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• Performance of Non-neurological Older Adults on the Wisconsin Card Sorting Test and the Stroop Color-Word Test: Normal Variability or Cognitive Impairment?

  Authors: Jessica H Gunner, Andrea S Miele, Julie K Lynch, Robert J McCaffrey

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(4):398-405.

  There is currently no standard criterion for determining abnormal test scores in neuropsychology; thus, a number of different criteria are commonly used. We investigated base rates of abnormal scoresThere is currently no standard criterion for determining abnormal test scores in neuropsychology; thus, a number of different criteria are commonly used. We investigated base rates of abnormal scores in healthy older adults using raw and T-scores from indices of the Wisconsin Card Sorting Test and Stroop Color-Word Test. Abnormal scores were examined cumulatively at seven cutoffs including >1.0, >1.5, >2.0, >2.5, and >3.0 standard deviations (SD) from the mean as well as those below the10th and 5th percentiles. In addition, the number of abnormal scores at each of the seven cutoffs was also examined. Results showed when considering raw scores, ∼15% of individuals obtained scores >1.0 SD from the mean, around 10% were less than the 10th percentile, and 5% fell >1.5 SD or <5th percentile from the mean. Using T-scores, approximately 15%-20% and 5%-10% of scores were >1.0 and >1.5 SD from the mean, respectively. Roughly 15% and 5% fell at the <10th and <5th percentiles, respectively. Both raw and T-scores >2.0 SD from the mean were infrequent. Although the presence of a single abnormal score at 1.0 and 1.5 SD from the mean or at the 10th and 5th percentiles was not unusual, the presence of ≥2 abnormal scores using any criteria was uncommon. Consideration of base rate data regarding the percentage of healthy individuals scoring in the abnormal range should help avoid classifying normal variability as neuropsychological impairment.

• The Letter Digit Substitution Test: Demographic Influences and Regression-Based Normative Data for School-Aged Children.

  Authors: W Van der Elst, S Dekker, P Hurks, J Jolles

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  The Letter Digit Substitution Test (LDST) was administered to a sample of N = 296 healthy children (aged between 8.03 and 15.87). The aim of the present study was to evaluate the impact of age,The Letter Digit Substitution Test (LDST) was administered to a sample of N = 296 healthy children (aged between 8.03 and 15.87). The aim of the present study was to evaluate the impact of age, gender, and parental educational level on LDST performance and to establish demographically corrected normative data. The results showed that the relationship between age and LDST performance was curvilinear (i.e., improvements in test performance were more pronounced for younger children than for older children) and was moderated by gender (i.e., the gender differences were small at younger ages but increased as a function of age, with girls outperforming boys). Moreover, children who had parents with a higher level of education outperformed their counterparts who had parents with a lower level of education. Regression-based normative LDST data were established, and an automatic scoring program was provided.

• A Bayesian Latent Group Analysis for Detecting Poor Effort in the Assessment of Malingering.

  Authors: Alonso Ortega, Eric-Jan Wagenmakers, Michael D Lee, Hans J Markowitsch, Martina Piefke

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Despite their theoretical appeal, Bayesian methods for the assessment of poor effort and malingering are still rarely used in neuropsychological research and clinical diagnosis. In this article, weDespite their theoretical appeal, Bayesian methods for the assessment of poor effort and malingering are still rarely used in neuropsychological research and clinical diagnosis. In this article, we outline a novel and easy-to-use Bayesian latent group analysis of malingering whose goal is to identify participants displaying poor effort when tested. Our Bayesian approach also quantifies the confidence with which each participant is classified and estimates the base rates of malingering from the observed data. We implement our Bayesian approach and compare its utility in effort assessment to that of the classic below-chance criterion of symptom validity testing (SVT). In two experiments, we evaluate the accuracy of both a Bayesian latent group analysis and the below-chance criterion of SVT in recovering the membership of participants assigned to the malingering group. Experiment 1 uses a simulation research design, whereas Experiment 2 involves the differentiation of patients with a history of stroke from coached malingerers. In both experiments, sensitivity levels are high for the Bayesian method, but low for the below-chance criterion of SVT. Additionally, the Bayesian approach proves to be resistant to possible effects of coaching. We conclude that Bayesian latent group methods complement existing methods in making more informed choices about malingering.

• The Efficiency and Accuracy of The Test of Memory Malingering Trial 1, Errors on the First 10 Items of The Test of Memory Malingering, and Five Embedded Measures in Predicting Invalid Test Performance.

  Authors: John H Denning

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  The current study attempted to improve upon the efficiency and accuracy of one of the most frequently administered measures of test validity, the Test of Memory Malingering (TOMM) by utilizing twoThe current study attempted to improve upon the efficiency and accuracy of one of the most frequently administered measures of test validity, the Test of Memory Malingering (TOMM) by utilizing two short forms (TOMM trial 1 or TOMM1; and errors on the first 10 items of TOMM1 or TOMMe10). In addition, we cross-validated the accuracy of five embedded measures frequently used in malingering research. TOMM1 and TOMMe10 were highly accurate in predicting test validity (area under the curve [AUC] = 92% and 87%, respectively; TOMM1 ≤40 and TOMMe10 ≥1; sensitivities >70% and specificities >90%). A logistic regression of five embedded measures showed better accuracy compared with any individual embedded measure alone or in combination (AUC = 87%). TOMM1 and TOMMe10 provide evidence of greater sensitivity to invalid test performance compared with the standard TOMM administration and the use of regression improved the accuracy of the five embedded cognitive measures.

• Criterion Validity of the Neuropsychological Assessment Battery after Traumatic Brain Injury.

  Authors: Jacobus Donders, Terry Levitt

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  The performance of 54 patients with complicated mild-severe traumatic brain injury (TBI) was evaluated on the Attention, Executive Functions, and Memory modules of the Neuropsychological AssessmentThe performance of 54 patients with complicated mild-severe traumatic brain injury (TBI) was evaluated on the Attention, Executive Functions, and Memory modules of the Neuropsychological Assessment Battery (NAB) and compared with that of 54 demographically matched healthy controls. All three NAB indices demonstrated statistically significant group differences and negative covariances with the duration of coma, with large effect sizes. The Numbers and Letters and Mazes subtests had the most consistent evidence for sensitivity to brain injury. The findings provide preliminary support for the criterion validity of the NAB in the assessment of patients with complicated mild-severe TBI.

• Neurocognitive Correlates of the Trail Making Test for Older Children in Patients with Traumatic Brain Injury.

  Authors: Nicholas S Thaler, Daniel N Allen, Jacqueline S Hart, James R Boucher, Janice C McMurray, Joan Mayfield

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Studies have found that processing speed and working memory influence performance on the Trail Making Test (TMT), though little research is available in this regard for the TMT for Children (TMT-C),Studies have found that processing speed and working memory influence performance on the Trail Making Test (TMT), though little research is available in this regard for the TMT for Children (TMT-C), particularly in clinical populations. The purpose of the present study was to examine cognitive mechanisms that are thought to underline performance on the TMT-C in a sample of children who sustained traumatic brain injury. Sixty-one children and adolescents with moderate to severe brain injuries completed the TMT-C and performed a battery of neuropsychological tests. Regression analysis was used to analyze the relationship between cognitive constructs and TMT-C performance. Results indicated that processing speed predicted Trails A performance while backwards span tasks predicted Trails B performance. These findings corroborate with previous studies and provide evidence of the mechanisms that underlie TMT-C performance in brain injured children.

• Variability in Wechsler Adult Intelligence Scale-IV Subtest Performance Across Age.

  Authors: Nick M Wisdom, Joseph Mignogna, Robert L Collins

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Normal Wechsler Adult Intelligence Scale (WAIS)-IV performance relative to average normative scores alone can be an oversimplification as this fails to recognize disparate subtest heterogeneity thatNormal Wechsler Adult Intelligence Scale (WAIS)-IV performance relative to average normative scores alone can be an oversimplification as this fails to recognize disparate subtest heterogeneity that occurs with increasing age. The purpose of the present study is to characterize the patterns of raw score change and associated variability on WAIS-IV subtests across age groupings. Raw WAIS-IV subtest means and standard deviations for each age group were tabulated from the WAIS-IV normative manual along with the coefficient of variation (CV), a measure of score dispersion calculated by dividing the standard deviation by the mean and multiplying by 100. The CV further informs the magnitude of variability represented by each standard deviation. Raw mean scores predictably decreased across age groups. Increased variability was noted in Perceptual Reasoning and Processing Speed Index subtests, as Block Design, Matrix Reasoning, Picture Completion, Symbol Search, and Coding had CV percentage increases ranging from 56% to 98%. In contrast, Working Memory and Verbal Comprehension subtests were more homogeneous with Digit Span, Comprehension, Information, and Similarities percentage of the mean increases ranging from 32% to 43%. Little change in the CV was noted on Cancellation, Arithmetic, Letter/Number Sequencing, Figure Weights, Visual Puzzles, and Vocabulary subtests (<14%). A thorough understanding of age-related subtest variability will help to identify test limitations as well as further our understanding of cognitive domains which remain relatively steady versus those which steadily decline.

• Stress Management and Multiple Sclerosis: A Randomized Controlled Trial.

  Authors: Artemios K Artemiadis, Angeliki A Vervainioti, Evangelos C Alexopoulos, Antonis Rombos, Maria C Anagnostouli, Christina Darviri

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  There is a well-established adverse reciprocal relationship between stress and multiple sclerosis (MS). However, stress management in these patients has been parsimoniously studied. In this parallelThere is a well-established adverse reciprocal relationship between stress and multiple sclerosis (MS). However, stress management in these patients has been parsimoniously studied. In this parallel randomized controlled trial, relapsing-remitting MS patients were randomly assigned to undergo either an 8-week stress management program (n = 31; relaxation breathing and progressive muscle relaxation, twice a day) or not (n = 30). Self-reported validated measures were used to evaluate perceived stress, health locus of control, anxiety, and depression. Daily diaries of MS symptoms were also kept by patients. In patients in the intervention group, perceived stress and symptoms of depression were significantly decreased after 8 weeks of relaxation. Repeated measures analyses showed significant group-by-time interactions for both the number of weekly symptoms and the mean intensity per symptom. No other significant change was reported. We deem that our results should encourage future studies that will incorporate more objective clinical and laboratory outcomes.

• Assessment of Acute Concussion in the Combat Environment.

  Authors: Mark P Kelly, Rodney L Coldren, Robert V Parish, Michael N Dretsch, Michael L Russell

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Despite the prevalence of concussion in soldiers deployed to Iraq and Afghanistan, neuropsychological tests used to assist in concussion management have not been validated on the battlefield. ThisDespite the prevalence of concussion in soldiers deployed to Iraq and Afghanistan, neuropsychological tests used to assist in concussion management have not been validated on the battlefield. This study evaluated the validity of the Automated Neuropsychological Assessment Metrics (ANAM) in the combat environment. Cases meeting criteria for concussion, healthy controls, and injured controls were assessed. Soldiers were administered the ANAM, traditional neuropsychological tests, and a background questionnaire. Cases were enrolled within 72 h of concussion. Cases exhibited poorer performance than controls on all ANAM subtests, with significant differences on simple reaction time (SRT), procedural reaction time (PRT), code substitution, and matching to sample (p < .001). Discriminant ability of scores on SRT and PRT subtests was 71%, which improved to 76% when pre-deployment baseline scores were available. An exploratory clinical decision tool incorporating ANAM scores and symptoms improved discriminant ability to 81%. Results provide initial validation of the ANAM for detecting acute effects of battlefield concussion.

• Cortisol and Self-report Measures of Anxiety as Predictors of Neuropsychological Performance.

  Authors: Shelley Leininger, Reid Skeel

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Although increased anxiety and cortisol reactivity can disrupt neural activity and impact cognition, little research has evaluated associations between anxiety, cortisol, and performance onAlthough increased anxiety and cortisol reactivity can disrupt neural activity and impact cognition, little research has evaluated associations between anxiety, cortisol, and performance on neuropsychological instruments. The current study investigated the relationship between exogenous salivary cortisol activity and self-report state anxiety on measures tapping a variety of cognitive domains. Fifty-eight male participants were randomly assigned to either a control (no stress induction) or an experimental condition simulating testing anxiety. Self-report state anxiety measures and saliva samples were jointly collected on three occasions. The experimental group generally performed worse than controls on declarative memory and working memory tests. Cortisol and self-report anxiety were not correlated. Inverse relationships were demonstrated between self-report anxiety and neuropsychological test scores. Baseline levels of cortisol at session arrival were positively associated with facilitative memory effects, though there was little association between changes in cortisol and cognitive performance. This study highlights the importance of considering the impact of anxiety during neuropsychological evaluations.

• Differential Impairment of Source Memory in Progressive Versus Non-progressive Behavioral Variant Frontotemporal Dementia.

  Authors: Muireann Irish, Andrew Graham, Kim S Graham, John R Hodges, Michael Hornberger

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Episodic memory has recently been shown to be impaired in the behavioral variant of frontotemporal dementia (bvFTD) when so-called non-progressive cases are excluded. Such non-progressive casesEpisodic memory has recently been shown to be impaired in the behavioral variant of frontotemporal dementia (bvFTD) when so-called non-progressive cases are excluded. Such non-progressive cases present with the behavioral features of bvFTD, but show no evidence of cognitive decline over time. To date, evidence regarding episodic memory performance in bvFTD subgroups on more stringent tasks is lacking. We investigated temporal and spatial source memory in progressive (n = 7) versus non-progressive (n = 12) bvFTD. BvFTD cases were retrospectively classified based on general cognitive decline on the Addenbrooke's Cognitive Examination Revised, and the presence of atrophy on structural neuroimaging, over 3 years following diagnosis. Progressors showed impaired temporal and spatial source retrieval. Non-progressors displayed temporal source deficits only. These differential source memory profiles point to the variability of episodic memory performance in bvFTD, and underscore the importance of differential diagnosis of bvFTD subgroups using longitudinal and neuroimaging data.

• The Neuropsychological Profile of Children, Adolescents, and Young Adults with Anorexia Nervosa.

  Authors: Kristin Stedal, Mark Rose, Ian Frampton, Nils Inge Landrø, Bryan Lask

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The currentThe neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. The patients displayed good verbal fluency skills, but performed poorly on tests of visuospatial memory, associated with relatively weak central coherence. They were within the average range on the assessment of executive functioning except for one measure of set-shifting. This study provides a valuable point of reference for clinicians when considering treatment options.

• Measuring Effort in Neuropsychological Evaluations of Forensic Cases of Spanish Speakers.

  Authors: Vala Burton, Raquel Vilar-López, Antonio E Puente

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Changing demographics indicate a dramatic growth in Spanish speakers in the USA. There is an increasing need to provide valid neuropsychological evaluations to these individuals as well as interestChanging demographics indicate a dramatic growth in Spanish speakers in the USA. There is an increasing need to provide valid neuropsychological evaluations to these individuals as well as interest in providing the same in Latin American countries. This is especially the case with symptom validity testing, in general, and those involved with litigation in particular. To address this situation, the Dot Counting Test, the Rey 15-Item Test, and the Test of Memory Malingering were administered to clinical controls as well as individuals involved in litigation-forensic non-capital and forensic capital murder cases. The results represent a first step toward the determination of the utility of those tests to address effort in Spanish speakers in the USA.

• Can Executive Cognitive Measures Differentiate Between Patients with Spinal- and Bulbar-Onset Amyotrophic Lateral Sclerosis?

  Authors: Ioannis Zalonis, Foteini Christidi, Georgios Paraskevas, Thomas Zabelis, Ioannis Evdokimidis, Evangelia Kararizou

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Although executive functions in sporadic non-demented amyotrophic lateral sclerosis (ALS) patients are mostly affected, it remains unclear whether executive measures can differentiate betweenAlthough executive functions in sporadic non-demented amyotrophic lateral sclerosis (ALS) patients are mostly affected, it remains unclear whether executive measures can differentiate between patients with bulbar and spinal ALS forms. Thirty spinal and 18 bulbar-onset ALS patients (ALS-s and ALS-b, respectively) as well as 47 demographically related healthy controls were examined in executive processes (Trail Making Test-part B [TMT-(B-A)]; Stroop Neuropsychological Screening Test [SNST]; Similarities subtest of the Wechsler Adult Intelligence Scale [WAIS Similarities]; Wisconsin Card Sorting Test [WCST]). ALS subgroups were similar with regard to demographic characteristics and disease duration; yet, ALS-b showed greater disease severity compared with ALS-s patients (p = .006). Both ALS-s and ALS-b patients were significantly inferior to healthy controls on TMT-(B-A) (p < .001), SNST (p = .009 and p = .02, respectively) and WAIS Similarities (p = .031 and p = .021, respectively), whereas ALS-s performed significantly worse than controls on the WCST perseverative responses (p = .005). However, neuropsychological measures did not significantly differ between ALS subgroups (p > .05). Despite the fact that ALS-b patients may present greater disease severity, specific executive impairments that are present early in the course of ALS seems to be independent of the site of onset.

• Psychosocial Subtypes on the Behavior Assessment System for Children, Second Edition Following Pediatric Traumatic Brain Injury.

  Authors: Jonelle Ensign, Denise E Maricle, Carmen Brown, Joan W Mayfield

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  This study identified the subtypes of psychosocial functioning in children who had sustained traumatic brain injury using the Behavior Assessment System for Children, Second Edition. Participants (NThis study identified the subtypes of psychosocial functioning in children who had sustained traumatic brain injury using the Behavior Assessment System for Children, Second Edition. Participants (N = 91) were aged 6-20. Using hierarchical agglomerative clustering techniques, a reliable typology emerged that consisted of two subtypes, which were labeled as Normal and Pervasive Emotional Difficulties. Using further exploratory analyses, other less statistically reliable subtypes were also observed, which were thought to have clinical significance. These were labeled as Mild Externalizing/Depression, Mild Externalizing/Attention Problems, Mild Depression, and Mild Anxiety. The majority of participants were assigned to the Normal subtype. Relationships between subtypes and other variables, including gender, time elapsed since injury, age at injury, and age at testing were also analyzed, with time elapsed since injury being the only variable to significantly differentiate the subtypes.

• Evidence-Based Indicators of Neuropsychological Change in the Individual Patient: Relevant Concepts and Methods.

  Authors: Kevin Duff

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms)Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms) and methods (e.g., reliable change index, standardized based regression) that are used in repeated neuropsychological evaluations. The focus will be on the understanding and application of these concepts and methods in the evaluation of the individual patient through examples. Finally, some future directions for assessing change will be described.

• Cognitive Disturbances and Neuropsychological Changes after Surgical Treatment in a Cohort of 185 Patients with Idiopathic Normal Pressure Hydrocephalus.

  Authors: Elisabeth Solana, Juan Sahuquillo, Carme Junqué, Manuel Quintana, Maria A Poca

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

  Although idiopathic normal pressure hydrocephalus (iNPH) is considered a treatable dementia, there is still some controversy regarding the cognitive improvement in these patients. The main aims ofAlthough idiopathic normal pressure hydrocephalus (iNPH) is considered a treatable dementia, there is still some controversy regarding the cognitive improvement in these patients. The main aims of this study were to analyze baseline cognitive status and to study the neuropsychological changes after surgical treatment in a sample of 185 consecutive iNPH patients. An additional aim was to identify the variables that influenced the cognitive outcome. Specific tests assessing memory, attention, visual scanning, executive functions (EFs), and motor speed were used before and 6 months after shunting. The cognitive domains most affected at baseline were memory, EFs, attention, and psychomotor speed. After shunting, significant differences in the group as a whole were found in all tests except Digits Forward and Trail Making Part B. However, less than 50% of patients showed a significant improvement when analyzed individually. Previous global cognitive status assessed by Mini-Mental State Examination baseline scores was the best predictor for the cognitive outcome.

• The repeatable battery for the assessment of neuropsychological status effort scale.

  Authors: Julia Novitski, Shelly Steele, Stella Karantzoulis, Christopher Randolph

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):190-5.

  The measurement of effort is now considered to be an important component of neuropsychological assessment. In addition to stand-alone measures, built-in, or embedded measures of effort have beenThe measurement of effort is now considered to be an important component of neuropsychological assessment. In addition to stand-alone measures, built-in, or embedded measures of effort have been derived for a limited number of standard neurocognitive tests. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used brief battery, employed as a core diagnostic tool in dementia and as a neurocognitive screening battery or tracking/outcome measure in a variety of other disorders. An effort index (EI) for the RBANS has been published previously (Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. 2007. An EI for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Clinical Neuropsychology, 21 (5), 841-854), but it has been reported to result in high false positive rates when applied to patients with "true" amnesia (e.g., Alzheimer's disease). We created a new effort scale (ES) for the RBANS based on the observation of patterns of free recall and recognition performance in amnesia versus inadequate effort. The RBANS ES was validated on a sample of patients with amnestic disorders and a sample of mild traumatic brain injury participants who failed a separate measure of effort. The sensitivity and specificity of the new ES was compared with the previously published EI. Receiver-operating characteristic analyses demonstrated much better sensitivity and specificity of the ES, with a marked reduction in false positive errors. Application and limitations of the RBANS ES, including indications for its use, are discussed.

• Detection of suboptimal effort with symbol span: development of a new embedded index.

  Authors: J Christopher Young, Joshua E Caron, Brandon C Baughman, R John Sawyer

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):159-64.

  Developing embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning. The current study exploredDeveloping embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning. The current study explored whether Symbol Span, a novel Wechsler Memory Scale-fourth edition measure of supraspan visual attention, could be used to discriminate adequate effort from suboptimal effort. Archival data were collected from 136 veterans classified into Poor Effort (n = 42) and Good Effort (n = 94) groups based on symptom validity test (SVT) performance. The Poor Effort group had significantly lower raw scores (p < .001) and age-corrected scaled scores (p < .001) than the Good Effort group on the Symbol Span test. A raw score cutoff of <14 produced 83% specificity and 50% sensitivity for detection of Poor Effort. Similarly, sensitivity was 52% and specificity was 84% when employing a cutoff of <7 for Age-Corrected Scale Score. Collectively, present results suggest that Symbol Span can effectively differentiate veterans with multiple failures on established free-standing and embedded SVTs.

• Montreal cognitive assessment: influence of sociodemographic and health variables.

  Authors: Sandra Freitas, Mário R Simões, Lara Alves, Isabel Santana

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):165-75.

  The Montreal Cognitive Assessment (MoCA) is a brief cognitive instrument for screening milder forms of cognitive impairment. The present study aimed to analyze the influence of sociodemographic (age,The Montreal Cognitive Assessment (MoCA) is a brief cognitive instrument for screening milder forms of cognitive impairment. The present study aimed to analyze the influence of sociodemographic (age, gender, educational level, marital and employment status, geographic region, geographic localization, and residence area) and health variables (subjective memory complaints of the participant and evaluated by the informant, depressive symptoms, and family history of dementia) on the participants' performance on the MoCA. The investigation was carried out in a Portuguese community-based sample of 650 cognitively healthy adults, who were representative of the distribution observed in the Portuguese population. Educational level and age significantly contributed to the prediction of the MoCA scores, explaining 49% of the variance. Regarding health variables, only the subjective memory complaints of the participant showed a small contribution (9%) to the variance on the MoCA scores. This study contributes a useful approach to understanding MoCA performance, stressing the great impact of education and age on scores.

• Factor analysis of nineteen executive function tests in a healthy adult population.

  Authors: Renee Testa, Pauleen Bennett, Jennie Ponsford

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):213-24.

  Although there has been some progress in identifying the range of skills that comprise the executive neurocognitive system, their assessment has proved to be a challenge. Operationalization ofAlthough there has been some progress in identifying the range of skills that comprise the executive neurocognitive system, their assessment has proved to be a challenge. Operationalization of executive functions (EFs) may be progressed by identifying the cognitive constructs that underlie EF test performance via principal components analysis. The underlying factor structure of 19 EF tests was examined in a non-clinical sample of 200 adults (mean age = 30.8 [18-64] years); the sample comprised 97 men. Findings revealed only weak correlations between various measures derived from the EF tests. Exploratory factor analysis revealed a model comprising six independent factors, consistent with previous reports, describing the functions of the EF system. The factors comprised: Prospective Working Memory, Set-Shifting and Interference Management, Task Analysis, Response Inhibition, Strategy Generation and Regulation, and Self-Monitoring and Set-Maintenance. Results confirm the diverse and heterogeneous nature of EFs and caution against conceptualizations that underestimate its complexity. Furthermore, variability within the "normal" executive system is evident, and further research is required to understand executive functioning in healthy populations.

• Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder.

  Authors: Yu-Kai Chang, Suyen Liu, Hui-Hsiang Yu, Yuan-Hung Lee

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):225-37.

  This study was conducted to determine the effect of acute aerobic exercise on executive function in children with attention deficit hyperactivity disorder (ADHD). Forty children with ADHD wereThis study was conducted to determine the effect of acute aerobic exercise on executive function in children with attention deficit hyperactivity disorder (ADHD). Forty children with ADHD were randomly assigned into exercise or control groups. Participants in the exercise group performed a moderate intensity aerobic exercise for 30 min, whereas the control group watched a running/exercise-related video. Neuropsychological tasks, the Stroop Test and the Wisconsin Card Sorting Test (WCST), were assessed before and after each treatment. The results indicated that acute exercise facilitated performance in the Stroop Test, particularly in the Stroop Color-Word condition. Additionally, children in the exercise group demonstrated improvement in specific WCST performances in Non-perseverative Errors and Categories Completed, whereas no influences were found in those performances in the control group. Tentative explanations for the exercise effect postulate that exercise allocates attention resources, influences the dorsolateral prefrontal cortex, and is implicated in exercise-induced dopamine release. These findings are promising and additional investigations to explore the efficacy of exercise on executive function in children with ADHD are encouraged.

• Do you know what I mean? Laypeople and experts' concepts of cognition.

  Authors: Linda A Schoo, Esther van den Berg, Martine J E van Zandvoort, Albert Postma

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):182-9.

  Patients' cognitive complaints and subsequent performance on neuropsychological tests often fail to relate. This could, in part, be caused by a Babylonic incongruence between laypeople's and experts'Patients' cognitive complaints and subsequent performance on neuropsychological tests often fail to relate. This could, in part, be caused by a Babylonic incongruence between laypeople's and experts' use of cognition words or "jargon." The present study examined the concurrency of experts and laypeople for 18 neuropsychological tests in the cognitive domains "language," "memory," "attention/concentration," "perception," and "thinking" (executive functioning). This was done by correlating the classifications of the laypeople and experts for individual tests and within each domain. A high domain concurrency was found, indicated by domain correlations of the classifications between laypeople and experts ranging from r(s)=.79 to .92, with exception of the domain "attention" (r(s)=.32). Importantly, with respect to the classification of each individual test in a cognitive domain, large variations in correlations were found, ranging from r(s)=.30 up to r(s)=1.0. These results indicate that there is agreement between the concepts laypeople use and the theory-based concepts of the experts. Our study also offers valuable insight for the clinical practice: tests with a high correlation should be used to aid the clarity of communication in the clinical practice, for instance when giving feedback on performance.

• The use of all three test of memory malingering trials in establishing the level of effort.

  Authors: Nick M Wisdom, Whitney L Brown, David K Chen, Robert L Collins

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):208-12.

  Assessment of the effort level is an essential step in establishing the internal validity of any neuropsychological evaluation. The use of response bias measures as part of a core battery, however,Assessment of the effort level is an essential step in establishing the internal validity of any neuropsychological evaluation. The use of response bias measures as part of a core battery, however, is less common outside of forensic evaluations. The amount of time needed to administer many of these tests is often cited as a likely explanation for their exclusion from routine neuropsychological evaluations. This study examined all three trials of the Test of Memory Malingering (TOMM) in a large sample (n = 213) of inpatients on an epilepsy monitoring unit with the goal of establishing cut scores for early termination. TOMM Trial 1 demonstrated impressive diagnostic accuracy for determining both adequate and suboptimal levels of effort; various cut scores and classification statistics are presented. The optional Retention trial from the TOMM also increased the hit rate 16% in the detection of poor effort. Clinical implications, limitations, and directions for further research are discussed.

• Exploration of malingering indices in the wechsler adult intelligence scale-fourth edition digit span subtest.

  Authors: Caitlin S Reese, Julie A Suhr, Tara L Riddle

  Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 27(2):176-81.

  Prior research shows that Digit Span is a useful embedded measure of malingering. However, the Wechsler Adult Intelligence Scale-IV (Wechsler, 2008) altered Digit Span in meaningful ways,Prior research shows that Digit Span is a useful embedded measure of malingering. However, the Wechsler Adult Intelligence Scale-IV (Wechsler, 2008) altered Digit Span in meaningful ways, necessitating another look at Digit Span as an embedded measure of malingering. Using a simulated malingerer design, we examined the predictive accuracy of existing Digit Span validity indices and explored whether patterns of performance utilizing the new version would provide additional evidence for malingering. Undergraduates with a history of mild head injury performed with best effort or simulated impaired cognition and were also compared with a large sample of non-head-injured controls. Previously established cutoffs for the age-corrected scaled score and Reliable Digit Span (RDS) performed similarly in the present samples. Patterns of RDS length using all three subscales of the new scale were different in malingerers when compared with both head-injured and non-head-injured controls. Two potential alternative RDS scores were introduced, which showed better sensitivity than the traditional RDS, while retaining specificity to malingering.

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