Archives of Clinical Neuropsychology - Advance Access

The Warrington Recognition Memory Test for Words as a Measure of Response Bias: Total Score and Response Time Cutoffs Developed on "Real World" Credible and Noncredible Subjects

Wed, 11 Nov 2009 01:52:30 PST

Several studies have examined the usefulness of the Warrington Recognition Memory Test–Words as a measure to detect suspect effort, although samples have generally been small and/or comprised of simulators rather than "real world" credible and noncredible patients. The current study examined the Warrington Recognition Memory Test–Words total score and response time of "real world" noncredible patients (as determined by motive to feign, failure on >2 independent measures of response bias, low cognitive scores inconsistent with normal ADLs; n = 190) versus credible patients (as determined by no motive to feign, failure of <1 measure of response bias; n = 124) derived from an archival database of individuals from the Harbor-UCLA Medical Center, Department of Psychiatry, Outpatient Neuropsychology Service, and the private practice of the second author. Noncredible patients obtained significantly lower total scores and longer times to complete the task. A total correct cutoff of ≤42 was found to have excellent specificity (91.9%) and sensitivity (88.9%), whereas a time cutoff of ≥207'' was associated with 65.5% sensitivity at 90.7% specificity, and when the time cut-score was used in combination with the total score cutoff, an additional 5% of the noncredible participants were captured, raising overall sensitivity to 93.7% (at 87.1% specificity). Thus, the Warrington Recognition Memory Test–Words, although not originally created for the purposes of measuring suspect effort, appears to be an excellent measure for detecting response bias on neuropsychological testing.

Brain, Behavior and Learning in Language and Reading Disorders

Nicholls, C. J. — Tue, 10 Nov 2009 07:01:02 PST

Poverty and Brain Development During Childhood: An Approach from Cognitive Psychology and Neuroscience

Hebben, N. — Tue, 10 Nov 2009 07:01:01 PST

Measuring Post-concussion Symptoms in Adolescents: Feasibility of Ecological Momentary Assessment

Lewandowski, L., Rieger, B., Smyth, J., Perry, L., Gathje, R. — Wed, 04 Nov 2009 22:57:09 PST

Although there is a large literature examining head trauma in general, several areas remain understudied. Notably, little is known about symptom expression over the course of a day for adolescents recovering from concussion. Furthermore, intra-individual symptom variability has not been well characterized. This pilot study examined the feasibility of a momentary data-gathering method, as well as the sensitivity of the assessment to the subtle and dynamic changes in symptoms of concussion. Six adolescents, three of whom suffered a concussion and three non-injured controls, provided symptom ratings five times per day for 5 days. This ecological momentary assessment (EMA) was conducted on a personal digital assistant to capture variability in symptom reports while in the natural environment. Preliminary results indicated that the EMA method showed great promise as a research tool in natural settings (e.g., school and home). Adolescents were able to comply with all tasks with little interference in their daily activities. Students with concussion showed generally higher symptom ratings across physical, cognitive, and affective domains, and temporal and diurnal patterns for symptoms emerged. Implications for future research and patient care are discussed.

Gender-related Differences in Visuospatial Memory Persist in Alzheimer's Disease

Millet, X., Raoux, N., Le Carret, N., Bouisson, J., Dartigues, J.-F., Amieva, H. — Tue, 03 Nov 2009 22:21:37 PST

Gender differences in visuospatial cognition favoring men are larger in tasks requiring active information manipulation than in tasks requiring passive storage. This study was designed to determine whether male advantage in active manipulation of visuospatial information can still be evidenced in Alzheimer's disease (AD). Twenty male and 20 female AD patients with equivalent age, education, dementia severity (Mini-Mental State Examination and Mattis Dementia Rating Scale), and visual discrimination abilities were recruited. We administered the forward span of Corsi block-tapping task and Vecchi's matrix memory task involving passive temporary retention of stimuli location. Active manipulation of visuospatial information was assessed with the backward span of Corsi block-tapping task and Vecchi's pathway task in which patients were required to mentally generate a pathway within a matrix. The results showed that scores on the tasks involving passive storage of visuospatial information were equivalent between the two groups of patients, whereas men performed significantly better than women in tasks requiring active manipulation of visuospatial information. This result was limited to visuospatial processing since no difference between male and female patients was evidenced in the verbal short-term memory tasks, neither when the task involved passive storage nor when the task required active processing. Therefore, this study suggests that, besides other variables such as education or lifestyle factors, gender might also modulate the cognitive manifestation of AD.

Neuropsychological Function 5 Years after Cardiac Surgery and the Effect of Psychological Distress

Tully, P. J., Baker, R. A., Knight, J. L., Turnbull, D. A., Winefield, H. R. — Thu, 29 Oct 2009 00:59:09 PDT

Research has shown conflicting results with regard to the influence of depression and anxiety on neuropsychological performance following coronary artery bypass graft (CABG) surgery. Notably, the independent effects of depression and anxiety have not been examined among CABG candidates in the longer term where it is has been suggested that these patients show marked cognitive deterioration. A neuropsychological test battery and measures of psychological distress were completed by 86 CABG patients and 50 nonsurgical control participants at baseline and 6 months, whereas 75 patients and 36 controls, respectively, completed a 5-year follow-up. In CABG patients, cognitive and affective depressive symptoms were independently associated with lower and worse performance on the Boston Naming Test, Purdue Peg Board, and Digit Symbol Coding 6 months after surgery, whereas at 5-year follow-up an effect for Digit Symbol persisted, and an association was also observed for the Trail Making Test (TMT). On average, CABG patients performed worse on TMT and Digit Symbol at 6 months, whereas at 5-year follow-up their performance was worse on short-term delayed verbal recall. The results among the CABG patients did not show a consistent pattern of association between psychological distress and those neuropsychological domains that were on average significantly lower than a nonsurgical control group. The results here also support the use of nonbiased statistical methodology to document dysfunction among heterogeneous cognitive domains after CABG surgery.

Clinical Evaluation of the Mini-Mental State Exam with Culturally Deaf Senior Citizens

Dean, P. M., Feldman, D. M., Morere, D., Morton, D. — Tue, 27 Oct 2009 01:36:32 PDT

The Mini-Mental State Exam (MMSE) is commonly used to screen cognitive function in a clinical setting. The measure has been published in over 50 languages; however, the validity and reliability of the MMSE has yet to be assessed with the culturally Deaf elderly population. Participants consisted of 117 Deaf senior citizens, aged 55–89 (M = 69.44, SD = 8.55). Demographic information, including state of residence, age, and history of depression, head injury, and dementia diagnoses, were collected. A standard form of the MMSE was used with modification of test administration and stimuli including translation of English test items into a sign-based form and alteration of two items in order to make them culturally and linguistically appropriate. Significant correlations were observed between overall test score and education level (r = .23, p = .01) as well as test score and age (r = –.33, p < .001). Patterns of responses were analyzed and revealed several items that were problematic and yielded a fewer correct responses. These results indicate that clinicians need to be aware of cultural and linguistic factors associated with the deaf population that may impact test performance and clinical interpretation of test results. On the basis of these data, there is an increased risk of false positives obtained when using this measure. Further research is needed to validate the use of this measure with the culturally Deaf population.

Developing a Spatial Analogue of the Reliable Digit Span

Ylioja, S. G., Baird, A. D., Podell, K. — Fri, 23 Oct 2009 01:04:34 PDT

It is recommended that performance validity be assessed in all neuropsychological cases involving external incentive. The present study sought to develop an embedded performance validity measure based on the Spatial Span task of the Wechsler Memory Scale-III in a sample of litigating persistent postconcussion complainants. The Reliable Spatial Span (RSS) calculation had specificity, sensitivity, and predictive power values within the range of other embedded measures. This finding suggests that RSS is able to distinguish between persistent postconcussion complainants demonstrating valid and invalid performance. Other calculations involving Spatial Span scores had lower classification accuracy. Reliable Digit Span (RDS) classification accuracy within the present sample was lower than that of previous research, as well as of RSS. Potential reasons for lack of RDS replication are discussed, along with the potential use of RSS as an embedded validity performance indicator.

Intellectual Deficits in Children with ADHD Beyond Central Executive and Non-Executive Functions

Tillman, C. M., Bohlin, G., Sorensen, L., Lundervold, A. J. — Tue, 13 Oct 2009 03:18:17 PDT

This study aimed to specify the deficit in intellectual ability in children with attention deficit hyperactivity disorder (ADHD), by studying the mediating role of impairments in central executive function (EF)-related components (working memory, inhibition, sustained attention) and non-EFs (short-term memory and processing speed). Two hundred and thirty children aged 8–11 years from a population-based sample were assigned to either the ADHD group, the clinical comparison group, or the normal comparison group. The results showed that children with ADHD had poorer fluid and crystallized intelligence, relative to both comparison groups. Further, regarding fluid intelligence, these deficits were not fully mediated by, but rather went beyond, poorer functioning on the studied EF-related components and non-EFs. We tentatively interpret these fluid deficits in children with ADHD as representing deficiencies in a general intellectual resource reflecting executive attentional processes. Concerning crystallized ability, in contrast, the deficit signified impairment in the studied cognitive functions, as indicated by the significant full mediation effect.

Cognitive Aging in Patients with Multiple Sclerosis: A Cross-Sectional Analysis of Speeded Processing

Bodling, A. M., Denney, D. R., Lynch, S. G. — Fri, 09 Oct 2009 21:37:22 PDT

Studies have identified generalized slowing in information processing speed as the primary cognitive deficit in multiple sclerosis (MS). Similar changes are also commonly observed in healthy cognitive aging. The present study is the first to examine the combined impact of aging and disease on the course of cognitive slowing. MS patients (N = 245) and healthy controls (N = 188) were assessed using two measures of processing speed (the preliminary word reading and color naming trials of the Stroop). Participants ranging in age from 18 to 74 were grouped into five age cohorts. Slowing in processing speed was evident for patients vs. controls and for older vs. younger cohorts. The age-related declines in performance were parallel for patients and controls, indicating that the disease process in MS does not interact with general cognitive aging to effect a more rapid decline in functioning.

High Specificity of the Medical Symptom Validity Test in Patients with Very Severe Memory Impairment

Singhal, A., Green, P., Ashaye, K., Shankar, K., Gill, D. — Fri, 09 Oct 2009 21:37:21 PDT

Failure on effort tests usually implies insufficient effort to produce valid cognitive test scores. However, many people with very severe cognitive impairment, such as dementia patients, will produce failing scores on nearly all effort tests. In such patients, effort tests have low specificity. The Medical Symptom Validity Test (MSVT) and the nonverbal MSVT (NV-MSVT) were designed to address this problem. They produce profiles of scores across multiple subtests to facilitate discrimination between low scores from people trying to feign impairment and low scores attributable to severe impairment. To study the specificity of the MSVT and NV-MSVT in people with very severe memory impairment, we tested (a) 10 institutionalized patients with dementia and (b) 10 volunteers who were asked to simulate memory impairment. It was hypothesized that the "possible dementia profile" would be found significantly more often in the dementia patients than in the simulators. The MSVT and the NV-MSVT both displayed 100% specificity in the dementia group, while retaining a combined sensitivity of 80% to suboptimal effort in the simulator group.