Continuous Performance Test-II (CPT-II) has been used with several clinical populations and is sensitive to attentional impairment reflecting acquired and developmental brain dysfunction. Despite its prevalent use, there is only one published study of its factor structure. The aim of the current study is to examine the factor structure of the CPT-II in a sample of children that have sustained traumatic brain injury (TBI). Method: The sample consists of 198 (75 female) subjects referred for neuropsychological assessment following mild to severe traumatic brain injury. The mean age of the sample was 13.0 years, mean time between injury and assessment was 8.85 months and 185 individuals sustained closed head injuries. Several individuals also received other neuropsychological tests that were used to examine construct validity of the CPT-II factors. Results: Principle components analysis of the CPT-II indicated three factors that appeared to represent Inattention, Impulsivity, and Vigilance. Correlating these factors with measures academic achievement, motor functioning, and intellectual functioning provided modest support for convergent and discriminant validity. Conclusion: These results suggest that the structure of the CPT-II reflects three factors in a sample of children and adolescents with TBI. Future research should examine whether these factors are associated with other relevant outcomes following TBI, such as behavioral disturbances and academic achievement.
Construct Validity of the Neuropsychological Assessment Battery Naming Test in Patients with Intractable Epilepsy
Objective: Assessment of confrontation naming is an integral component in the neuropsychological assessment of epilepsy. However, clinical experience suggests that the most widely used test of naming may be confounded by factors such as culture. This pilot study assessed the construct validity of the Neuropsychological Assessment Battery Naming Test (NAB Naming). Method: Thirty-one patients seeking neurosurgery for intractable seizures (mean age = 33.4, SD = ;− 12.9; mean education = 14, SD = 1.9; 64.5% female, mean Full-Scale IQ = 88.8, SD = 15.8) were administered NAB Naming, Boston Naming Test (BNT), and Wechsler Adult Intelligence Scale (WAIS-IV) as part of a pre-surgical assessment. Spearman correlations were performed to evaluate convergent/divergent validity of NAB Naming. Results: NAB Naming was significantly associated with BNT (rho = 0.61, p < .001). Additionally, both instruments were significantly associated with WAIS-IV Verbal Comprehension (NAB: rho = 0.56, p = .001; BNT: rho = 0.52, p = .003) but not Perceptual Reasoning, Working Memory, or Processing Speed. Upon closer inspection, both NAB Naming and BNT were significantly associated with Vocabulary (NAB: rho = 0.55, p = .001; BNT: rho = 0.57, p = .001) and Similarities (NAB: rho = 0.40, p = .027; BNT: rho = 0.47, p = .008). Yet, only BNT was significantly associated with Information (rho = 0.49, p = .006). Conclusion: NAB Naming shows relatively strong convergent validity with BNT and those verbal comprehension subtests most associated with lexical skill. Evidence of divergent validity was also found, as NAB Naming was not associated with perceptual, working memory, or processing speed skills. Finally, BNT (and not NAB Naming) was found to be confounded by fund of knowledge. These findings support the use of NAB Naming over BNT when evaluating pre-surgical epilepsy patients as it appears to be a purer measure of confrontation naming.
COWAT/FAS Output by 15 Second Epochs: A Quantitative Examination of a Qualitative Process Approach
Objective: Previous research suggested that differences between overall COWAT/FAS output and output by 15-s epochs of combined FAS trials differentiated ability to maintain cognitive set in dementia. This study examined if different COWAT/FAS time epoch performances were differentially associated with distinct cognitive abilities in a healthy sample. Method: Data from 66 undergraduate participants were utilized. Mean (SD) demographics: age 19.5 years (9.7), education 13.3 years (1.2); 51% female; 67% white, 26% African American, 3% Asian, 2% Latino, and 2% Other. All participants completed the COWAT and WAIS-IV. Epochs were defined as ordered 15-s increments across all three trials (F, A, and S). The sample was divided into halves based on greater output in epochs 1 + 2 (first half) than 3 + 4 (second half). Results: Linear regressions found >10% of the variance in WAIS-IV subtests accounted for by COWAT/FAS epoch for the following: for epoch 1 Vocabulary (10.8%); epoch 2 Vocabulary (11.0%) and Symbol Search (10.4%); epoch 3 Digit Span (13.8%), Vocabulary (12.8%), Arithmetic (10.7%), Symbol Search (14.7%), Information (10.2%), and Digit-Symbol Coding (13.0%); and epoch 4 Digit Span (18.3%), Arithmetic (12.7%), and Information (14.1%). One-way ANOVA found significant differences between first half and second half epoch groups for Digit Span, F(1, 61) = 8.33, Vocabulary, F(1, 61) = 4.98, Symbol Search, F(1, 61) = 6.82, Information, F(1, 61) = 4.43, and Digit-Symbol Coding, F(1, 61) = 5.04, all p < .05. Second half group had better performance. Conclusion: FAS output in the first 30 s (epochs 1 and 2) had little association with other cognitive variables. Epoch 3 was most associated with executive abilities followed by epoch 4.
Effects of Gender and Seizure Laterality on Verbal Fluency Performances among Individuals with Temporal Lobe Epilepsy
Objective: Studies examining the extent of temporal lobe involvement in verbal fluency tasks have yielded mixed results, as have studies examining gender differences in language lateralization. The aim of this investigation is to assess how gender and seizure laterality impact verbal fluency performances among temporal lobe epilepsy (TLE) patients. Method: A 2 × 2 between subjects design compared the effects of gender and seizure laterality on verbal fluency among medication refractory localization-related TLE patients undergoing comprehensive neuropsychological testing as part of an evaluation to determine surgical candidacy. The Controlled Oral Word Association Test and Animals test were administered to assess phonemic and semantic fluency, respectively, and raw and demographically adjusted T-scores were collected. A total of 70 participants equally split by gender and seizure laterality met inclusion criteria after depression screening and matching of age and education. Results: Phonemic fluency showed a main effect of seizure laterality, F(1, 66) = 4.64, p < .05, ηp2 = 0.07, with right TLE patients earning higher raw scores. Semantic fluency showed a main effect of seizure laterality for raw scores, F(1, 66) = 8.90, p < .01, ηp2 = 0.12, and T-scores, F(1, 66) = 4.98, p < .05, ηp2 = 0.07, with higher performances among right TLE patients. A gender by seizure laterality interaction also existed for semantic fluency raw scores, F(1, 66) = 4.62, p < .05, ηp2 = 0.07, and T-scores, F(1, 66) = 4.80, p < .05, ηp2 = 0.07. Conclusion: Data suggest temporal lobe involvement in both measures of verbal fluency. Gender differences may exist in lateralization of category fluency performances, with men showing a pattern suggestive of more lateralized temporal involvement.5
The Effect of Bilingualism on Verbal Fluency
Objective: Disturbances in verbal fluency can occur in many neurological disorders. Verbal fluency studies have primarily focused on monolingual subjects with little research examining the potential influence of bilingualism on word retrieval. Method: This study compared performance of a collected bilingual sample of 78 Arab-American participants on Verbal Fluency Tests (FAS/Animal Naming) to monolingual norms compiled by Tombaugh, Kozak, and Rees (1999). The FAS and Animal Naming, Verbal Fluency tests, were used for the English version. The Arabic version was created by this study and never used before. Instead of FAS, three Arabic letters, H, M, T, were selected based on letter frequency in that language most compatible with the letters FAS. For the Animal Naming task, the same category was used in Arabic. To examine the effect of bilingualism on fluency, bilinguals' performance when compared with monolinguals' performance. Results: Bilinguals scored statistically lower on English phonemic tests than monolinguals for every age group, education group, and gender group which was significant at the p < .0001 level. Additionally, results found a moderately strong, significant correlation between English (FAS) and Arabic (HMT) (r = .55, p < .001), and between English and Arabic Animal Naming (r = .46, p < .001), suggesting that proficiency in one language may be taxing on the other. Finally, it was observed that bilingual participants scored higher on English words than Arabic words regardless of age, education, or gender. Conclusion: While bilinguals' English performance was their best phonemic performance, it was still lower than standardized norms of monolinguals performance demonstrating a positive effect of bilingualism on fluency.
Normative Data of Two Measures of Verbal Fluency for Arabic/English Bilinguals
Objective: Due to the progressively rising number of Arab Americans in the USA, the demand for language-appropriate and culturally appropriate assessments for this population is becoming essential and yet still lacking. In an effort toward closing this gap, a study was conducted to provide a normative sample for bilingual Arab Americans on the Verbal Fluency Test (FAS and Animal Naming). Method: The research was announced through fliers that asked for bilingual Arabic/English immigrants to volunteer and 78 volunteers were entered ages 20–80, after being screened for bilingualism. The FAS and Animal Naming, Verbal Fluency tests were used for the English version. The Arabic version was created by this study and never used before. Instead of FAS, Arabic letters, H (hah), M (meem), and T (teh), were selected based on letter frequency most compatible with the letters FAS. For the Animal Naming task, the same category was used in Arabic. Results: A sample of norms with average and standard deviation was compiled and stratified by gender, education, and age. There was a good spread across all age groups (20–29, 30–39, 40–49, 50–59, and 60–69) except, there were only three participants in the age group 70–79. Results demonstrated statistically significant age and education related trends. Conclusion: Overall, the mean score decreased with age and dramatically increased with education level. No gender related trends were observed.
Rates of Apparently Abnormal WMS-IV Index Differences in the Normal Population
Objective: Interpretation of the WMS-IV involves examination of multiple Index score differences. For example, Immediate > Delayed or Auditory > Visual Index patterns may suggest memory impairment. Base rate data from the standardization sample suggest that 15-point differences between any specific pair of Index scores are relatively uncommon in normal individuals, but these data refer to comparisons between individual Index pairs rather than multiple possible comparisons among five Indexes. This paper provides normative data for the simultaneous occurrence of these Index score discrepancies. Method: The normal incidence of Index score differences was calculated using Monte Carlo simulations and validated against standardization data. Correlations among Indexes from the standardization sample were used to recreate the distributions of expected score differences. The frequency of observed Index discrepancies was then determined. Results: Differences of 15 points between any two Indexes occurred in 60% of the normative sample, and at least one 20-point Index difference was present in 38% of the normal population. Forty-four percent had at least two Index pairs that were 15 points discrepant, and 23% had a 20-point difference between two or more Index pairs. The percentage of the population with differences between individual index pairs did not differ significantly when Monte Carlo results were compared with published standardization data. Conclusion: WMS-IV Index score discrepancies are normally common when all possible such comparisons are made, and this reduces their clinical significance. Specific prior interpretive hypotheses are necessary to reduce the number of Index comparisons and associated false positive conclusions. Monte Carlo simulation accurately predicts these false-positive rates.
Apparently Abnormal IQ-Memory Differences in the Normal Population
Objective: Comparison between IQ and memory ability can identify memory impairment caused by neurological disorders. WMS-IV interpretation involves comparison of Memory Indexes to the WAIS-IV General Ability and other Indexes. Published base rates in the standardization sample suggest that 15-point differences between pairs of WAIS-IV/WMS-IV Index scores are normally uncommon, but these data refer to one specific comparison rather than multiple possible comparisons among Indexes. This study reports normative data for the incidence of multiple IQ-Memory Index discrepancies. Method: The normal incidence of IQ-Memory Index score differences were calculated using Monte Carlo simulations. Correlations among Indexes in the normative sample were used to recreate the distributions of expected scores and subsequently validated against standardization data. The frequency of observed IQ/Memory Index discrepancies was then determined. Results: One or more 15-point IQ > Memory Index difference occurred in 48% of the normal population, and 20-point Index differences occurred in 30% of the standardization sample. 31% had at least two Index pairs that were 15 points discrepant, and 17% had a difference of 20 points between two or more Index pairs. The percentage of the population with differences between specific individual IQ/Memory Indexes did not differ significantly when Monte Carlo results were compared with published standardization data. Conclusion: WAIS-IV/WMS-IV Index score discrepancies are normally common and therefore lack clinical meaning when multiple such comparisons are made. Empirically supported a priori interpretive hypotheses are necessary to reduce the false-positive diagnoses associated with potentially numerous Index comparisons. Monte Carlo simulation accurately predicts these observed Index score differences.
Abnormal ImPACT Reliable Change Indices in Asymptomatic Athletes: A Common Occurrence
Objective: The Reliable Change Indexes (RCI) from the Immediate Post-concussion Assessment Testing (ImPACT) Test are used to inform return to play decisions. Previous research has found the RCIs to achieve an unacceptable false-positive rate between 22% and 38%. The current investigation examined RCIs in a sample of non-concussed athletes. Method: ImPACT data were collected pre- and post-season from 120 high-school and collegiate athletes. Athletes suffering concussion or with a diagnosis of Attention-Deficit/Hyperactivity Disorder were excluded (n = 5). Athletes were classified based on whether they exceeded at least one ImPACT cognitive composite or total symptom score (TSS) RCI (n = 59). Results: At least one significant RCI was achieved by 50% of the sample. These athletes tended to be male, younger, attend high school, and play either football or volleyball. A significant verbal memory RCI was most common (49%), followed by visual memory (25%), and reaction time (24%). ANOVA analyses controlling for age, high-school versus collegiate participation, gender, and sport found no group differences in pre-season composite or symptom scores; however, at post-season groups differed on the verbal, visual, and visual motor composite scales (p < .05–.01). Conclusion: Our results suggest that significant RCI scores are frequently achieved by asymptomatic high-school and collegiate athletes. Previous authors have suggested a significant RCI on the TSS and at least one cognitive composite should be considered as genuinely injured (Van Kampen et al., 2006). Applying this criterion to our sample, 7% would have been incorrectly classified. Implications for management will be discussed.
The Relation of Impulsivity and the Anterior Cingulate Cortex: Convergence of the Barratt Impulsiveness Scale-11 and Color Word Interference Task
Objective: The current study aimed to examine the relation of white matter integrity in the anterior cingulate cortex (ACC) and impulsivity, using two measures sharing that theoretical construct. The two measures, the Barratt Impulsiveness Scale (BIS-11) and the Color-Word Interference Test (CWIT) measure impulsivity from behavioral and performance perspectives, respectively, and this study aimed to provide convergent validity of the relation of impulsivity and ACC. Method: Thirteen male participants underwent brain MRI and completed the BIS-11 and CWIT. Maps of FA within ACC were created for each individual. Separate linear regressions were performed using BIS-11 and CWIT as predictors of FA within ACC (voxelwise threshold of p < .005 uncorrected) were used to identify areas of significant correlation for each measure. Results for each regression were then overlaid on each other to determine voxels that showed significantly correlation between FA and both BIS-11 and CWIT. Results: Regions of significant negative correlation between FA and CWIT inhibition (# of voxels and BIS-11 non-planning subscale) were found. However, overlap of the significantly correlated regions for the measures was not found. Conclusion: Although both measures showed regions of correlation with FA within ACC, these regions did not spatially overlap. Thus, convergent validity between BIS-11 and CWIT was not fully supported. However, clusters for significant correlation of each measure fall within close proximity of each other within dorsal ACC, a region functionally associated with cognitive control, indicating that behavioral and performance measures of impulsivity share convergent neural underpinnings.
Sequencing in the WAIS-IV Digit Span Subtest
Objective: The Digit Span subtest of the Wechsler Intelligence Scales has traditionally consisted of two components: a baseline digit repetition task (Digit Span Forward, DSF) and a “working memory” task (Digit Span Backward, DSB). According to its technical manual, the fourth edition of the Wechsler Adult Intelligence Scale (WAIS-IV) sought to increase the working memory contribution of the Digit Span subtest by adding a face valid digit sequencing task (Digit Span Sequencing, DSS). However, the validity of this additional component was not empirically examined, and the contribution of DSS to the working memory component of the Digit Span subtest has not been evaluated. Method: A mixed clinical sample (n = 70) was administered WAIS-IV Digit Span as part of a flexible clinical protocol. Results: Results demonstrate that DSS is less strongly related to DSB (r = .35) than to DSF (r = .43). The DSB–DSS correlation was the weakest of the three intercorrelations, and DSS had the weakest correlation with Arithmetic (r = .30, ns, vs. DSF r = .47, p = .003, and DSB r = .35, p = .031). Conclusion: This clinical sample performed somewhat differently than the WAIS-IV's non-clinical standardization sample, in that DSS was more closely related to DSF than to DSB in this sample. It appears that these clinical data derived from a reasonable sample size demonstrate that DSS does not improve on the measurement of the specific working memory construct that DSB assesses and that it does not shift the weight of the Digit Span subtest toward DSB.
Analysis of the Fazio Laterality Inventory in a Population with Established Atypical Handedness
Objective: To validate the factor structure of the newly published Fazio Laterality Inventory (FLI; Fazio, Dunham, Griswold, & Denney, 2013) in a population with established atypical handedness. Method: Participants were 100 adult males referred for the phallometric assessment of their sexual preference post-conviction for sexual offenses. All were administered the FLI as part of a neuropsychological screening battery. Data concerning the handedness of this population are well-published (Cantor et al., 2004, 2005). Results: The FLI demonstrated an acceptable level of internal consistency reliability (Cronbach's alpha = 0.921). The factor structure, however, significantly differed from that discovered in the normative sample. A principal components analysis with Oblimin rotation suggested two factors should be retained in the solution (Eigenvalues of 5.9 and 1.4); this was confirmed with a parallel analysis. The two factors, best described as fine motor/ballistic movement and expressive/functional movement, explained 73.4% of the variance. Conclusion: The FLI was initially developed to assess four domains of movement: fine motor skills, ballistic movement, social/communicative movement, and movement involving the midline of the body. Therefore, it is not entirely surprising more factors emerged when the FLI was administered to a population with atypical handedness. As outlined in Delis and colleagues (2003), oftentimes when a measure is administered to a “normal” population, one factor will emerge, whereas when it is administered to a variety of clinical populations, the underlying components of the concept will dissociate. These results warrant the use of the FLI with additional clinical populations to further elucidate the underlying theorized factor structure.
Development of a Confrontation Naming Test for Spanish Speakers: The Cordoba Naming Test
Objective: To date, a psychometrically sound standardized Spanish-language test of confrontation naming has not been developed for clinical use. Because of the shortcomings of adapting tests developed in other cultures, it was decided to develop a confrontation naming test suitable for Spanish speakers. Method: For the validity study, the performance on the test of 26 control subjects between 70 and 87 years old and 23 subjects with a mild to moderate degree of dementia of the Alzheimer type was compared. Stability of the test was assessed with a test–retest design (n = 86). Norms were developed using a regression-based method. Four hundred and fifty-six Spanish-speaking subjects of both sexes were recruited for the normative sample. Subjects were between 14 and 94 years old, and three educational levels were represented. Results: Mean differences between the control and dementia groups were significant, yielding a large effect size (eta2 = 0.25). The test–retest correlation coefficient was r = .89. Education, age, and gender significantly influenced test scores. Conclusion: The validity study confirmed that the test discriminates between individuals with and without anomia. The magnitude of the reliability coefficient of this test can be considered as “high.” Norms were developed considering the influence of three demographic variables: gender, age, and education. The CNT is a valid and reliable test for the assessment of confrontation naming skills and has a large and heterogeneous normative sample of Spanish-speaking subjects.
Comparing the Canadian and American WAIS-IV Normative Systems in Postsecondary Assessment Data
Objective: Psychologists practicing in Canada must decide which set of normative data to use for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). The purpose of this study is to compare the interpretive effects of applying American versus Canadian normative systems for the WAIS-IV. Method: A large sample (n = 374) of university students was administered the WAIS-IV at a Regional Assessment Center in Canada as part of an evaluation for a learning disability, Attention-Deficit/Hyperactivity Disorder, or other health problem. All protocols were scored using the Canadian and American normative data. Results: The Canadian normative system yielded scores that were systematically lower than the American scores. The average FSIQ using the American norms was 98.5 (SD = 13.2) compared with 91.3 (SD = 14.9) using the Canadian norms. The average Working Memory Index score was 92.9 (SD = 12.9) and 86.0 (SD = 14.0) for the American and Canadian norms, respectively. For individual subtests, the largest differences were on Letter Number Sequencing (Cohen's d = 0.47), Digit Span (d = 0.44), Similarities (d = 0.39), Visual Puzzles (d = 0.37), and Vocabulary (d = 0.36). The smallest difference was on Information (d = 0.18). The percentage agreement in normative classifications, defined as American and Canadian index scores within 5 points or within the same classification range, was as follows: FSIQ = 51.2%, GAI = 58.3%, VCI = 68.3%, POI = 75.0%, WMI = 50.2%, and PSI = 71.5%. Conclusion: Substantial differences are present between the American and Canadian WAIS-IV norms. Clinicians should consider carefully the implications of which normative system is most appropriate for specific types of evaluations.
Working Memory Performance and fNIRS Activation: Does Attention-Deficit/Hyperactivity Disorder Make a Difference?
Objective: Functional near-infrared spectroscopy (fNIRS), a portable neuroimaging technology, offers the opportunity to conduct ecologically valid assessments of brain–behavior interactions. Yet, few studies have used fNIRS simultaneously with neuropsychological tests to explore relationships among cognitive performance and neurophysiological factors in Attention-Deﬁcit/Hyperactivity Disorder (ADHD). This study aimed to test if fNIRS can identify differences in prefrontal neural activity related to cognitive functioning in an ADHD case comparison against healthy normative performance. Method: Seven right-handed, healthy control (HC) participants (five females; mean age 20.4 years) and one unmedicated female participant diagnosed with ADHD (age 19) completed a computerized verbal n-back working memory task. Participants' anterior prefrontal cortex brain activation was monitored using an fNIRS headband. Testing included parameters for minimizing cerebral blood flow altering activities (i.e., exercise, caffeine). Results: Behavioral performance concentration changes in oxygenated hemoglobin (oxy-Hb) were analyzed for each difficulty level of the n-back task (0-back, 1-back, 2-back). On 1-back and 2-back conditions, the ADHD participant exhibited higher oxy-Hb levels than HCs; no difference was observed during the 0-back condition. Behaviorally, no difference in accuracy was observed on task performance, but longer reaction times occurred in all conditions for the ADHD participant. Conclusion: This study provides preliminary results comparing cognitive functioning and underlying physiological differences in ADHD. Further defining these differences is critical to establishing interpretation of the fNIRS measurement of cognitive performance and differentiating among clinical populations. Findings provide an example of how fNIRS normative data can inform clinical comparison in ADHD. However, a larger pool of subjects and further analyses are necessary to improve this study's generalizability.
A Comparison of the Internal Reliability of the Test of Memory Malingering and a Complex Figure Recognition Memory Test
Objective: To determine the internal reliability of the Test of Memory Malingering (TOMM) and an author-created recognition memory test that contains complex figures. Method: Twenty-eight undergraduate students from a small U.S. state university were administered only the first two booklets of the TOMM and two booklets of a complex figure recognition memory test. The order of test presentation was counter-balanced to account for any practice effects. Results: The internal reliability of the TOMM was pretty low (KR20 = 0.57), but the complex figure recognition memory test demonstrated a higher internal reliability (KR20 = 0.86). The TOMM had item difficulties ranging from 78.6% correct (items 27 and 44 of Trial 1) to 100% correct (19 items on Trial 1, 48 items on Trial 2). The complex figure recognition memory test had item difficulties ranging from 32.1% correct (items 4 and 31 from Trial 1) to 100% correct (4 items on Trial 1, 20 items on Trial 2). Conclusion: The TOMM's manual does not present internal reliability data. The present study investigated the internal reliability of the TOMM and a complex figure recognition test. One of the strengths of the TOMM is the apparent versus actual level of difficulty. The actual level of difficulty is very low, which produces very little variability and which affects the internal reliability. Although the complex figure test produces a higher KR20, the difficulty of the items is much higher, which produces a much smaller margin between apparent and actual difficulty.
Impact of User Interface for Online Assessment of Simultaneous Processing with Compressed Speech
Objective: Continuing a project adapting neuropsychological screening scales for online administration, this study compared two user interface modes for administering a compressed speech (CS) measure of Luria's simultaneous processing function. Method: Data were provided by 82 university subject pool participants. Most were female (76%), between 18 and 35 (84%). Ethnicity was African American (8.6%), Asian American (9.9%), Hispanic (14.8%), Caucasian (55.6%), and Other (11.1%). Condition 1 (C1), n = 35, completed the CS online with traditional Perl script used in prior studies. Condition 2 (C2), n = 47, completed the CS online with software enabling future smart phones/tablets migration. Automated Neuropsychological Assessment Metrics (ANAM) scales were administered in a computer lab. There were no statistically significant differences in demographics or ANAM scores between C1 and C2. Results: CS accuracy in C2 (m = 88.3%) was higher than C1 (m = 75.1%), p = .007, ES = 0.906. Throughput (accuracy/response time) was markedly stronger in C2 (m = 6.20) than C1 (m = 2.64), p = .000, ES = 4.674. Alpha throughput reliability in C1 (0.138) was problematic. C2 had moderate reliability, 0.663 and 0.609, for accuracy and throughput. Both conditions had statistically significant correlations with ANAM scales for Matching to Sample (r = .356 and .323) and Spatial Processing (r = .391 and .538). Conclusion: Both conditions resulted in the hypothesized relationship with ANAM scales associated with Simultaneous Processing. But marked differences in time required for stimulus presentation and response warrant concerns about viability of Perl script for online assessment of CS, particularly for direct interpretation of throughput scores. Test time was more than twice as long in Perl script condition. Further study with clinical samples is needed.
Pre- and Post-Season Concussion Screening of Student Athletes: Test–Retest Reliability of the Updated ImPACT Battery Version 2.1
Objective: A commonly used sports-related concussion assessment program is the Immediate Post Concussion Assessment and Cognitive Testing battery (ImPACT). The reliability of ImPACT over time absent a concussive event is unclear; therefore, reliance on it as the primary clinical tool for managing sports-related concussion may be premature. This study examined test–retest indices of ImPACT pre- and post-season in non-concussed student athletes. Method: Participants were male and female high school (n = 49) and collegiate (n = 21) athletes tested twice using ImPACT, approximately 3–4 months between test sessions. Exclusion criteria included: (a) invalid baseline performance, (a) a concussive event within 24 months prior to testing, or (c) diagnosis of Attention-Deficit/Hyperactivity Disorder or learning disability. Results: Intraclass correlation coefficient values for visual processing speed (.72) and reaction time (.65) provided the highest reliability measures in this sample, whereas verbal memory (.42), visual memory (.49), cognitive efficiency index (.29), and concussion symptom scale (.47) scores indicated much lower reliability rates. Paired-samples t-test revealed significant change in visual processing speed performance and in total symptom scores (p < .01). After applying reliable change indices, 21% of the athletes showed reliable improvement in processing speed and 10% demonstrated reliable change in symptom scale scores. Conclusion: Due to the low-to-moderate reliability indices of ImPACT, findings of this study raise the importance of implementing other relevant computerized neurocognitive test batteries together with ImPACT not only for post-concussion but for pre-season evaluation of athletes. Further research is needed to establish psychometric properties of such assessment tools specific to concussion management.
To Exclude or Not to Exclude: Further Examination of the Influence of White Matter Hyperintensities in Diffusion Tensor Imaging Research
Objective: White matter hyperintensities (WMHIs) on magnetic resonance imaging (MRI) are common in both healthy adults and those with medical or psychiatric problems. A practical methodological issue for diffusion tensor imaging (DTI) researchers is whether to include participants from a control group who have WMHIs. This study examines the influence of WMHIs on whole brain DTI in trauma control subjects. Method: Participants were 50 patients (No-WMHIs, n = 38; 2 + WMHIs, n = 12) recruited from a Level 1 trauma center following orthopedic injury. Participants completed an MRI brain scan at 6–8 weeks post-injury (M = 47.3 days, SD = 6.2, range = 39–66). DTI was used to examine the integrity of white matter in 50 regions of the brain using measures of fractional anisotropy (FA), and mean (MD), radial (RD), and axial (AD) diffusivity. FA values that were >2 SDs below the mean, and MD, RD, and AD values that were >2 SDs above the mean were classified as “abnormal scores” indicative of reduced white matter integrity. Results: In the entire sample, the 2 + WMHI group had a greater number of abnormal FA, MD, RD, and AD scores compared with the no-WMHI group (ps < .031 and Cohen ds > 0.83, indicating large to very large effect sizes, for all comparisons). Controlling for the effects of age and alcohol misuse using a matched-groups design, the 2 + WMHI group had a significantly greater number of abnormal FA, MD, and RD scores compared with the no-WMHI group (all p < .025, all d > 0.85). Conclusion: The inclusion or exclusion of subjects with incidental WMHIs will influence the results of DTI studies.
Factor Structure of the Search Identification Task (SIT): A Novel Measure of Attention and Working Memory
Objective: Cancellation tasks are commonly used to assess visual scanning, attention, response shifting, and psychomotor speed. The SIT is a novel paper and pencil measure that includes both verbal (letters) and non-verbal (figures) stimuli that increase in level of difficulty across four trials (trials 1–4). In addition, it contains two alternate equivalent forms (A and B). The current study examined the factor structure of the SIT to provide preliminary support for its construct validity. Method: The SIT (forms A and B) was administered to 111 participants (age = 21.8 years, 53.6% female) who were recruited through the psychology subject pool and reported no history of neurological or psychiatric illness. Testing was conducted individually in a private quiet setting. Results: Principal components analysis with Varimax rotation was conducted on scores of each trial of the SIT A and B. According to Kaiser–Guttman criteria and inspection of the factor scree plot, three factors were retained. The extracted factors underwent a Varimax rotation to attain simple structure. The first factor was composed of scores from trials 1 and 2 (eigenvalue = 6.98), the second factor was composed of trial 4 scores (eigenvalue = 2.57), and the third factor was composed of trial 3 scores (eigenvalue = 1.99). Only letter trial 3 of Form A had crossloadings on the second factor. Conclusion: The factor structure of the SIT identified in this study provides preliminary support for the factorial validity of the measure. Further investigations using the SIT with larger normal and clinical samples are needed in order to provide additional support for its construct validity.
The Performance of a Random Number Generator on Designs II from the WMS-IV
Objective: Designs II, one of two measures assessing delayed visual memory on the Wechsler Memory Scale-IV, measures test takers' ability to select and place cards with specific designs on a 4 × 4 grid to match a previously viewed page. It is hypothesized, based on clinical observation, that raw scores achieved by chance selection will result in relatively high standardized scores, particularly in older aged groups, on Designs II. Method: An internet-based random number generator was used to create two sequences, corresponding to card location and card number, for each of the four standard trials on Designs II. One hundred sets were generated for each sequence to simulate the random selection and placement of cards by 100 participants. Results: Raw scores were tabulated for each simulated participant, resulting in a mean of 36.26 (SD = 3.86). Raw scores were converted to scaled scores for each WMS-IV defined age group. Overall, scaled scores derived from the random simulations increased as a function of increasing age. In the oldest age group, 65–69, the mean simulated performance resulted in a scaled score of 7, with scores 1 SD below and above the mean translating to scaled scores of 5 and 8, respectively. Conclusion: These findings indicate that clinicians should use caution when interpreting Designs II performance, particularly in adults aged 65–69. Our simulations show that individuals in this group are expected to perform within the low average to average ranges when recollection of designs is completely absent and when patients are relying solely on chance performance.
A Preliminary Look into the Validity of the Neuropsychological Symptoms Assessment (NPSA)
Objective: We sought to develop a self-reported measure of malingered neuropsychological symptomatology, entitled the Neuropsychological Symptoms Assessment (NPSA). It is a simple questionnaire of 60 Yes/No items. We sought to investigate whether the NPSA could be used to differentiate feigning and non-feigning individuals and if performance on the NPSA correlated with performance on other measures of symptom validity. Method: Data were collected from a random sample of litigating patients with traumatic brain injury (n = 130) with complaints of cognitive impairment. Comparisons were made between the NPSA performance in feigning and non-feigning individuals. Pearson's r correlations were computed to evaluate concordance with other tests of symptom validity. Results: Feigning individuals scored significantly poorer than non-feigning individuals on the NPSA (p < .01), and performance significantly correlated with performance on the TOMM Trial 1 (r = −.603), Trial 2 (r = −.518), and Retention (r = −.424), Rey-15 Item Test Total Correct (r = −.339), Total Intrusions (r = .363), Recognition Hits (r = −.484), and False Positives (r = .467), Dot Counting Test (r = .430) along with VSVT Easy Items (r = −.413), Difficult Items (r = −.413), and Total Score (r = −.555). Conclusion: These encouraging results are a positive indicator for the NPSA as a potential measure of symptom validity, and further investigation seems promising. Once it is further honed and validated, the NPSA could prove to be an attractive test for clinicians to employ, as it is very quick to administer and score.
Clinical Utility of the PROMIS®-57 Health Outcome Measures
Objective: The National Institutes of Health funded the development, evaluation, and distribution of the Patient-Reported Outcomes Measurement Information System (PROMIS®). These tests are designed to measure physical, psychological, and social well-being. This study examines the reliability and clinical utility of the PROMIS®-57 scales. Method: Eighty-eight adults and older adults were seen for a wellness intake interview after joining a multidisciplinary healthcare center (age = 52.5, SD = 14.3; 64.8% women). Participants completed a medical history form, the PROMIS®-57 scales, Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder scale (GAD-7). Results: The internal consistency reliabilities (Cronbach's alpha) of the PROMIS®-57 scales were Anxiety = 0.95, Depression = 0.95; Fatigue = 0.96, Pain Interference = 0.96, Physical Functioning = 0.90, Satisfaction with Social Roles = 0.97, and Sleep Disturbance = 0.92. In the total sample, the percentages obtaining problematic scores (those at or worse than 1SD from the US population means) were as follows: Anxiety = 13.6%, Depression = 4.5%, Fatigue = 9.1%, Pain Interference = 10.2%, Physical Functioning = 6.8%, Satisfaction with Social Roles = 6.8%, and Sleep Disturbance = 8.0%. A subgroup (n = 18; 20.5%) was identified as having chronic bodily pain. The percentages who obtained problematic scores were as follows: Anxiety = 27.8%, Depression = 11.1%, Fatigue = 22.2%, Pain Interference = 38.9%, Physical Functioning = 22.2%, Satisfaction with Social Roles = 16.7%, and Sleep Disturbance = 16.7%. A subgroup (n = 9; 10.2%) screened positive for depression on the PHQ-9 (total score > 9). The percentages who obtained problematic scores were as follows: Anxiety = 55.6%, Depression = 33.3%, Fatigue = 44.4%, Pain Interference = 55.6%, Physical Functioning = 22.2%, Satisfaction with Social Roles = 44.4%, and Sleep Disturbance = 22.2%. Conclusion: The PROMIS®-57 scales are brief, easily-administered, they have excellent internal consistency reliability, and they have normative data for the general population in the USA. Additional research is needed to refine the clinical interpretation of these scales.
Comprehension of Research Consent Information among Spanish and English Speaking Latinos with Schizophrenia
Objective: To investigate the degree to which cognition, psychopathology, and level of acculturation were associated with understanding of information during the consent process for schizophrenia research. Method: Subjects were 32 Latinos with schizophrenia participating in an ongoing study of informed consent. All assessments and procedures were administered in the participant's preferred language (17 English, 15 Spanish). Measures included a composite cognitive score from a brief test battery (Hopkins Verbal Learning Test, Digit Symbol, Letter Number Sequencing, Trial Making Parts A and B, and Stroop Color Word Interference), as well as the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAM-D), and the Marin Acculturation Scale. Comprehension of consent information was measured with the UCSD Brief Assessment of Consent Capacity (UBACC). Results: The strongest Pearson's r correlation of the UBACC was the composite cognitive score (r = .66, p < .001), followed by severity of negative symptoms from the PANSS (r = −.42, p = .023). There were no significant correlations between understanding and severity of positive symptoms (r = .12, p = .553), depressive symptoms (r = −.14, p = .522), or acculturation (r = .05, p = .812). Conclusion: Cognitive functioning is the strongest predictor of comprehension during the research consent process. These findings confirm and extend the patterns seen in studies of English-speaking (predominantly non-Latino white) patients. Researchers may need to consider participants' level of cognitive functioning when conducting the informed consent process.
Effects of Third Party Observation behind a One-Way Mirror on Neuropsychological Tests with Varying Conative Load
Objective: This study investigated the effects of third party observation with a one-way mirror on tests that differ in conative load from the Halstead–Reitan Neuropsychological Battery (HRNB). Additionally, the California Verbal Learning Test-II (CVLT-II) was examined, as this is a popular measure of memory with which the effects of third party observation is unknown. Method: Participants (n = 65) were recruited from an undergraduate research pool of a large State University. All were administered the Medical Symptom Validity Test (MSVT), Finger Tapping Test (FTT), Digit Span from the Wechsler Adult Intelligence Scale-3rd edition, Trail Making Test A and B, CVLT-II, and Category Test (CT). Participants were randomized to two conditions: 30 were observed by a third party behind a one-way mirror and 35 had only the examiner present. Performance validity was assessed using the MSVT, Reliable Digit Span, and CVLT-II forced choice recognition. Mean total errors on the CT, time on Trails A and B, time on FTT-Dominant and Non-dominant Hand, and total correct on immediate and delayed recall of the CVLT-II were compared between the two conditions, while controlling for gender, handedness, ethnicity, age, and education. Results: All participants were identified as putting forth valid performance. Analyses revealed no significant differences in performance on the measures between the two conditions. Conclusion: This study found no effects of third party observation with the use of a one-way mirror on tests of varying conative load from the HRNB or on immediate and delayed recall of the CVLT-II. Implications for forensic practice are addressed.
Supervision in Neuropsychological Assessment: A Survey of Training, Practices, and Perspectives of Supervisors
Objective: Within professional psychology supervision, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to neuropsychology has garnered little attention (e.g., Stucky, Bush, & Donders, 2010). This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Method: Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provide supervision to students, interns, or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Results: Most supervisors (84%) had no formal coursework in supervision and 84% reported supervision was discussed in graduate school “minimally” or “not at all.” Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Fifty-six percent of respondents were familiar with at least one model of supervision, but only 19% ascribe to a model in their work with trainees. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Conclusion: Few supervising neuropsychologists received training specific to supervising neuropsychology trainees, very few ascribe to a formal model of supervision, and most would be interested in receiving further supervision training. Results indicate that clinical neuropsychology as a specialty has paid scant attention to training in supervision skills. We recommend that the specialty develop models of supervision, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.
Evaluating the Efficacy of Repetitive Transcranial Magnetic Stimulation Treatment in Alleviating the Cognitive Deficits in Iranian Geriatric Patients Diagnosed with Major Depressive Disorder
Objective: Assess the effect size of repetitive transcranial magnetic stimulation (rTMS) on Iranian antidepressant medication resistant elderly participants and evaluate the efficacy of rTMS in alleviating the cognitive deficits of them. Method: Participants were screened using Geriatric Depression Scale, Beck Anxiety Inventory, Montreal Cognitive Assessment, Rey–Osterrieth Complex Figure Test, and Rey Auditory Verbal Learning Test. Left dorsolateral prefrontal cortex was the stimulation site during the rTMS treatment. Five-second trials (frequency of 10 Hz and 110% of the motor threshold) were applied. Twenty treatment sessions were administered. Sixty older adults (51.7% males, 48.3% females) were recruited from Atieh Psychiatric Clinic in Tehran, Iran. The mean age was 65.72 years and the mean education was 13.72 years. Twenty of the participants had taken antidepressant and received rTMS treatment simultaneously. Second group (n = 20) received only rTMS treatment, the remaining had undergone only antidepressant treatment. Results: There were statistically significant differences regarding overall cognitive functions (F = 23.63, p < .001), short (F = 7.80, p = .001) and long delay (F = 10.36, p < .001) visual memory, immediate memory, novel verbal learning (F = 4.77, p = .012), vulnerability to interference (F = 8.90, p < .001), retention of information (F = 15.90, p < .001), depressive (F = 18.544, p < .001), and anxious (F = 9.60, p < .001) symptoms between the subjects who received rTMS treatment and took antidepressant medication simultaneously and subjects who only took antidepressant medication and between subjects who received only rTMS treatment and the subjects who only took antidepressant medications. Conclusion: rTMS alone and combined with antidepressant medications had therapeutic effects in elderly Iranian subjects whose depression was resistant to antidepression medication treatment.
Neuropsychological Developmental Disorder Following Mold Exposure
Objective: A prospective birth cohort study of 6-year-old children exposed to mold-contaminated homes in early post-natal period found a decline in IQ (Jedrychowski et al., 2011). The present case, which was in litigation, expands the existing literature on this topic and provides further context in which to evaluate pediatric mold cases. Method: The child was gestated, born, and raised in a moldy apartment. When she was 6–9 months old, her location received 37 inches of rain. During her first 3 years of life, medical records showed skin rashes, coughs, fevers, ear infections, watery eyes, nasal congestion, bronchitis, strep throat, irritability, balance issues, and speech delays, symptoms consistent with mold poisoning. Family members had similar illnesses. Ten years of work records showed on-going problems with mold from water intrusions. At 7 years and younger, the child experienced homicidal ideation along with suicidal ideation and gestures and auditory hallucinations. Results: In the multiple interviews, the child appeared very well cared for and was fairly well behaved. Rapport was well-established fairly rapidly and maintained. Her predicted IQ was in the high average range (115–119), which was higher that her observed WISC-IV IQ (75). The Test of Memory and Learning showed Composite Memory Index at the 18th percentile, with Learning Index at the 9th percentile. Stroop Color/Word Test, Children's Version results for Color/Word were at the 19th percentile. The Vineland-II Adaptive Behavioral Scales, Second Edition Adaptive Behavior Composite was at the 9th percentile. Conclusion: When evaluating pediatric developmental disorders, it is important to check for possible toxic causes of illness. Moldy environments increase the risk of neurotoxicity/developmental delays and should be minimized.
A Pattern of Resilience in a Pediatric Case of Dandy–Walker Syndrome and Co-Morbid Health Impairments
Objective: Dandy–Walker syndrome (DWS) is a congenital brain malformation that occurs in approximately 1 of 30,000 births and is characterized by the enlargement of the fourth ventricle, partial/complete absence of the cerebellar vermis, and cyst formation near the base of the skull. Hydrocephalus occurs in approximately 90% of all cases with DWS; however, little research has evaluated the neuropsychological profile of children with DWS who possess co-morbid (and related) health impairments. Method: A 9-year-old girl was referred for a neuropsychological evaluation in the context of a complex medical history of DWS and associated history of craniosynostosis, hydrocephalus (one shunt), congenital heart defect, and Chiari malformation. This was the first neuropsychological assessment that the patient had undergone, as her parents were primarily focused on her medical care during her childhood. The patient's parents expressed concerns about their daughter's socioemotional functioning, motor skills, and impulsivity. Results: Results indicated that the patient demonstrated average intellectual and adaptive functioning. She showed many areas of strength, including receptive and expressive language skills, verbal fluency, novel problem-solving, verbal memory, and academic abilities (average and above grade level). She showed select areas of weakness that were consistent with areas compromised by cerebellar/frontal lobe functioning, including graphomotor and fine motor skills, executive functioning, attention, behavioral regulation, nonverbal memory, memory retrieval, social cognition, and visual-spatial skills. Conclusion: Despite this patient's complex medical history, she demonstrated a pattern of resilience in most neuropsychological domains. The patient's weaknesses were consistent with the neuropsychological profile of other children with hydrocephalus.
Normative Data for the Cognitive Screening Test in a Memory Clinic Population
Objective: The Cognitive Screening Test (CST) is a computerized screener for cognitive impairment that has been validated previously in a primary care setting (Lichtenberg et al., 2006). Our aim was to validate the instrument in a memory clinic population and create age and diagnostic norms. Methods: A random sample of 304 patients referred to the East Central Florida Memory Disorder Clinic was used. Participants were mostly Caucasian (92.2%) and female (59.2%). The mean education was 14 years, and ages ranged from 60 to 93 years (M = 77). The CST was administered as part of standard evaluation. The four scales on the CST measure response speed, response inhibition, visual learning, and visual memory. A MANOVA compared CST subtests across diagnostic groups and age cohorts. Results: CST scores differed significantly across diagnoses, l = 0.526, F (16, 904) = 13.236, p < .001, with scores on visual learning and memory scales exhibiting greatest impairment in the dementia groups. The CST scales also differed significantly across age cohorts, l = 0.822, F (24, 1,026) = 2.476, p < .001, with scores decreasing as ages increased. No differences across age cohorts were noted for the cognitively normal group. Conclusion: The CST differentiated clearly between individuals with and without cognitive impairments. Although performance on the CST decreased with age when all diagnostic groups were included, there may be minimal age differences in a cognitively normal group. Therefore, the CST proved to be a sensitive measure of cognitive impairment in the memory clinic population and provided easily administered measures of visual learning and memory, response inhibition, and psychomotor speed.
The Sensitivity of the RBANS as a Screening Measure for Cognitive Impairment in Older Adults
Objective: Neuropsychologists are often prevented from conducting full assessments as they can be cumbersome and fatiguing to patients. There is a paucity of research on the effectiveness of brief assessments to identify older adults needing full neuropsychological assessment with an acceptable degree of accuracy. This study examines the utility of the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) as a sensitive screening tool for distinguishing older adults with and without cognitive impairment. Method: Participants were 46 neurologically normal older adults, 50 with mild cognitive impairment (MCI), and 26 with Alzheimer's (AD), ages 65–93 (M = 78, SD = 5.20), 99% Caucasian. Diagnoses were determined by a licensed psychologist based on patient and collateral interviews, full neuropsychological battery, and neuroimaging. Participants received the RBANS, not used for classification. Results: Discriminant functions analyses determined the RBANS index scores discriminate between (a) individuals with MCI and normals with 86% accuracy and (b) individuals with AD and normals with 75% accuracy. The indices discriminated between individuals with MCI and AD with 71% accuracy; however, 50% of participants with MCI were classified as AD. The RBANS is fairly sensitive to cognitive impairment and capable of discriminating older adults without cognitive impairment from those with MCI or AD. Conclusion: The RBANS had less specificity among individuals with cognitive impairment and may over-classify individuals with MCI as AD. Results suggest that the RBANS can be used as a brief screener for cognitive impairment in older adults; however, follow-up testing is needed for individuals with milder cognitive impairment to prevent over-pathologizing.
AMNART and RIST Differences Across Groups with MCI, Dementia, and Normal Individuals
Objective: Brief measures of intelligence are often used in dementia evaluations to estimate an individual's current and/or baseline abilities. A comparison of two such measures, the Reynolds Intelligence Screening Test (RIST) and the American version of the Nelson Adult Reading Test (AMNART) across various patient groups is presented. Method: One hundred and twenty-six of 181 patients from a memory disorder clinic who were consecutively referred for neuropsychological evaluation and met study criteria (valid test effort and the ability to establish a consensus diagnosis of normal aging, Mild Cognitive Impairment [MCI], or dementia between the referring neurologist and neuropsychologist based on all available examinations and diagnostic studies) were included. Scores for the AMNART and RIST were compared across the three groups. Results: AMNART results were not different across the three groups. RIST scores, in contrast, were significantly different between normal, those with MCI, and those with dementia. These results were seen for not only the Total score but also the subtests consisting of Guess What and Odd Item Out, suggesting that all three indices are able to detect cognitive decline. Conclusion: Two brief intelligence estimates function differently with individuals who have MCI and dementia. The AMNART appears to be a classic measure of prior word knowledge and is relatively resistant to early dementia. The RIST is a strong indicator of current intellectual abilities, as it taps aspects of long-term memory, semantic ability, and visual reasoning that can be affected by early cognitive changes. Further uses and the limitations of both measures are discussed.
Relationships Between Testosterone Levels and Cognition in Alzheimer's Disease Patients and Healthy Elderly Males
Objective: This study examined whether low levels of testosterone are more prevalent among Alzheimer's disease (AD) patients than controls, whether low levels of testosterone are linked to worse performance on neuropsychological tests and more depressive symptoms, and whether testosterone levels interact with APOE allele status in predicting severity of cognitive dysfunction. Method: This study utilized data from 61 healthy older men and 68 men with probable AD who were at least 55 years old and enrolled in the Texas Alzheimer's Research and Care Consortium. Neuropsychological test data were obtained on the same date at which blood was drawn to measure testosterone levels and other biomarkers. Results: Results of ANCOVA (with age as covariate) indicated that testosterone levels did not differ between groups. Regression analyses revealed that testosterone levels did not significantly predict scores on neuropsychological tests or on a measure of depression among AD men. Testosterone marginally significantly predicted performance on Logical Memory delayed recall, with higher levels of testosterone associated with a higher score (p = .04). Among controls, testosterone levels predicted estimated premorbid VIQ as measured by the American National Adult Reading Test (p < .001). Testosterone was found to marginally significantly predict performance on the FAS Verbal Fluency Test, with higher levels of testosterone associated with better performance (p = .03). Conclusion: Findings suggest that testosterone is not meaningfully associated with most neuropsychological test performances in AD patients (with the possible exception of delayed verbal recall), but interestingly, appears to be related to verbal intellectual functioning among healthy elderly men.
Temporal Order Memory and Intentional Learning in Individuals with Mild Cognitive Impairment
Objective: Research indicates content memory and temporal order memory (TOM) can be enhanced by intentional encoding in healthy older adults (HOA). We evaluated the effects of intentional encoding in individuals with Mild Cognitive Impairment (MCI). Method: Forty participants with MCI and age- and education-matched HOA performed two different sets of eight activities (e.g., dusting) in a campus apartment. For the first set, no mention was made of a memory test (i.e., incidental condition). For the second set, participants were told to remember the activities and its completion order (i.e., intentional condition). Results: Group (HOA, MCI) by condition (incidental, intentional) mixed-model ANOVAs were used to evaluate activity recall and TOM proficiency. For recall accuracy, the MCI group (M = 5.35, SD = 0.16) recalled fewer activities than controls (M = 6.28, SD = 0.16), F(1,78) = 16.16, p < .001. Additionally, a significant interaction, F(1,78) = 4.97, p < .05, revealed lower recall accuracy in the intentional than the incidental condition for the MCI group, but not the HOA. For TOM, individuals with MCI (M = 3.30, SD = 0.23) exhibited poorer TOM than HOA (M = 4.16, SD = 0.23), F(1,78) = 7.14, p = .01. The group by condition interaction approached significance, F(1,78) = 2.81, p = .098, with a trend for TOM to improve with intentional encoding in the HOA, but not the MCI group. Conclusion: Consistent with the memory deficits characteristic of an MCI diagnosis, individuals with MCI exhibited poorer recall and TOM than HOA and did not benefit from intentional learning.
Increased Depressive and Anxiety Symptoms as an Indicator of Conversion to Probable Alzheimer's Disease
Objective: The current study examined the ability for changes in anxiety and depressive symptoms as an indicator to predict individuals' cognitive decline toward dementia. Method: The sample was made up of 92 non-demented individuals (Age: M = 6.06, SD = 11.55), who were administered neuropsychological battery along with mood measures. Upon follow-up, six individuals had converted in their cognitive status to Probable AD. Changes in initial and follow-up Hamilton Anxiety and Depression scales were used to predict cognitive decline. Results: Individuals who converted to probable AD had increased depression (M = 5.33, SD = 6.47) and anxiety (M = 6.33, SD = 7.71) when compared with non-converters respectively (M = 0.13, SD = 3.47; M = −0.97, SD = 4.15). Univariate binary logistic regression was performed to test the predictive values of the change in anxiety and depressive symptoms on converters to Probable AD. In the univariate analysis, both depressive symptoms (OR = 1.32, p = .005) and anxiety symptoms (OR = 1.33, p = .004) were predictive of conversion to AD. However, when included together within a multivariate model, neither depression nor anxiety significantly predicted conversion. Conclusion: The preliminary results are offered with caution, especially due to the limited sample size within the predictive models. The literature has documented increased mood symptoms associated with cognitive decline; therefore, it is not surprising that the present findings are congruent. However, these changes in mood symptoms might pose as an early warning sign suggesting cognitive decline in some individuals. It may be important for clinicians/researchers to monitor changes in mood symptoms for the purpose of predicting cognitive decline.
Two Word List Learning Tasks in a Memory Center Population: Relationships with Hippocampal Volume
Objective: Word lists such as the Hopkins Verbal Learning Test-Revised (HVLT-R) are a key task in the neuropsychological assessment of episodic memory. Clinical trials generally implement the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word list used as a component of the ADAS Cog. Word list trials should, in theory, be related to the integrity of the hippocampus, especially on the left. Here, we assess the differential relationships of the CERAD and HVLT-R word lists to hippocampal volume (HCV). Method: Data were collected on consecutive patients seen by neuropsychology at the Cleveland Clinic Center for Brain Health (Cleveland and Las Vegas). Data included here include all patients who were administered the ADAS Cog and had quantified MRI imaging (using Neuroquant software; n = 34) and a sample of patients administered the HVLT-R matched on MOCA score (n = 66). Age of ranged from 51 to 89. Correlations were conducted between the word learning (T1, 2, 3) and delayed recall (DR) trials and the left and right HCV, corrected for intracranial volume. Results: The CERAD word list T3 correlated with left HCV. The HVLT-R T1, 2, 3 and DR correlated with left HCV. T3 and DR also correlated with right HCV (all p < .05). Conclusion: These results suggest that word lists relate to one of the key biomarkers of Alzheimer's disease. The differences seen between the CERAD and HVLT-R might be an artifact of the different size groups, but the results are especially encouraging for the use of the HVLT-R in a memory center setting.
Older Adults with Subjective Cognitive Decline but Intact Episodic Memory Show Mild Performance Deficits on a Lab-Based Prospective Memory Task
Objective: There is increasing evidence that subjective cognitive complaints (CCs) in individuals with intact cognitive test performance may represent the first clinical manifestation of Alzheimer's disease (i.e., a pre-mild cognitive impairment [pre-MCI] stage). Significant CCs in otherwise healthy older adults may indicate underlying neurodegenerative changes even when unaccompanied by deficits on traditional neuropsychological tests. Widely used episodic memory tests, which fail to correlate reliably with self-reported memory ability, may lack sensitivity for pre-MCI. The current study investigated whether older adults with significant CCs, despite intact scores on traditional memory tests, exhibit deficits on a performance-based prospective memory task. Method: Participants were 208 non-demented, community-dwelling older adults, aged 70 and above, from the Bronx, NY. Participants were classified as healthy controls (n = 102), CC (n = 63), or MCI (n = 43). As part of a comprehensive battery, we administered the Royal Prince Alfred Prospective Memory Test (RPA) (Radford et al., 2011), which combines time-based and event-based tasks measuring prospective memory over short- and long-retention periods. Results: When compared with the healthy control and MCI groups, CCs showed an intermediate level of performance on the RPA (p < .01), and this was particularly notable on long-term retention tasks. Conclusion: Significant CCs in otherwise healthy older adults may reflect subtle cognitive deficits not readily detected by conventional episodic memory tasks. Prospective memory tasks, which draw upon metacognitive activities for effective performance (such as task monitoring, switching, and updating of intentions), may provide a more sensitive criterion for testing the relationship between subjective and objective memory in pre-MCI.
Nursing Home Use and Dependency Across the Full Trajectory of Cognitive Decline: Normal, Mild Cognitive Impairment, Newly Discovered, and Prevalent Dementia
Background: We previously found increased medical costs across the trajectory of cognitive decline. Objective: To similarly provide data on nursing home (NH) use and dependency across the trajectory of cognitive decline. Method: Subjects were a subset of the population-based Mayo Clinic Study of Aging (MCSA), which used unique Rochester Epidemiology Project (REP) resources to construct a stratified random sample of Olmsted County, MN residents, age 70–89 years. All provider-linked medical records were subject to neurologist's review for prevalent dementia (review date = index). Remaining individuals were invited to participate in sequential evaluations, including comprehensive clinical and neuropsychological assessments (initial assessment date = index). Individuals categorized at index as normal, mild cognitive impairment (MCI), and newly discovered or prevalent dementia were merged with Centers for Medicare and Medicaid Services Minimum Data Sets (available 1 October 1998–30 September 2010) to determine Olmsted County NH use 1 year before index and followed until emigration, death, or 1 year after index for days at risk of NH use and NH use. A stratified-random subset (n = 400) was selected for REP medical-record review to determine level of dependency (need for assistance) and residency type (e.g., home, Alzheimer's cottages) as of the encounter closest to and before index. Results: (Tables 1 and 2). Conclusion: Across the full trajectory of cognitive decline, the percentages of individuals with any NH use and days spent in a NH increased. NH use and NH days also increased over time. The percentages needing assistance were 19%, 37%, and 96% for normal, MCI, and dementia (newly discovered and prevalent combined), respectively. Among dementia subjects needing 24-h care/supervision, 42% of care occurred outside the NH.
|Cognitive status||Age at index in years, mean (SD)||Year before index date subjects were limited to persons with 365 days at risk of Olmsted County NH use before index||Year after index date subjects were followed from index forward 1 year, until earliest of death, emigration from Olmsted County, or end of study period (30 September 2010)|
|Number (%) of subjects in NH ≥1 day||Among subjects with any NH use||Number (%) of subjects in NH ≥1 day||Among subjects with any NH use|
|Number of days in a NH, Mean Median (Q1,Q3)||% of days in a NH per days at risk of NH use, Mean Median (Q1,Q3)||Number of days at risk of NH use, Mean Median (CM, 03)||Number of days in a NH, Mean Median (Q1, Q3)||% of days in a NH per days at risk of NH use, Mean Median (Q1, Q3)|
|Normal (n = 2,438)||79 (5.2)||75 (3.1%)||4814(8.0, 28)||13%3.8%(2.2, 7.7)||93 (3.8%)||348365(365, 365)||6125(14, 56)||18%7.4%(3.8, 16)|
|MCI (n = 528)||81 (5.0)||24 (4.5%)||9026(13, 78)||25%7.0%(3.6,21)||46 (8.7%)||341365(365, 365)||7937(15, 74)||22%12%(5.2, 24)|
|Newly Discovered Dementia (n = ll8)||83 (4.9)||14(12%)||15347(25, 365)||42%13%(6.8, 100)||22 (19%)||312365(365, 365)||160119(30, 307)||44%33%(8.7, 84)|
|Prevalent Dementia (n = 461)||83 (4.5)||162 (35%)||242357(84, 365)||66%98%(23,100)||183 (40%)||323365(365, 365)||238304(92, 365)||80%100%(67, 100)|
|Dementia Combined (n = 579)||83 (4.6)||176 (30%)||235338(69, 365)||64%93%(19, 100)||205 (35%)||321365(365, 365)||229296(87, 365)||76%100%(46,100)|
|Cognitive status||Age at index in years, mean (SD)||Year before index date subjects were limited to persons with 365 days at risk of Olmsted County NH use before index||Year after index date subjects were followed from index forward 1 year, until earliest of death, emigration from Olmsted County, or end of study period (30 September 2010)|
|Number (%) of subjects in NH ≥1 day||Among subjects with any NH use||Number (%) of subjects in NH ≥1 day||Among subjects with any NH use|
|Number of days in a NH, Mean Median (Q1,Q3)||% of days in a NH per days at risk of NH use, Mean Median (Q1,Q3)||Number of days at risk of NH use, Mean Median (CM, 03)||Number of days in a NH, Mean Median (Q1, Q3)||% of days in a NH per days at risk of NH use, Mean Median (Q1, Q3)|
|Normal (n = 2,438)||79 (5.2)||75 (3.1%)||4814(8.0, 28)||13%3.8%(2.2, 7.7)||93 (3.8%)||348365(365, 365)||6125(14, 56)||18%7.4%(3.8, 16)|
|MCI (n = 528)||81 (5.0)||24 (4.5%)||9026(13, 78)||25%7.0%(3.6,21)||46 (8.7%)||341365(365, 365)||7937(15, 74)||22%12%(5.2, 24)|
|Newly Discovered Dementia (n = ll8)||83 (4.9)||14(12%)||15347(25, 365)||42%13%(6.8, 100)||22 (19%)||312365(365, 365)||160119(30, 307)||44%33%(8.7, 84)|
|Prevalent Dementia (n = 461)||83 (4.5)||162 (35%)||242357(84, 365)||66%98%(23,100)||183 (40%)||323365(365, 365)||238304(92, 365)||80%100%(67, 100)|
|Dementia Combined (n = 579)||83 (4.6)||176 (30%)||235338(69, 365)||64%93%(19, 100)||205 (35%)||321365(365, 365)||229296(87, 365)||76%100%(46,100)|
|Level of Dependency||Normal (n = 185)||MCI (n = 96)||Dementia (Newly Discovered and Prevalent combined) (n = 119)|
|Grade 1 : No need for assistance||150 (81%)||60 (63%)||5 (4.2%)|
|Grade 2: Need for some (including daily) assistance||33 (18%)||32 (33%)||50 (42%)|
|Grade 3: Need for 24-h care or supervision||2 (1.1%)||4 (4.2%)||64 (54%)|
|Of those needing 24-h care or supervision, the % for whom that care occurred outside the NH||0 (0.0%)||1 (25%)||27 (42%)|
|Level of Dependency||Normal (n = 185)||MCI (n = 96)||Dementia (Newly Discovered and Prevalent combined) (n = 119)|
|Grade 1 : No need for assistance||150 (81%)||60 (63%)||5 (4.2%)|
|Grade 2: Need for some (including daily) assistance||33 (18%)||32 (33%)||50 (42%)|
|Grade 3: Need for 24-h care or supervision||2 (1.1%)||4 (4.2%)||64 (54%)|
|Of those needing 24-h care or supervision, the % for whom that care occurred outside the NH||0 (0.0%)||1 (25%)||27 (42%)|
The Relationship between Individual Items of the MMSE and ADLs and IADLs in Dementia Patients
Objective: This study examined the relationship between individual items of the Mini Mental Status Examination (MMSE), activities of daily living (ADLs), and instrumental activities of daily living (IADLs) to determine if certain aspects of the MMSE predict daily life activities in dementia patients. Method: Archival data were used from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study. The participants (n = 670) completed cognitive measures and questionnaires that included the MMSE and a questionnaire assessing ADLs and IADLs. Results: Results indicated significant negative correlations between MMSE total score and ADLs and IADLs. However, the MMSE total score was more strongly correlated to the ADL total (r = −.466) compared with the IADL total (r = −.202). Additionally, all of the individual MMSE items were significantly correlated to the ADL total, but only a few with the IADL total. Furthermore, individual ADL items were more strongly correlated to the MMSE items and total score compared with the individual IADL items. Conclusion: The results suggest that MMSE items have a stronger relationship with the decline in ADLs in dementia patients. This may be because IADLs are more sensitive to measures of executive functioning, mental flexibility, and planning abilities, which are not well represented on the MMSE (Bell-McGinty et al., 2002; Jefferson et al., 2006). Additionally, dementia patients may score very low on the IADLs resulting in a restriction of range that makes correlating with the MMSE more difficult. This study suggests that the MMSE is useful in predicting basic daily activities, but not higher cognitive activities required for independence in dementia patients.
Neuropsychological Correlates of Delay and Probability Discounting in Older Adults
Objective: To determine whether delay discounting (DD) and probability discounting (PD) could serve as markers for cognitive decline in older adults. Hypotheses: cognitive decline would be associated with (1) more impulsive DD, (2) more risky PD, and (3) less consistent DD and PD preferences. Method: Forty older adults were recruited from the surrounding community (65–85 years, mean age = 75.45, 72.5% female). Exclusionary criteria included neurological illness, substance dependency within past 5 years, and score of ≤20 on the Mini-Mental State Examination. DD involved dichotomous choices between small, immediate, and large delayed monetary values. PD involved dichotomous choices between small, guaranteed, and large probabilistic monetary values. DD impulsivity and PD risk proneness were operationalized as hyperbolic discounting functions. Response consistency was calculated as percentage trials consistent with estimated discounting functions. Total Score and Index Scores from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess cognitive functioning. Results: RBANS scores were generally unrelated to hyperbolic discounting functions (p > .05). However, RBANS Language and Attention were significantly related to DD response consistency (r = .457, p = .003 and r = .368, p = .020, respectively) and RBANS Immediate Memory was significantly related to PD response consistency (r = .337, p = .033). Conclusion: Discounting response consistency may be a sensitive marker of cognitive decline in older adults, possibly due to the deterioration of brain regions necessary to maintain an internally consistent cognitive template for discounting preferences.
Everyday Functioning and Neuropsychiatric Symptoms in Healthy Older Adults and Individuals with Mild Cognitive Impairment
Objective: Associations between everyday difficulties and neuropsychiatric symptoms among individuals with Alzheimer's disease have been demonstrated. Few studies have examined this relationship in cognitively healthy older adults (HOAs) or individuals with mild cognitive impairment (MCI). We investigated the relationship between everyday difficulties and clinically significant neuropsychiatric symptoms among HOAs and individuals with MCI. Method: Knowledgeable informants for 114 HOAs and 44 individuals with MCI completed the Dysexecutive Questionnaire (DEX), a 20-item measure of everyday dysexecutive problems, and the Neuropsychiatric Inventory (NPI), a measure of 12 domains of neuropsychiatric symptoms. Results: For HOAs, mild and clinically significant behavioral symptoms were reported by informants in 41% with the most common being depression (25%) and sleep difficulties (21%). Sixty-two percent of individuals with MCI had mild and clinically significant behavioral symptoms with depression (38%) followed by apathy, irritability, and sleep and appetite changes (19%–20%) most commonly reported. Compared with HOAs (20%), twice as many individuals with MCI (41%) had clinically significant symptoms. HOAs with clinically significant symptoms had more informant-reported everyday dyesexecutive problems (M = 19.68) than those with none (M = 6.90) and mild (M = 9.81) symptoms, F(2, 109) = 31.45, p < .001, whereas MCI with mild and clinically significant symptoms had more everyday difficulties (M = 17.31 and 21.91, respectively) than those with no symptoms (M = 8.81), F(2, 42) = 12.88, p < .001. Conclusion: Neuropsychiatric symptoms are not uncommon among HOAs and individuals with MCI and may contribute to poorer everyday functioning.
The Neuropsychological Assessment Battery Naming Test Spanish Translation and Validation: Pilot Test Results
Objective: The incidence and prevalence of dementia were higher in Latinos and blacks than in non-Latino whites in a study completed in 1999 (Gurland et al., 1990). Additionally, reports show growth within the Hispanic or Latino population, and an increase in bilingualism in the USA (U.S. Census Bureau, 2010b). Despite demographic and cultural shifts, few measures of language functioning for Spanish speakers are available to providers. The translation and validation of the Neuropsychological Assessment Battery (NAB) naming test is an attempt at improving current methods for assessing lexical retrieval deficits in U.S. Spanish/English bilingual population. Method: Initial translation, back-translation, committee review, and pilot testing were conducted. Pilot testing included a neuromedical questionnaire, Short Acculturation Scale (SAS), Spanish Word Accentuation Test (WAT), and Spanish NAB naming test; inclusion criteria for subjects (n = 5) were age <55, Spanish language proficiency, and no history of neurological abnormality. Results: Participants were diverse in country of origin (Mexico, El Salvador, Honduras), time in the USA (∼ 2–15 years), years of education (8–20 years), acculturation scores (range: 21–33, M = 28, SD = 4.89), and performance on the WAT (range: 9–32, M = 25, SD = 10.34). Of 31 translated test items, 14 items received different than expected responses from one or more participants. Conclusion: Findings support the need for translation refinement, as more than one Spanish name for stimuli presented may be appropriate and commonly used. Country of origin, education, and acculturation variables also appear to impact test performance. Field testing (n = 25) is underway to explore heterogeneity of responses demonstrated in the pilot study.
To Dement or Not to Dement: The 3-Year Clinical Course of a Non-Progressive Behavioral Variant of Frontal Temporal Dementia
Objective: The early diagnosis of the behavioral variant of frontotemporal dementia (bvFTD) is characterized by deficits in social interaction and personality leading to an insidious neurodegeneration. In recent years, a non-progressive form of bvFTD, that is, indistinguishable at initial symptom presentation from the traditional neurodegenerative form, has been identified in the literature. We present the 3-year clinical course of a 63-year-old male attorney who initially presented with the classic symptoms of bvFTD and who, following serial evaluations, was found to have the non-progressive form of this condition. Method: The patient underwent serial comprehensive neuropsychological evaluations, including personality and mood assessment. He also underwent a neurologic evaluation, including neuroimaging. Results: At initial assessment, the patient presented with social inappropriateness, impulsivity, perseveration, word-finding difficulties, blunted affect, and a bilateral tremor. Formal cognitive testing revealed a pattern of subtle executive dysfunction. Over the ensuing 2-year follow-up evaluations, his behavioral symptoms, as well as his cognitive profile and daily living skills, remained stable. Cranial MRI scan from the initial neurologic work-up revealed mild atrophy. Conclusion: Despite initial presentation and MRI findings, the patient's cognitive and personality profile remained stable over a 2-year period. This case illustrates the need for caution in diagnosing probable (progressive) bvFTD without consideration of the potential for the non-progressive form.
Combining Select Neuropsychological Assessment with Blood-Based Biomarkers to Detect Mild Alzheimer's Disease: Proof of Concept for Molecular Neuropsychology
Objective: The current project sought to create a biomarker-cognitive profile to detect mild Alzheimer's disease (AD). Method: Data were analyzed from 278 participants (Early AD n = 93; Very Early AD n = 36; 137 controls). Non-fasting serum samples were collected from participants and assayed via a multi-plex biomarker assay platform. Logistic Regression was utilized to detect early AD using two serum biomarkers (TNFα and IL7), age, and the Clock-4 point test as predictor variables. Disease severity was determined via Clinical Dementia Rating (CDR) scale global scores. Results: In the total sample (all levels of CDR scores), the combination of biomarkers, cognitive test score, and demographics yielded a sensitivity (SN) of 0.94, specificity (SP) of 0.90, and an overall accuracy of 0.92. When examining early AD cases (i.e. CDR = 0.5–1), the biomarker-cognitive profile yielded SN of 0.94, SP of 0.83, and an overall accuracy of 0.94. When restricted to very early AD cases (i.e., CDR = 0.5), the biomarker-cognitive profile yielded SN of 0.97 and SP of 0.72 with an overall accuracy of 0.91. Conclusion: This study provides a proof of concept for Molecular Neuropsychology. The combination of age + 2 biomarkers + 1 cognitive test created a biomarker-cognitive profile that was highly accurate in detecting AD presence. Interestingly, while age, education, and gender were significant predictors when only cognitive testing was utilized, once the biomarkers were entered into the model, age was the only demographic variable that continued to add to the predictive accuracy of the model. This work demonstrates the complementary nature of each modality (blood biomarkers + neuropsychological assessment) and additional work is needed.
Specific Executive Function Impairments Contribute to Comorbid Psychopathology in Autism and Attention Deficit/Hyperactivity Disorder
Objective: Hypotheses of the current study were that deficits in specific executive functioning (EF) domains in Autism Spectrum (ASD) and Attention-Deficit/Hyperactivity Disorders (ADHD) mediate comorbid syndromes, such that inflexibility in ASD mediates internalizing problems, whereas behavioral disinhibition in ADHD mediates externalizing problems. Method: Archival data from the Behavior Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL) were obtained for 125 children (55 ADHD Combined or Hyperactive/Impulsive type, 70 ASD) evaluated at a children's hospital in the Mid-Atlantic. Data were analyzed using path analysis. Results: Results supported a slightly modified model (Fig. 1), χ2(2) = 2.943, p = .229; CFI = 0.994, RMSEA = 0.061, SRMR = 0.058; children with ASD exhibited significantly more inflexibility than those with ADHD, which accounted for the variability in internalizing problems as reported on the CBCL (indirect effect = 1.465, p = .023; 95% bias-corrected, bootstrapped CI of 5,000 samples: 0.203, 2.728). Children with ADHD exhibited significantly more behavioral disinhibition than those with ASD, which partly accounted for the variability in CBCL externalizing problem scores (indirect effect = −3.228, p < .001; 95% bias-corrected, bootstrapped CI of 5,000 samples: −4.842, −1.613); however, inflexibility also mediated differences in externalizing problems across diagnostic groups (indirect effect = 1.229, p = .040; 95% bias-corrected CI based on 5,000 samples: 0.055, 2.404). Conclusion: Findings support that there are distinct EF impairment profiles in ASD and ADHD that mediate associations with comorbid psychopathology. In addition, determinants of externalizing disorders are complex, consistent with preliminary research on potentially different dimensions of externalizing psychopathology.
The Role of Inhibition and Cognitive Set-Shifting in Verbal Performance in Youth with a History of Interpersonal Violence
Objective: Few studies have investigated executive function (EF) impairments in youth with posttraumatic stress (PTS), and those that have report mixed findings. EF measures of inhibition and cognitive set-shifting have been associated with verbal performance in adults. This study examined the relationship between verbal performance and EF measures of inhibition and cognitive set-shifting in youth with PTS. It was hypothesized that EF measures would be associated with verbal performance in youth with PTS, and this relationship would differ significantly compared with healthy controls (HCs). Method: Twenty-eight youth exposed to interpersonal violence and 18 HCs completed the Wechsler Abbreviated Scale of Intelligence (WASI), Wide Range Achievement Test 3 (WRAT-3), and the Delis–Kaplan Executive Function System Color Word Interference Test (CWIT). Results: For the PTS group, CWIT inhibition was associated with WRAT-3 spelling (p = .001); CWIT inhibition/switching was associated with WASI verbal (p = .002), WASI total (p = .001), WRAT-3 reading (p = .016), and WRAT-3 spelling (p = .003); CWIT was not associated with either WASI or WRAT-3 in HCs. Fisher's transformation showed significant differences between PTS and HC on correlations of CWIT inhibition/switching and WASI verbal (p = .05), WASI total (p = .02), and WRAT-3 reading (p = .03). Conclusion: Results suggest that the experience of trauma affects resources available for EF in youth or that this profile represents a risk factor for PTS in traumatized youth. Compared with HC, the PTS group displayed a significant relationship between CWIT inhibition/switching and verbal domains, suggesting that impairments in EF are a contributing factor to deficits in verbal performance. The implications will be discussed for practitioners and researchers.
Neurocognitive Deficits Identified in a Pediatric Patient with a 4.1 Megabase Deletion of 3q22.1-3q22.3 Chromosomal Deletion
Objective: Identify and define neurocognitive, behavioral, emotional, and physical characteristics of a pediatric patient who was one of only two pediatric patients noted in medical research with a rare 4.1 megabase deletion of 3q22.1-3q22.3 chromosomal deletion. The ultimate goal was to help establish baseline and comparative analysis for practitioners who encounter this deletion in practice. Method: From birth, the patient presented with clearly identifiable physical characteristics, self-soothing behaviors, early-onset seizures, aberrant breathing patterns, and cognitive deficiencies that worsened at predictable times, based on the only other identified patient with this condition. A standard pediatric neuropsychological evaluation was conducted. Results: There were global impairments in language, memory, executive functioning, and perception, but not with mood or sustained auditory attention. Milder deficits were noted on visual tasks of perception than verbal tasks. Conclusion: The identified physical characteristics can help practitioners, teachers, and physicians conduct early interventions and testing to assist with some skill development.
Executive Functioning in Abused Children Prior to Treatment
Objective: Early trauma exposure is a serious public health problem that has potential long-term negative consequences. Children who experience PTSD are at a high risk for developing cognitive deficits; however, the effects of abuse without being diagnosed with PTSD are unclear. The current study aims to further elucidate executive functioning (EF) in children who have experienced abuse. Method: Fourteen children who sustained abuse and 10 controls between the ages of 8–12 years matched for age, education, and gender were recruited at a large urban hospital. A series of EF measures, including the Wisconsin Card Sorting Test (WCST), the Trail Making subtest of the Delis Kaplan EF System scale, the Mazes subtest from the Wechsler Intelligence Scale for Children-III, and the Behavioral Rating Inventory of EF-Parent Report (BRIEF) were administered prior to receiving treatment. Results: Independent samples t-tests indicated group differences on all the subscales of the BRIEF (t = −5.41, p < .05, in all cases). There were similar differences on the WCST, including conceptual level responses and amount of errors, with the patient group performing more poorly (t = 3.01, p < .01, in all cases). There were no differences on the other measures of executive functioning. Conclusion: These results suggest that prior to receiving treatment, children who have experienced abuse are reported by their parents to have increased problems in executive functioning, with objective measures supporting decreased problem-solving skills, but intact planning and cognitive flexibility. These skills may contribute to impaired functional outcomes in abused children and treatment could focus on facilitating the development of these skills.
Relations between Fine Motor Skill and Parental Report of Attention in Young Children with Neurofibromatosis Type 1
Objective: This study aims to examine the fine motor functioning of young children with neurofibromatosis type 1 (NF1) and relations to attention difficulties. Method: Thirty-eight children with NF1 and 23 unaffected children 4 through 6 (siblings and community members) were enrolled in the study. Children with NF1 were recruited through two Midwest academic hospitals. Non-verbal reasoning abilities and fine motor functioning skills of varying complexity were examined using select subtests from the Differential Ability Scales-Second Edition (DAS-II) and NEPSY-II. Parental report of everyday fine motor functioning was examined using the Scales of Independent Behavior-Revised (SIB-R) Fine Motor subscale. Parental report of attention difficulties was examined using the Conners' Parent Report Rating Scales-Revised. Results: There were no significant differences between groups on age, gender, ethnicity, and SES. For children with NF1, significant difficulties were demonstrated on higher-order fine motor tasks, even after controlling for nonverbal reasoning abilities, F(4, 55) = 5.23, p = .001; partial eta squared = 0.275. Parent-reported fine motor skills were related to lab-based complex fine motor abilities. Elevated attention problems were observed for the NF1 group, but no significant correlations were found between complex fine motor ability and attention difficulties. Conclusion: These findings suggest that children with NF1 do not show difficulties on simple fine motor tasks, but do show difficulties, in comparison with unaffected children, on higher-order fine motor tasks. The findings also suggest that the difficulties observed with higher-order fine motor tasks in young children with NF1 do not appear to be clearly driven by attention problems. This research was supported by funds from the UWM Research Growth Initiative, University of Chicago CTSA (UL1 RR024999), NF Midwest, NF MidAtlantic.
Health-Related Quality of Life Following Encephalitis in Childhood and Its Relationship with Neuropsychological Sequelae
Objective: Following encephalitis in childhood, young people can experience neuropsychological, psychological, and medical consequences, making health-related quality of life (HRQL) of interest in this clinical population. Method: This study investigated whether relationships exist between the two most frequently reported neuropsychological consequences of encephalitis (executive function and everyday memory problems) and parent/carer reported HRQL. In addition, it explored to what extent these and other illness-specific factors are predictors of parent/carer reported HRQL. This study utilized an exploratory cross-sectional design. Correlations and multiple linear regression were utilized to explore primary and exploratory hypotheses. Thirty-eight parents/carers of children/adolescents, aged 8–15 years old, who had experienced encephalitis responded to an invitation to take part. Participants were recruited through the Encephalitis Society. Parents/carers completed a Pediatric Quality of Life InventoryTM (PedsQLTM), a Behavior Rating Inventory of Executive Function (BRIEF), a Children's Memory Questionnaire (CMQ), and a demographic/illness specific questionnaire in relation to their child. Results: Everyday memory, executive function (p < .001), and sleep difficulties (p < .002) correlated significantly with parent/carer reported HRQL. Combined, these sequelae accounted for up to 71% of the variance of parent/carer reported HRQL, with everyday memory being the most significant predictor (p < .001). Conclusion: Frequently reported neuropsychological impairments and sleep difficulties following encephalitis in childhood are found to relate significantly to parent/carer reported HRQL. Important implications for children and specific areas for rehabilitation post-encephalitis are highlighted. Recommendations for future research are proposed.
Cognitive Predictors of Parents' Ratings of Externalizing Behaviors in Children
Objective: The relationship between two neuropsychological tasks and reports of children's behavioral functioning as assessed by a behavior rating scale was evaluated. It was hypothesized that reduced functioning on neuropsychological tasks would be associated with higher ratings of behavioral problems. Method: The sample consisted of 60 participants from an archival database of children seen in a private practice in a southwestern metropolitan area ranging in age from 6 to 16 years. They were tested by a clinical professional on an individual basis. Two tasks from the NEPSY-Second Edition (NEPSY-II), “Auditory Attention” and “Inhibition,” were selected as independent variables and transformed for directionality. T-scores from the Behavior Assessment Scales for Children-2, Parent Rating Scale (BASC-2 PRS) Externalizing composite comprised the dependent variable. A multiple regression analysis was conducted to assess the abilities of the two neuropsychological tasks to predict parents' perceptions of behavior problems as measured by T-scores on the BASC-2 Externalizing scale. Results: The linear combination of the two neuropsychological tasks was not significantly related to the BASC-2 scores, F(2, 29) = 2.72, p = .08. The correlation of .40 between the Auditory Attention subtest only and the BASC-2 Externalizing scale was statistically significant (p = .01). Conclusion: Results indicate that the task designed to measure selective auditory attention, vigilance, and inhibition was a better predictor of parents' rating of behavior than the task designed to measure inhibition of automatic responses in favor of novel responses and switching between response types.
Attention-Deficit/Hyperactivity Disorder Subtypes in Pediatric Epilepsy
Objective: Children with epilepsy are at increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD). This study examined differences among children with epilepsy and subtypes of ADHD on a variety of neurocognitive and behavioral variables. Method: Children with epilepsy and ADHD (n = 87), ranging in age from 5 to 18 years, referred to an outpatient neuropsychology service of an academic medical center, comprised the sample. 47.1% received a diagnosis of ADHD-Predominantly Inattentive Type (n = 41) and 52.9% received a diagnosis of ADHD-Combined Type (n = 46). Both groups were compared on seizure-related variables (age of seizure onset, number of anti-epilepsy drugs, seizure type), neurocognitive functions (WISC-IV FSIQ, Working Memory, and Processing Speed, and CPT-II Omissions, Commissions, Hit RT, Variability, and Perseverations), and parent and teacher behavior rating scales (BASC-2 Hyperactivity and Attention Problems scales and BRIEF Behavioral Regulation Index and Metacognition Index). Results: Independent samples t-tests did not reveal significant group differences for children with epilepsy and ADHD-Combined Type versus children with epilepsy and ADHD-Predominantly Inattentive Type on any seizure-related variables or neurocognitive variables. Parent and teacher behavior rating scales yielded significant group differences, indicating higher levels of hyperactivity (BASC-2 TRS Hyperactivity, p < .001), inattention (BASC-2 PRS Attention Problems, p = .024), and behavioral dysregulation (Parent BRIEF Behavioral Regulation, p < .001) for children with epilepsy and ADHD-Combined Type when compared with those with epilepsy and ADHD-Predominantly Inattentive Type. Conclusion: Not unlike children with developmental ADHD, parent and teacher completed behavior rating scales appear to more effectively identify subtypes of ADHD among children with epilepsy, when compared with measures of neurocognitive functioning. Inclusion of behavior checklists as part of standard care in neurology clinics may be a cost-effective way to screen for this comorbidity in children with epilepsy.
Impact of a Parent-Directed Intervention for Children with Cancer-Related Neurobehavioral Late Effects
Objective: Children diagnosed with cancer involving the central nervous system (CNS) or those who have had CNS-directed therapies are at risk for neurocognitive and behavioral late effects. While promising, child-directed behavioral interventions in the clinic to treat such sequelae have shown mostly small effects that are not sustained. We proposed an intervention directed at parents for the purpose of improving “pro-learning” parenting behavior and thus to indirectly improve the child's cognitive and behavioral outcomes. Method: Forty-four childhood cancer survivors with cognitive deficits and their parents were randomized to either the intervention or the control arm. Intervention parents participated in eight individual training sessions over a 3-month period (Phase 1) to improve their pro-learning parenting behaviors intended to promote their child's functioning. Bi-weekly phone support was provided for the next 3 months (Phase 2). Child impact was evaluated by objective testing and questionnaires at pre- and post-intervention. Results: Generalized Estimating Equation analyses found that children in the intervention arm improved significantly more on the WIAT numerical operations subtest of academic achievement (p = .015) and on the parent report BRIEF Initiate subscale compared with the control arm (p = .044). Trends on the BASC parent report of daily living skills subtest was also observed (p = .061). Child report indicated improved study strategies (p = .023) and reduced test anxiety (p = .042) at post-intervention, but not sustained at follow-up. Conclusion: A parent-direct intervention to indirectly benefit outcomes in the survivors was determined to have modest impact on child outcomes over a 6-month period and shows promise as an intervention approach for further development.
Construct Validity of LANSE-C/A: Neurocognitive Screening Instruments for Children and Adolescents
Objective: The study evaluates the construct validity of two screening instruments: LANSE-C and LANSE-A, which assess functioning within multiple cognitive domains for children and adolescents, ranging in age from 6 years to 17 years 11 months. Method: Participants (n = 249) were non-injured control (NC) participants without a prior history of head injury, neurological disorder, seizure disorder, psychiatric disorder, or Attention-Deficit/Hyperactivity Disorder (n = 190) and brain-injured participants assessed at Children's Hospital Central California following damage to the brain (n = 59). Results: A MANOVA was conducted to investigate LANSE-C/A scores among brain-injured and non-brain-injured children and adolescents. A statistically significant difference was found, F(14, 234) = 46.530, p < .001; Wilk's Lambda = 0.264; partial eta2 = 0.763. Brain-injured scored significantly lower on the LANSE-C/A than controls. As a follow-up, a DFA was calculated to determine if subtests scores predict brain-injured versus non-brain-injured. The DFA was significant with an overall Wilk's lambda Λ = 0.264, χ2(14, n = 249) = 319.376, p < .001; indicating all 14 subtests of the LANSE-A/C significantly differentiated between the two groups: normal controls and brain injured. Loading matrix suggests that the LANSE-C/A are good predictors of identifying the hallmarks of brain injury. The MANOVA and DFA results suggest greater cognitive impairment among brain injured. Conclusion: The results suggest that the LANSE-C/A are useful screening measures for children and adolescents and good predictors of identifying the hallmarks of brain injury. The instruments provide a screening tool that can be conducted by health care professionals to quickly identify individuals with probable cognitive compromise.
Comparison of IQ in Children with Partial Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorder
Objective: Fetal Alcohol Spectrum Disorders (FASD) are common causes of birth defects and developmental disability. These deficits can include low cognitive abilities. Two of the three alcohol-related diagnoses that fall within FASD are Partial Fetal Alcohol Syndrome (pFAS) and Alcohol Related Neurodevelopmental Disorder (ARND). Diagnosis of these disorders require damage in the CNS and a confirmed prenatal-alcohol exposure. Additionally, growth deficits are not required for both. The major difference between these disorders' diagnostic criteria is the presence of facial abnormalities. That is, in order to meet pFAS, the individual should have two of the three facial abnormalities present, whereas facial abnormalities are not necessary to diagnose ARND. This present study aimed to examine the cognitive abilities in children diagnosed with pFAS and ARND. We hypothesized that those with pFAS would perform poorer on the WISC-IV than children with ARND. Method: Participants of this study were children who were seen at the University of Minnesota Children's Hospital, Pediatric Psychology Clinic within the age range of 6–18 (pFAS group n = 100; ARND group n = 119). Results: The results showed significant difference on overall cognitive functioning (p < .05). In addition, we found non-verbal reasoning (p < .05) and auditory working memory (p < .05) were significantly different. Children with pFAS had more deficits than those with ARND. Conclusion: These findings demonstrate that although the diagnostic criteria for pFAS and ARND are similar, there are still significant differences in cognitive functioning. This may be associated with pFAS having more (or required) dysmorphic facial features, which would be consistent with the literature.
The Utility of the TOMM and Reliable Digit Span as Performance Validity Measures in Children and Adolescents
Objective: The necessity of assessing effort in pediatric evaluations is gaining recognition. Though free standing measures like the Test of Memory Malingering (TOMM) appear promising in youngsters, the utility of embedded performance validity tests (PVTs), such as reliable digit span (RDS), is uncertain. The present study assessed the TOMM and RDS in a pediatric sample. Method: One hundred and seven children and adolescents, ages 6–17, were included. All were non-medical referrals, presenting with academic, emotional, and behavioral difficulties (e.g., Attention-Deficit/Hyperactivity Disorder, Learning Disability). As part of a comprehensive evaluation, all received the TOMM, Digit Span, and assessment of intellectual functioning (i.e., WISC-IV, WASI, or WAIS-IV). Verbal comprehension (VCI) and perceptual reasoning indices (PRI) were utilized as estimates of intellectual ability. Pass rates were calculated for TOMM and RDS, according to presently accepted guidelines. Correlational analyses assessed their relationship with age and intellectual abilities. Results: 96% of the sample passed the TOMM on Trial 2, whereas only 73% passed RDS, a rate below the recommended threshold for PVT utility suggested by Donders (2005). Further younger children (i.e., those age 7 and below), the RDS failure rate was 43%. Moreover, although TOMM scores were unrelated to patient factors, RDS was correlated with age (r = .60, p < .001), VCI (r = .39, p < .001), and PRI (r = .23, p = .017). Conclusion: Whereas the TOMM continues to show promise as a PVT in childhood samples, RDS appears to have an unacceptably high failure rate, especially in younger children. Further, its relation to cognitive measures makes its utility as a PVT questionable.
Neural Activity Differences Between Typically Developing Adolescents and Those with Autism Spectrum Disorders During Social Viewing Condition
Objective: Autism Spectrum Disorders (ASDs) are disorders characterized by deficits in social functioning (APA, 2000). Researchers interested in the neural correlates of these deficits employ continuous electroencephalography (EEG) during a “resting state” despite a lack of knowledge regarding the significance of activation during this condition. Here, we aim to identify differences in activation in adolescents with ASDs during presentation of a social stimulus when subjects are believed to be engaged in social information processing. Method: Twenty-eight typically developing adolescents (TYPs) were recruited from community advertisements and 16 adolescents with autism spectrum disorders (ASDs) were recruited from intervention agencies, support groups, and an in-house intervention waiting list. TYPs were screened for clinical psychopathology and ASD diagnoses were confirmed for ASDs. All subjects were 11–16-year old and had an Intelligence Quotient above 70. EEG was recorded while viewing a 3-min video depicting an autobiographical monologue delivered by a neurotypical peer. EEG power in the theta, alpha, beta, and gamma frequency bands was calculated for the frontal, parietal, and temporal lobes in both hemispheres. Results: Analyses indicated higher power values in all bands except gamma, across all lobes investigated, in TYPs (p < .05). Conclusion: Given our understanding of the roles of each frequency band in information processing (Rippon, 2006; von Stein, 2000), these findings suggest impairments in inhibitory and mid- and long-range binding but intact local processing in the “social brain” (Brothers, 1990; Frith, 2007) in ASDs. Moreover, they suggest that presentation of a social stimulus in future projects with this population may be appropriate.
Bacterial Meningitis: A Case Study
Objective: Bacterial Meningitis (BM) is an infection of the CNS that affects the tissues surrounding the brain and spinal cord. In some cases, BM can be fatal if not treated promptly with antibiotics (Quagliarello & Scheld, 1997). Even after successful treatment, residual neurological deficits may still present. Most often, patients experience problems primarily related to functions of the hippocampus such as difficulty learning new information, problems with short-term and working memory, a decrease in processing speed, and deficits in visual memory and concentration (de Jong et al., 2008; Merkelbach et al., 2000). Research on prognosis and long-term outcomes for adults diagnosed with BM is limited. Method: Data were collected on a right-handed, 62-year-old female who was referred for a neuropsychological evaluation in order to assess the extent of cognitive impairment following a diagnosis of BM. Initial symptoms included poor equilibrium, fever, and severe headache. After treatment, the patient reported vertigo, fatigue, and light sensitivity. Cognitively, the patient reported difficulty multitasking, slowed processing speed, and increased distractibility. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed relative weaknesses in executive functioning, specifically related to working memory and processing speed. With regard to mood, there was evidence of minimal anxiety and depression, with no evidence of suicidal ideation. Conclusion: The patient presented with relative weaknesses in executive functioning secondary to a diagnosis of BM. Neuropsychological assessment can be extremely helpful in clarifying etiology and extent of difficulties, thereby guiding intervention.
Measuring Self-Awareness after Brain Injury in the Inpatient Rehabilitation Setting and at 6 Months Follow-Up: Comparison of the Functional Self-Assessment Scale and Patient Competency Rating Scale in Understanding Outcome
Objective: Few studies have examined the relationship of self-awareness early in recovery from brain injury to outcome. The Functional Self-Assessment Scale (FSAS) and the Patient Competency Rating Scale (PCRS) were employed to examine the relationship of early self-awareness with later self-awareness along with cognitive and functional status in order to better understand the role of self-awareness in recovery and rehabilitation. Method: Subjects were 70 adult inpatient admissions to a brain injury program. Subjects were administered the FSAS and RBANS and clinicians also completed the FSAS. A Self-Awareness Score (SAS) for each subject was calculated as the difference between subject and staff ratings. The subjects were then divided into good self-awareness (n = 49) and poor self-awareness (n = 21) groups. Thirty-seven subjects were available 6 months later at which time they and family members completed the PCRS and divided into good self-awareness (n = 28) and poor self-awareness (n = 9) groups based on Time 1 assessment. Results: The SAS and cognitive functioning at Time 1 were significantly correlated with PCRS discrepancy scores (difference between subject and family ratings) at Time 2. Step-wise linear regression showed that only the Time 1 SAS predicted Time 2 PCRS discrepancy scores. Impaired awareness was associated with Time 2 functioning in terms of employment and accessing transportaion. Conclusion: Early self-awareness assessment is capable of predicting later awareness. More subjects demonstrated good awareness versus poor awareness, consistent with studies that have noted awareness is not a universal problem after brain injury. Poor self-awareness was a risk factor for poorer outcome regarding employment and supervision needs.
Trajectory of Neuropsychological Scores Following Pediatric Brain Injury
Objective: Recovery trajectories from adult brain injury are well established, but in pediatric populations recovery is more complicated by the dynamic brain and critical developmental periods. In adults, recovery may progress for up to 3 years, but in children the empirical research is unclear regarding time since injury, amount of recovery, and effects on academic skills. The purpose of this study was to examine the relationship between neuropsychological test score patterns and length of time since brain injury onset in a pediatric sample. Method: Participants included 132 children (boys = 61%; ages 5–18 years; mean age of 10.47 years) who were referred for neuropsychological evaluations following brain injury. All children had acquired brain injuries. Children with epilepsy or genetic conditions were excluded from this sample. The mean FSIQ was 83.53 (16.87). The mean age of brain injury onset was 3.44 (4.53). Duration (age at testing – age at onset) ranged from birth to 15 years. Descriptive analysis and correlations were performed. Results: Pearson's correlations between times since injury and subtest standard score revealed significance (p < .05) across academic domains including reading (WRAT-4, r = .216, p = .048) and spelling (WRAT-4, r = .243, p = .025). No significance was found across measures of intelligence, attention, visual, verbal, and memory ability. Conclusion: Results support that as time continues to lapse from date of injury or diagnosis, most neuropsychological scores remain constant with no significant positive or negative trajectory. However, academic functioning appears to be a cognitive domain which continues to improve over time following brain injury in children.
Processing Speed in Traumatic Brain-Injured War Veterans
Objective: The purpose of the study was to determine whether (a) blast versus other traumatic brain injuries differed, (b) number of blasts made a difference, and (c) type of blast are related to processing speed in war veterans. Method: Data were utilized from 822 veterans returning from Iraq and Afghanistan who were administered a neuropsychological battery. The following tests were used in the analyses; Trail Making Test A and B, Grooved Pegboard Test, along with Symbol Search and Coding subtests from the WAIS. The independent variables were (a) blasted versus not blasted, (b) single blasts versus multiple blasts, (c) type of blast (mounted [i.e., inside a vehicle] vs. dismounted [i.e., outside of a vehicle]). Results: A linear regression analysis revealed that (a) relationship of blast versus other types of head injuries, (b) the number of blasts was significantly correlated with processing speed, and (c) the type (mounted vs. unmounted) of blast was significant. As to number of blasts, there was a positive correlation for Trails B performance and negative correlations for Grooved Pegboard (both hands) performance. As to mounted versus unmounted, there was a negative correlation for Trails B and Symbol Search. Conclusion: Processing speed has been closely linked to blast injuries. However, no effects between blast versus non-blast head injuries were noted. When there were multiple blasts, processing speed was generally slower. Where the injury occurred also made a difference as to processing speed. Processing speed is indeed affected but specific aspects of the type of injury mediate how processing speed is reduced.
Expectation of Outcome from a Mild Traumatic Brain Injury: Does the Mechanism of Injury Matter?
Objective: Mild traumatic brain injury (mTBI) outcome is influenced by pre-injury expectations of recovery, but the factors that contribute to such expectations are not well understood. This study investigated whether (a) injury context influences expectations when injury details (e.g., loss of consciousness duration) are held constant, and (b) whether contact sport (CS) participation influences expectations. We hypothesized that (a) worse outcomes would be expected from a motor vehicle accident-related (MVA) mTBI compared with a sport-related mTBI, and (b) compared with non-CS players, regular CS players would expect less severe outcomes from mTBI, irrespective of the context. Method: Participants with no mTBI history (n = 204; Mage = 21.60, SD = 5.71; 80.2% female) were randomly allocated to read a mTBI vignette from a sport (n = 118; 22% CS players) or MVA context (n = 86; 22% CS players). Participants completed the timeline and consequences subscales of the Illness Perception Questionnaire-Revised to assess initial recovery expectations, and then they completed the Neurobehavioral Symptom Inventory to assess expectation of postconcussion syndrome (PCS) symptoms 6 months post-injury. Results: As hypothesized, greater PCS symptomatology, p(one-tailed) = .029, r = −.13, more severe consequences, p(one-tailed) = .001, r = −.21, and a longer recovery duration, p(one-tailed) = .008, r = −.17, were expected of an injury sustained in the MVA versus sport context. However, for each context, no significant differences in outcome were expected (all p > .05) by CS players versus n-CS players. Conclusion: mTBI outcome expectations are influenced by contextual extra-injury details. Participants expected worse outcomes of an mTBI sustained in a MVA versus a sporting context, despite the same injury parameters. CS participation may not reduce individuals' vulnerability to mTBI response expectancies as previously thought.
Neuropsychological Description of Blast Injuries: The Camp LeJeune Blast Data Set
Objective: To purpose of this project was to obtain and describe a comprehensive data set regarding blast injuries in returning war veterans. Method: The authors constructed a neuropsychological battery consisting of 11 tests and obtained a pilot sample of approximately 50 veterans from Iraq. The battery included the CVLT-II, COWAT, Groove Pegboard, Grip strength, Halstead–Reitan, Hayling and Brixton, MMPI, Stoop, TOMM, WAIS-III/WAIS-IV, MWS-III/MWS-IV, and WRAT-IV. Twenty-eight demographic variables and 128 neuropsychological variables were also included. The sample originally included 1,066 individuals who recently returned from Iraq and subsequently from Afghanistan. Of these, 238 were retests and 26 others had ages of 2.5 SDs above the means and therefore were excluded. Results: Most individuals were male, Caucasian, approximately 18 years of age, and had 12 years of education. Over half had a blast injury, while the remaining individuals had a non-blast injury. Of those having a blast injury, most had multiple blasts; approximately half were involved in an open (or dismounted) and other closed (or mounted) blasts. Neuropsychological testing indicated: CVLT-II trials1–5 scores in the 42nd percentile, COWAT letter fluency with a mean of 31 words, COWAT semantic fluency with mean of 20 words, Trails B mean time was 74.83 s, and WAIS-IV processing speed was in the 29.5 percentile. There was significant evidence that speed of processing, memory, and executive functions were most affected. Conclusion: This is the largest public data set gathered to date on blast injuries from a community sample of contiguously tested individuals. This has provided a data set that will promote future analyses and research collaboration.
Apathy Is Related to Quality of Life and Cognitive Function in Returning Veterans with Blast Exposure
Objective: Apathy (i.e., a decrease in the cognitive, behavioral, and emotional features of goal-directed functioning) is characterized by diminished motivation, emotion, interest, or concern. Apathy has been associated with traumatic brain injury and other neurological conditions, such as stroke and neurodegenerative disease. In this study, we examined the prevalence and effect of apathy on functional status in returning veterans with blast exposure. Method: Fifty blast-exposed veterans who presented with cognitive complaints were administered the Apathy Evaluation Scale (AES), Beck Depression Inventory-II (BDI-II), and the PTSD Checklist-Military (PCL-M), as well as subjective measures of community integration, life satisfaction, and cognitive function. Participants were divided into apathetic (AES ≥ 37, n = 31) or not apathetic (AES < 37, n = 19) groups. Results: Sixty-two percent of the participants were categorized as apathetic. Apathetic veterans showed significantly higher levels of depression and marginally higher levels of PTSD than non-apathetic group. Apathetic participants reported significantly lower levels of community integration and satisfaction with integration, social connectedness, life satisfaction, and daily cognition. Hierarchical regression indicated that, compared with PTSD and depression, apathy was the strongest predictor of all the subjective measures except community integration, which was more strongly associated with depression. Conclusion: Veterans with higher levels of apathy had poorer community integration satisfaction as well as diminished social connectedness, satisfaction with life, and everyday cognitive functioning. These findings highlight the prevalence of apathy in returning veterans and the relation between apathy and functional outcome. Early detection and treatment of this neuropsychiatric condition may enhance veterans' everyday functioning and improve their quality of life.
Normative Differences in Performance on the Conners' Continuous Performance Test among Individuals with Mild-to-Moderate Traumatic Brain Injury
Objective: The normative database of the Conners' Continuous Performance Test-Second Edition (CPT-II) includes data for a mixed neurological group, but lacks discrete norms for individuals who have experienced a mild-to-moderate traumatic brain injury (TBI). This study sought to develop preliminary normative data to be used with this population. Method: Participants were 20 patients selected from archival neuropsychology clinic data. Selection criteria included evidence of mild-to-moderate TBI through either a Glasgow Coma Score of 8–14, witnessed loss of consciousness, or positive neuroimaging results. Participants ranged from age 18–61 (M = 36.3; SD = 13.1) with a mean 13.7 years of education (SD = 2.4). Participants had mean time since injury of 20.6 months (SD = 32.7). The newly developed norms were compared with a non-clinical normative sample (M = 50, SD = 10). Results: Participants in the TBI database were found to have a slightly lower rate of errors of omission compared with a normative sample. No other significant differences were observed. Conclusion: For mild-to-moderate TBI, patients tested many months after their accident, this study suggests that the CPT-II is not a sensitive indicator of attention impairment as a result of head injury. Replication with a larger, more acutely injured sample would help clarify the usefulness of the CPT-II with this population. This small study suggests that mild-to-moderately head injured patients tested remotely from the injury generally demonstrate functional visual attention as assessed with the CPT-II. It remains to be seen whether a more acutely injured population would show more impairment on this measure.4
|TBI database mean T||Mean difference from normative database||SD||r||Significance (two-tailed)|
|Hit RT SD||48.94||−1.06||8.96||.121||.60|
|Hit SE block change||49.70||−0.30||10.17||.030||.90|
|Hit RT block change||50.05||0.05||10.26||.005||.98|
|ISI standared error||49.45||−0.55||10.47||.005||.82|
|ISi reaction time||50.28||0.28||10.24||.028<|