The Fake Bad Scale (FBS [Psychol. Rep. 68 (1991) 203]) was created from MMPI-2 items to assess faking of physical complaints among personal injury claimants. Little psychometric information is available on the measure. This study was conducted to investigate the psychometric characteristics of the FBS using MMPI-2 profiles from six settings: Psychiatric Inpatient (N=6731); Correctional Facility (N=2897); Chronic Pain Program (N=4408); General Medical (N=5080); Veteran's Administration Hospital Inpatient (N=901); and Personal Injury Litigation (N=157). Most correlations of the FBS and raw scores on the MMPI-2 were positive with correlations among the validity scales being lower than correlations among the clinical and content scales. The FBS was most strongly correlated with raw scores on Hs, D, Hy, HEA, and DEP. When the more conservative cutoff of 26 was used, the FBS classified 2.4-30.6% of individuals as malingerers. The highest malingering classification was for the women's personal injury sample (37.9%) while the lowest was among male prison inmates (2.3%). Compared to men, in most samples, almost twice as many women were classified as malingerers. The results indicate that the FBS is more likely to measure general maladjustment and somatic complaints rather than malingering. The rate of false positives produced by the scale is unacceptably high, especially in psychiatric settings. The scale is likely to classify an unacceptably large number of individuals who are experiencing genuine psychological distress as malingerers. It is recommended that the FBS not be used in clinical settings nor should it be used during disability evaluations to determine malingering.
Executive function, known to be impaired during late-life depression, is dependent on frontostriatal pathways. Memory is also frequently observed to be impaired among late-life depressed patients, so we assessed the possibility that executive function mediates the learning and recall deficit as a "downstream" effect of the frontostriatal compromise in executive function. A cross-sectional sample of minor and major depressed patients (N = 95) and nondepressed volunteers (N = 71), screened for other Axis I disorders, dementia, medical comorbidity and severity of depression, completed a neuropsychological battery that included the California Verbal Learning Test (CVLT) and other tests selected for convergent and divergent validity testing. Depressed patients differed from controls on learning the word list and on related and unrelated executive tasks. Executive function was a mediator for depressed patients verbal learning scores (z = -2.67, p = .01). A nonverbal executive score also mediated verbal learning (z = -2.18, p = .03) indicating convergent validity of executive dysfunction during verbal learning exercises. In conclusion, the verbal memory deficits typically attributed to late-life depression may result from impaired executive functioning during the learning phase of the recall task.
The reliable change index (RCI) expresses change relative to its associated error, and is useful in the identification of
post-operative cognitive dysfunction (POCD). This paper examines four common RCIs that each account for error in different
ways. Three rules incorporate a constant correction for practice effects and are contrasted with the standard RCI that had
no correction for practice. These rules are applied to 160 patients undergoing coronary artery bypass graft (CABG) surgery
who completed neuropsychological assessments preoperatively and 1 week post-operatively using error and reliability data from
a comparable healthy non-surgical control group. The rules all identify POCD in a similar proportion of patients, but the
use of the within subject standard deviation, expressing the effects of random error, as an error estimate is a theoretically
appropriate denominator when a constant error correction, removing the effects of systematic error, is deducted from the numerator
in a RCI.
The Wechsler Intelligence Scale for Children, Third Edition (WISC-III) was factor analyzed at ages 6 12 through 16 12 years of age (n = 200 per age group). The study replicated analyses conducted by Kaufman (1975) with the WISC-R using comparable subtests across the two scales. As in the WISC-R study, a three-factor structure emerged as consistent across the age range of the WISC-III: Verbal Comprehension, Perceptual Organization, and Freedom from Distractibility. The results of the study are discussed in terms of their clinical utility with useful statistics for the interpretation of the WISC-III presented.
Tests of possible malingering are in increasing demand among neuropsychologists. The Test of Memory Malingering (TOMM) is resistant to many neurological conditions, including traumatic brain injury, dementia, and aphasia. Less clear is the impact of psychological conditions on TOMM performance. This study examined a sample of community-based older adults (55-75) to determine whether scores on the TOMM are influenced by the presence of symptoms of depression or anxiety, as measured by the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), respectively. The results indicate that, regardless of BDI or STAI scores, all subjects scored above 45 correct out of 50 on TOMM Trial 2. These findings demonstrate that depression and anxiety levels in an older community-dwelling sample do not negatively affect performance on the TOMM.
The Oklahoma Premorbid Intelligence Estimate-3 (OPIE-3) combines Wechsler Adult Intelligence Scale-3rd edition (WAIS-III)
subtest raw scores (vocabulary, information, matrix reasoning, and picture completion) and demographic data (i.e., age, education,
gender, ethnicity, and region) to predict FSIQ scores. Differences between OPIE-3 estimated FSIQ scores and actual FSIQ scores
were compared across 13 age groups in a random sample (N=1201) of the WAIS-III standardization sample. There were mean differences in estimated FSIQ between age groups (P<.01). There was a trend that the OPIE-3 algorithms underestimated FSIQ for individuals 16–17 (2.7 points) and 80–89 years
old (3.5 points). However, the differences in estimation errors were small and the percentage of individuals misclassified
by more than 10 FSIQ points by age group was similar across groups. The OPIE-3(2ST), OPIE-3MR, and OPIE-3VOC yielded robust
estimates of FSIQ across age groups in a neurologically intact sample. Limitations, particularly with individuals aged 16–17
and 85–89 years, are discussed.
The neuropsychological reference groups reported in this study are based on a sample of 1,325 learning-disabled subjects aged 9 through 14 drawn from a midsize midwestern metropolitan community. The sample was composed of 1,006 males and 319 females. Separate means and standard deviations, reported for each gender and age group, were generated for 31 measures ordinarily included as part of the Halstead Neuropsychological Test Battery for Children. Several comparisons were made with other norms previously reported. The need for additional neuropsychological reference groups for children is discussed.
The diagnostic utility of a test is relative to the base rate of the diagnosis in the population of interest. The extensive use of tests in neuropsychological assessment makes knowledge of the relevance of base rates in this context an important issue. Professional and associate members of the National Academy of Neuropsychology (NAN; n=279) answered questions involving (1) a simple use of base rates in the absence of additional diagnostic information, (2) sensitivity and specificity, and (3) positive predictive value (PPV) presented in either a probability or frequency format. Although the majority of participants answered correctly the simple base rate, sensitivity, and specificity questions, only 8.6% answered correctly the PPV question presented in a probability format versus 63.0% correct using a frequency format. These results are discussed in terms of education about the importance and application of base rate information and difficulties applying base rate information in practice.
The utility of various measures of malingering was evaluated using an analog design in which half the participants (composed of three groups: naive healthy people, professionals working with head-injured people, individuals who suffered a head injury but not currently in litigation) were asked to try their best and the remainder was asked to feign believable injury. Participants were assessed with the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT) on three separate occasions in order to determine whether repeat administration of tests improves prediction. The results indicated that regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering.
Within a norm sample of 1,500 men and women, 17–94 years of age (13 age groupings), using Multivariate Analysis of Variance
and Covariance, it was found that four measures designed to indicate fluid reasoning (Gf) and the composite measure of Gf
declined steadily over the entire adulthood period, the decline accelerating during the period beginning at about age 55 years.
Also, four measures of crystallized knowledge (Gc) and the composite measure of Gc increased through the 20s, neither increased
nor decreased through mid-adulthood until about age 60 years, and declined thereafter. For the composite measures of Gf and
Gc, there were no main effects or interaction effects associated with Gender. When educational attainment was covaried, small
but statistically significant Gender main effects were found for four of the subtest measures of Gf and Gc; significant Gender
× Age interaction effects were found for two subtests. Interpreted within Gf-Gc theory, the results replicate and extend evidence
of the adulthood development of cognitive capabilities.
Reports base rate data for 50 controls and 170 personal injury claimants' self-reported symptoms associated with neuropsychological
impairment. These base rates were obtained from claimants with no history of brain injury or toxic exposure and no documented
neuropsychological impairments. Personal injury claimants reported high rates of complaints generally recognized as being
associated with neuropsychological impairment. For example, 93% reported anxiety or nervousness, 92% sleeping problems, 89%
depression, 88% headaches, 79% fatigue, 78% concentration problems, 77% irritability, 65% impatience, 61% feeling disorganized,
59% confusion, 56% loss of efficiency with everyday tasks, 53% memory problems, 44% dizziness, 39% numbness, and 34% word
finding problems. These results underscore the need for caution when relying, on self-reported symptoms as evidence of brain
damage in patients involved in litigation.
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 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.
Normative data for the Trail Making Test (TMT) A and B are presented for 911 community-dwelling individuals aged 18–89 years.
Performance on the TMT decreased with increasing age and lower levels of education. Based on these results, the norms were
stratified for both age (11 groups) and education (2 levels). The current norms represent a more comprehensive set of norms
than previously available and will increase the ability of neuropsychologists to determine more precisely the degree to which
scores on the TMT reflect impaired performance for varying ages and education.
The ability of the Test of Memory Malingering (TOMM; Tombaugh, 1996) to detect feigned-memory impairment was explored. The
TOMM was administered to three groups: (a) a control group instructed to perform optimally, (b) a symptom-coached group instructed
to feign memory problems after being educated about traumatic brain injury symptomatology, and (c) a test-coached group instructed
to feign memory problems after being educated about test-taking strategies to avoid detection. The recommended cutoff scores
(Tombaugh, 1996) on Trial 2 and the Retention Trial produced overall classification accuracy rates of 96%, with high levels
of sensitivity and specificity. Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached
group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms.
This article reports an investigation into the empirical status of a little understood cognitive factor—tactile-kinesthetic
ability. To this end, a variety of haptic tasks, including three subtests of the Halstead-Reitan Neuropsychological Test Battery
(HRB), were administered to 108 participants, along with established markers commonly employed in contemporary psychometric
investigations. The results suggest that these subtests of the HRB measure cognitive abilities conceptually equivalent to
fluid intelligence. Since these tests reflect efforts to operationalize Halstead's (1947) concept of “biological intelligence,”
the results reported herein allow evaluation of this concept in relation to current models of human intelligence. Previous
studies investigating the nature of abilities assessed by the HRB have reached contradictory conclusions. Present findings
clarify the source of these anomalies.
Substantial changes in our knowledge of the neurologic and cognitive processes underlying memory disorders have occurred between 1970 and 1991. Models of memory stressing consolidation, retrieval, and executive processes have had a positive effect on the way memory disorders are assessed in the clinical setting. The memory tests available today are superior to those used in the 1970s in terms of their sensitivity and selectivity. Similarly, cognitive psychologists have successfully used clinical patients to evaluate the validity of their models derived from normal subjects. It is concluded that cognitive and clinical psychology are not disparate fields; rather, the two have been highly interdependent in a positive manner.
Abstract In 1970, I assessed the status of a “new discipline”, clinical neuropsychology, and optimistically predicted growth and expansion
over the next decades. A current assessment in 1990 indicates that the dramatic increase in the number of clinical neuropsychologists
and in the scope and magnitude of their professional functioning far exceeds my expectations of two decades ago. Further,
there is every indication that clinical neuropsychology will continue to be a challenging, vital, and expanding profession.
A ten-year follow-up survey of clinicians in publicly funded adult psychiatric hospitals throughout the United States was
conducted to assess changes and trends in the practice of clinical neuropsychology. An 85% response rate was achieved. The
survey produced data on the type and number of neuropsychological testing instruments in use, the type of training received
by clinicians performing neuropsychological assessments, the psychiatric patient load and proportion of referrals which involve
neuropsychological questions, the proportion of institutions employing psychologists with primarily neuropsychological duties,
and the perceived efficacy of neuropsychological assessment techniques for discriminating functional from organic disorders.
The findings indicate an increase in the level and variety of training as well as in the number of neuropsychological specialists
in the field. However, levels of staffing appear to remain below service needs. Additional findings indicate the continued
popularity of a small number of neuropsychological test batteries, a marked increase in the variety of testing instruments
in use, and a general sense of trust in the efficacy of neuropsychological assessment techniques. The implications of these
findings for the future of applied human neuropsychology are discussed.
Predictions regarding research and service delivery in human neuropsychology during the 1990s are presented. Issues addressed
include considerations regarding the following: developmental studies of “normal” brain-behavior relationships; simultaneous
measurement of brain activity and behavior; dimensionality of psychometric instruments; statistics and mathematical models;
socioemotional and personality correlates of brain disease; study of “at risk” groups; neuropsychological taxonomies; model
and theory development; comparative neuropsychology; neurochemistry of brain-behavior relationships; impact of non-neurological
diseases; the interface of neuropsychology and psychiatry; applications in social problem areas; cognitive rehabilitation;
and trends in certification and credentialing.
This paper overviews the current status of neuroimaging in neuropsychological outcome in traumatic brain injury (TBI). The pathophysiology of TBI is reviewed and integrated with expected neuroimaging and neuropsychological findings. The integration of clinical and quantitative magnetic resonance (QMR) imaging is the main topic of review, but these findings are integrated with single photon emission computed tomography (SPECT) and magnetoencephalography (MEG). Various clinical caveats are offered for the clinician.
A Rey-Osterrieth Complex Figure Test (ROCFT) equation incorporating copy and recognition was found to be useful in detecting negative response bias in neuropsychological assessments (ROCFT Effort Equation; Lu, P. H., Boone, K. B., Cozolino, L., & Mitchell, C. (2003). Effectiveness of the Rey-Osterrieth Complex Figure Test and the Meyers and Meyers recognition trial in the detection of suspect effort. Clinical Neuropsychologist, 17, 426-440). In the current cross validation of this validity, the credible patient group (n = 146; 124 with equation data) outperformed the noncredible group (n = 157; 115 with equation data) on copy, 3-min recall, total recognition correct and the Effort Equation, but the latter was most effective in classifying subjects. A cut-off of ≤50 maintained specificity of 90% and achieved sensitivity of 80%. Results of the current cross validation provide corroboration that the ROCFT Effort Equation is an effective measure of neurocognitive response bias.
A conference specific to the education and training of clinical neuropsychology was held in 1997, which led to a report published in the Archives of Clinical Neuropsychology (Hannay, J., Bieliauskas, L., Crosson, B., Hammeke, T., Hamsher, K., & Koffler, S. (1998). Proceedings of the Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13, 157-250.). The guidelines produced by this conference have been referred to as the Houston Conference (HC) guidelines. Since that time, there has been considerable discussion, and some disagreement, about whether the HC guidelines produced a positive outcome in the training of neuropsychologists. To explore this question and determine how widely the HC guidelines were implemented, a meeting was held in 2006. Present and past leaders of the American Psychological Association Division 40 (Clinical Neuropsychology), the National Academy of Neuropsychology, and the Association of Postdoctoral Programs in Clinical Neuropsychology met to discuss the possible need for an Inter-Organizational Summit on Education and Training (ISET). A decision was reached to have the ISET Steering Committee conduct a survey of clinical neuropsychologists that could address the extent to which HC guidelines were present in the specialty and whether the influence of the HC guidelines was positive. An online survey was constructed, with data gathered in 2010. The current paper presents and discusses the ISET survey results. Specific findings need to be viewed cautiously due to the relatively low response rate. However, with some direct parallels to a larger recent survey of clinical neuropsychologists, the following general conclusions appear well founded: (a) the demographics of respondents in the ISET survey are comparable with a recent larger professional practice survey and thus may reasonably represent the specialty; (b) the HC guidelines appear to have been widely adopted by training programs, in that a large proportion of younger practitioners endorsed having had HC-adherent training; and (c) HC-adherent training is associated with a higher frequency endorsement of being well prepared to engage in key professional activities subsequent to the completion of training when compared with those not having HC-adherent training. Overall, the ISET Steering Committee has concluded that the HC guidelines have been widely adopted and that trainees associate participation in HC-adherent training as advantageous. A potential revision based on unfavorable outcomes is deemed unnecessary. Nonetheless, the ISET Steering Committee recognizes that training needs change as a function of the broadening of our field and the introduction of related new technologies, which may prompt updates. The ISET Steering Committee supports the idea that periodic review and updating of training models is prudent.
The evaluation of bilingual children is a complicated endeavor because there are various views of how bilingualism affects brain organization and functioning. Added to that is the challenge of determining language development of Hispanic children living in a monolingual Spanish-speaking home in a Spanish-speaking country, but mostly exposed to English language television programming and, in some cases, English language school curriculum. Our case will review the evaluation process of a 14-year-old Puerto Rican boy with previous diagnoses of expressive language disorder and Attention-deficit/Hyperactivity Disorder (ADHD). The neuropsychological evaluation revealed an IQ within the average range, with significant differences between the perceptual reasoning, verbal comprehension, and processing speed. The case will summarize performance in verbal, executive, and psycho-educational measures with a thorough review of his developmental history and the interpretation of these neuropsychological achievement and behavioral measures in light of other variables influencing his difficulties.
Objective: The seminal paper on cerebellar cognitive affective syndrome by Schmahmann and Sherman (1998), and subsequent studies, has expanded our understanding of the role of the cerebellum beyond motor functioning to psychological and cognitive functioning. However, many of these studies have examined patients between 1 week and 5 years post-injury and have tended to exclude patients with prior neurological injuries. Thus, the objective of this case study was to examine cerebellar injury in the context of remote traumatic brain injury (TBI) and describe the long-term cognitive, psychological, and psychosocial sequelae of injury in a 33-year-old, right-handed, Caucasian veteran (S.M.). Method: At age 23, S.M. was referred for neuroimaging by psychiatry due to concern that a TBI from age 16 was the cause of recent onset aggressive behavior. Multiple neuroimaging studies showed no neuroanatomical sequelae of TBI, but revealed a right cerebellar arteriovenous malformation (AVM). Embolization resulted in >50% removal of the AVM, but uncovered an intranidal aneurysm. Repeat neuroimaging revealed a large hemorrhage within the cerebellum with the mass effect and hydrocephalus; subsequent treatment resulted in a complicated 5-month hospital stay. Results: Neuropsychological evaluation conducted 10 years after injury revealed deficits in basic attention, working memory, and information processing speed with relatively intact executive functioning and memory. Physical deficits, including ataxia, dysarthria, and spasticity, and psychological difficulties, including impulsivity and low frustration tolerance, were more prominent and caused significant psychosocial distress, impacting interpersonal relationships. Conclusions: This case highlights the cognitive residual of cerebellar injury and the potential long-term impact on psychological and social functioning.
Objective: Presentation of an unusual case of amnesic syndrome following a suspected AVM. The subject was a 14-year-old female (N) who suffered a large right temporo-parietal intra-parenchymal hemorrhage with extension into the ventricular system requiring surgical evacuation. She presented with a significant anterograde amnesic disorder that was generalized and not circumscribed to the visual domain. A neuropsychological assessment was recommended to investigate the nature and extent of her amnesic symptoms. Two aspects were found to be fundamental in this case, firstly, the inconsistency between the image findings of acute cerebral injury and her general amnesic disorder, and secondly, her capacity to keep up with academic demands despite persisting memory impairment. Method: N was assessed on four occasions over a period of 4 years to monitor her recovery. The initial assessment was comprehensive and covered intellectual functions, attention, processing speed, general memory, and executive functions. The subsequent reviews targeted for the most part the areas of impairment to evaluate the recovery process. Follow-up MRI findings were also reviewed. Results: The initial neuropsychological findings 5-6 weeks post-injury confirmed the presence of a moderate to severe impairment in general memory. Subsequent reviews indicated some gains overall, but she demonstrated persisting mild memory dysfunctions particularly in the area of visual memory. Conclusions: Ns general memory impairment was surprising given her right hemispheric injury. Her profile suggested some probable left hemispheric injury. Ns grades at school indicated that her mild memory impairments were not affecting her ability to keep up academically at a level that was consistent with her intellectual ability. The etiology of her memory impairment as well as the course of recovery over time will discussed.
CNS Vital Signs (CNSVS) is a computerized neurocognitive test battery that was developed as a routine clinical screening instrument. It is comprised of seven tests: verbal and visual memory, finger tapping, symbol digit coding, the Stroop Test, a test of shifting attention and the continuous performance test. Because CNSVS is a battery of well-known neuropsychological tests, one should expect its psychometric properties to resemble those of the conventional tests upon which it is based.
1069 subjects age 7–90 participated in the normative database for CNSVS. Test-retest reliability (TRT) was evaluated in 99 Ss who took the battery on two separate occasions, separated, on the average, by 62 days; the results were comparable to those achieved by equivalent conventional and computerized tests. Concurrent validity studies in 180 subjects, normals and neuropsychiatric patients, indicate correlations that are comparable to the concurrent validity of similar tests. Discriminant validity is supported by studies of patients with mild cognitive impairment and dementia, post-concussion syndrome and severe traumatic brain injury, ADHD (treated and untreated) and depression (treated and untreated). The tests in CNSVS are also sensitive to malingerers and patients with conversion disorders.
The psychometric characteristics of the tests in the CNSVS battery are very similar to the characteristics of the conventional neuropsychological tests upon which they are based. CNSVS is suitable for use as a screening instrument, or as a serial assessment measure. But it is not a substitute for formal neuropsychological testing, it is not diagnostic, and it will have only a limited role in the medical setting, absent the active participation of consulting neuropsychologists.
Educational attainment and gender differences on fluid intelligence (Gf), crystallized intelligence (Gc), and academic skills in reading, math, and writing were analyzed for stratified adult samples ranging in age from 22 to 90 years. The data sources were the adult portions of the standardization samples of the second editions of Kaufman Brief Intelligence Test (N = 570) and the Kaufman Test of Educational Achievement-Brief Form (N = 555). Five univariate analysis of covariance were conducted with age as the covariate. Correlational analysis supplemented the covariate analyses to better understand the relationship of the five variables to education. All variables related significantly and substantially to years of formal schooling, an important finding in view of the key nature of this background variable for conducting neuropsychological assessments, as elaborated by Heaton and his colleagues. Surprisingly, Gf related just as strongly to education as did the school-related Gc. Among academic skill areas, math correlated higher with years of formal schooling than did either reading or writing. Women significantly outperformed men on the writing test and the reverse was true for the math test; other gender differences were not significant. These analyses fill a gap in the literature regarding the nature of gender and education differences in academic skills for heterogeneous samples of normal adults between young adulthood and old age and have practical implications for neuropsychological assessment.
Performance on Dutch adaptations of Rey's AVLT was examined in a sample of 225 6- to 12-year-old Dutch school children, selected
to be representative of the general population. With an interval of 3 months, they were tested twice, using two out of three
test forms which proved to be parallel. No test-retest practice effects were apparent. Age had a considerable impact on test
performance. Measured imperfectly, socioeconomic background and intellectual level had some additional influence, as did the
examiner who administered the tests. Boys made more errors than girls. Normative data corresponded well with those collected
in a smaller Australian sample, suggesting usefulness outside The Netherlands. With a parallel test-retest reliability of
.70, which was reduced to .59 when the influence of age was taken into account, the most reliable AVLT measure was the total
number of words correctly recalled over the five learning trials. On the basis of reliability data, implications for the clinical
use of the AVLT are discussed.
Scores on the New Adult Reading Test-Revised (NART-R) were used to estimate WA1S-R IQ scores obtained approximately 3.5 years
earlier from 54 normal older persons (M = 68 y; SD = 8.6). NART-R estimated IQ scores correlated reliably with earlier obtained
IQ scores: FS1Q r = 0.70; VIQ r = 0.68; PIQ r = 0.61 (all p's < 0.05). NART-R estimated FSIQs underpredicted obtained FSIQs
by an average of 3.8 points (SD = 9.3). The correlation between estimated and obtained FSIQ is fairly high and estimated FSIQ
is reasonably close to obtained IQ, despite the considerable length of time passing between WAIS-R and NART-R administration.
These results represent the first confirmation of the retrospective accuracy of the NART-R in estimating WAIS-R scores across
time, a previously untested but critical assumption for clinical application of this approach. These results also apparently
represent the first cross-validation of the NART-R in a sample of older Americans. These results suggest that further research
on the clinical utility of the NART-R is warranted.
Equations for prorating Wechsler Memory Scale-Revised General Memory (GM) and Delayed Recall (DR) index scores ([Woodard and Axelrod, 1995]) were confirmed in the [Mittenberg et al. (1992)] normative WMS-R sample of 50 subjects between the ages of 25 and 34, and confirmed in a separate clinical sample of 30 patients with closed head injury who were age, education, and gender matched with 30 subjects from that normative sample. Predicted GM and DR index scores fell within 6 points of the obtained scores for 98% of the [Mittenberg et al. (1992)] sample and 93% to 100% of the matched head injury and normative samples, despite statistically significant differences between these groups in obtained GM, DR, and percent retention of LM I and II and VR I and II. Six points is well within the standard error of measurement of these index scores. These findings confirm the earlier cross-validation results reported by [Axelrod et al. (1996)] in a mixed sample of traumatic brain injury and other neurological insult, and suggest that this method of estimating weighted score sums for WMS-R General Memory and Delayed Recall indices may be safely used in normative samples of patients in this age range as well as neurologically compromised patients without significantly impacting index score accuracy.
The Modified Mini-Mental State Examination (3MS) was developed to overcome shortcomings of the Mini-Mental Status Exam (MMSE), specifically its narrow range of possible scores and ceiling effects. Several studies have examined the psychometric characteristics of the 3MS, showing an improvement in reliability and increased sensitivity in detecting dementia in comparison to the MMSE. Despite research supporting the favorable psychometric features of the 3MS, the clinical value of the instrument is restricted by limited normative data, especially for the elderly population. In this study, we examine the influence of demographic characteristics on 3MS scores and present descriptive data for a sample of 393 community-dwelling older adults. Normative data, based on age and with adjustments for education, are provided for clinical use.
The present study explored several different procedures for determining the amount of change that occurred on the Mini-Mental State Exam [MMSE; Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-Mental State": A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198] and Modified Mini-Mental State Exam [3MS; Teng, E. L., & Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. Journal of Clinical Psychiatry, 48, 314-318] over short and extended test-retest intervals. The test-retest scores were drawn from a selected sample of elderly individuals who participated in the Canadian Study of Health and Aging [Canadian Study of Health and Aging. (1994). The Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899-913] and were tested on two occasions (CSHA-1 and CSHA-2) separated by 5 years. On each occasion the MMSE and 3MS were administered twice at approximately 3-month intervals. Thus, the mental status tests were administered four times: times 1 and 2 at CSHA-1 and times 3 and 4 at CSHA-2. Mean difference scores and percent of baseline scores showed relatively small group changes over both short and long test-retest intervals for the MMSE and the 3MS. A reliable change index based on a linear regression model controlled for practice effects, psychometric errors due to low reliability, regression to the mean, and accounted for the effects of various demographic variables. Consequently, this reliable change index provided a better estimate of the amount of change that occurred for individual participants than did the mean Retest-Test 1 difference, percent of baseline change, or a reliable change index based on a Retest-Test 1 difference score. Normative data for the change scores are provided.
Although the Wechsler Full Scale IQ (FSIQ) is a common component of most neuropsychological evaluations, there are many clinical situations where the complete administration of this battery is precluded by various constraints, including limitations of time and patient compliance. These constraints are particularly true for dementia evaluations involving elderly patients. The present study reports data on two short forms particularly suited to dementia evaluations, each requiring less than 20min of administration time. One of the short forms was previously validated in dementia for the WAIS-R [Randolph, C., Mohr, E., & Chase, T. N. (1993). Assessment of intellectual function in dementing disorders: Validity of WAIS-R short forms for patients with Alzheimer's, Huntington's, and Parkinson's disease. Journal of Clinical and Experimental Neuropsychology, 15, 743-753]; the second was developed specifically for patients with motor disabilities. These short forms were validated using the WAIS-III normative standardization sample (N=2450), neurologic sample (N=63), and matched controls (N=49), and a separate mixed clinical sample (N=70). The results suggest that each short form provides an accurate and reliable estimate of WAIS-III FSIQ, validating their use in appropriate clinical contexts. The present data support the use of these short forms for dementia evaluations, and suggests that they may be applicable for the evaluation of other neurological and neuropsychiatric disorders that involve acquired neurocognitive impairment.
This study sought to identify patterns of performance indicative of malingering on the Auditory Verbal Learning Test (AVLT). Participants were randomly assigned to perform normally, simulate head injury, or simulate head injury with warning that there might be attempts to detect malingering. Participants completed an expanded AVLT and a forced-choice task, in addition to several other memory tests. The warned simulators performed worse than normals on the forced-choice task, but better than those simulating head injury without a warning, suggesting that the warned subjects recognized forced choice as a malingering test. A combination of AVLT indices was able to predict group status for both nai;ve and warned malingerers (73.6% for nai;ve malingerers, 84.8% for warned, no false positives). The forced-choice measure detected only 31.6% of the nai;ve malingerers when specificity was maximized, and detected only 6.5% of the warned malingerers, a significant drop in detection rate. Findings suggest that pattern of performance indices are useful in detecting malingering, even when subjects are aware of attempts to detect malingering.
This report presents three cases of atypical degenerative dementias in order to illustrate challenges associated with the use of biologic markers of Alzheimer's disease (AD) for diagnosis and management. Clinical diagnostic methods followed the NINCDS-ADRDA criteria for AD. Additional diagnostic studies included serial neurocognitive testing, MRI, neuroSPECT, ApoE genotyping, and a CSF assay of tau and beta-amyloid(42). For patient 1, both the clinical and biologic markers were consistent with AD. The patient was diagnosed with AD with a high degree of confidence, even though the base rate of nonfamilial AD at this age group (<55 years) is exceedingly rare. This case argues favorably for the use of biologic markers to aid in confirming a diagnosis in an atypical dementia. Patient 2 met the NINCDS-ADRDA criteria for AD, although with less confidence. Neurocognitive data indicated a progressive right hemispheric syndrome, insight was preserved, and ApoE was 3/3, but tau concentrations and beta-amyloid(42) were highly consistent with cut-offs for AD; the differential fell on the Pick's disease/frontotemporal degeneration spectrum. Patient 3 had no clinical evidence of the disease, even when evaluated via extensive neurocognitive testing over a 2-year interval. However, ApoE was 4/4, and CSF assay of tau and beta-amyloid(42) were within the AD range. Therefore, while the CSF assay of tau and beta-amyloid(42) markers was confirmatory of AD, each case was highly atypical. Results illustrate the lack of normative data available when using biologic markers for highly atypical cases, calling into question their usefulness for such patients. These cases illustrate the interplay between neuropsychological and biological markers in establishing neurodegenerative diagnoses.
Rhombencephalosynapsis (RS) is a rare congenital disorder characterized principally by agenesis/hypogenesis of the cerebellar vermis and fusion of the dentate nuclei and cerebellar hemispheres. Fusion of the peduncles and colliculi is common, and associated anomalies of the cerebral hemispheres also can be present. Only about 50 cases with RS have been described and the majority of these have been children. While the literature suggests that RS often is associated with behavioral and/or intellectual impairment, no previous report has described overall neuropsychological functioning. This report describes an employed male who was diagnosed with RS by MRI at age 55. The neurological examination revealed only subtle sensory-motor abnormalities and the results of the neuropsychological evaluation were generally within normal limits, with the exception of poor immediate visual memory and motor dexterity. These findings suggest RS is not inevitably associated with substantial cognitive impairment.
Performance of elderly subjects on the Continuous Visual Memory Test (CVMT) was examined in a sample of neurologically normal
adults (74 males and 103 females). Means for age and education were 71.20 years (SD = 6.02) and 14.77 years (SD = 2.48). Results revealed that the recommended impairment cut-off scores provided in the CVMT manual did not generalize to
the current sample with 8% to 50% of healthy elderly persons falling within the impaired range. Therefore, the current sample
was used to provide updated preliminary elderly normative data for the CVMT.
Frontotemporal dementia (FTD) is characterized by dramatic changes of personality and behaviour. Impaired ability of emotional processing could contribute to these symptoms, as it may lead to misinterpretation of emotional cues that would normally guide behaviour. The aim of the present study was to investigate if the Ekman 60 Faces Test, an instrument to test the recognition of basic facial emotions, enables the differentiation between patients with mild FTD and cognitively healthy subjects (HC). We found that compared to 33 cognitively healthy subjects, 25 patients with mild FTD were impaired in the recognition of basic emotions. At a cut-off score from 46 out of 60 points, the Ekman 60 Faces Test discriminated between patients with mild FTD and HC with 97% diagnostic accuracy (sensitivity: 94%; specificity: 100%). The results of the present study were consistent with the findings of prior studies on smaller patient samples.
An issue that often confronts the clinician referred an elderly person for neuropsychological assessment is how to interpret
the significance of changes in test scores over time. In this report, data useful for estimating the statistical significance
of changes on the Rey Auditory Verbal Learning Test (AVLT) are presented. The sample tested comprised 253 healthy persons
aged 65 and over taking part in a randomized double-blind trial of the effect on cognitive performance of lowering homocysteine
using dietary supplements. Results were based on the full sample because of the absence of any treatment effects. Test–retest
data with a 1-year interval were used to estimate reliability coefficients and to calculate reliable change indices. The magnitude
of a change necessary for a deterioration or improvement in scores at the two-tailed 90% confidence interval is given for
the full sample, and persons above and below the age of 75.
The test-retest stability of the Sati-Mogel short form was evaluated in a sample of 61 persons 75 years and older. Means for age, education, and retest interval were 78.93 years (SD = 3.46), 9.74 years (SD = 1.91), and 64.92 days (SD = 26.84), respectively. Test-retest coefficients were.87,.70, and.89 for the Verbal, Performance, and Full Scales, respectively. Subtest stability ranged from.28 to.83. While the stability of the Verbal and Full Scales was adequate, it was unacceptable for the Performance Scale. Percent agreement for gain or loss between the complete WAIS-R and the Satz-Mogel short form was 80.0% for the Verbal Scale, 55.7% for the Performance Scale, and 67.2% for the Full Scale. The Satz-Mogel procedure reduces the stability of the Performance Scale to an unacceptable level in normal elderly persons.
The Mini-Mental State Exam (MMSE) is a clinically ubiquitous yet incompletely standardized instrument. Though the test offers considerable examiner leeway, little data exist on the normative consequences of common administration variations. We sought to: (a) determine the effects of education, age, gender, health status, and a common administration variation (serial 7s subtraction vs. "world" spelled backward) on MMSE score within a minority sample, (b) provide normative data stratified on the most empirically relevant bases, and (c) briefly address item failure rates. African American citizens (N = 298) aged 55-87 living independently in the community were recruited by advertisement, community recruitment, and word of mouth. Total score with "world" spelled backward exceeded total score with serial 7s subtraction across all levels of education, replicating findings in Caucasian samples. Education is the primary source of variance on MMSE score, followed by age. In this cohort, women out-performed men when "world" spelled backward was included, but there was no gender effect when serial 7s subtraction was included in MMSE total score. To ensure an appropriate interpretation of MMSE scores, reports, whether clinical or in publications of research findings, should be explicit regarding the administration method. Stratified normative data are provided.