Robert M. Roth

Geisel School of Medicine at Dartmouth | DMS · Department of Psychiatry

Little is known about the neuropsychological profiles associated with sexual abuse (SA). Using a serial case study design, we examined the cognitive profile from 11 patients medically referred for neuropsychological evaluation who endorsed a remote history of SA. The data can be best summarized as the co-existence of strong psychometric evidence of...

Intra-individual variability (IIV) quantifies an individual’s scatter in performances across a test battery (dispersion) or across reaction times within a single task (consistency). No studies have meta-analyzed the cross-sectional IIV literature in those with mild cognitive impairment (MCI) and Alzheimer’s dementia (AD). An additional aim of this...

Objective The Identi-Fi is a test of visuospatial organization with overall performance represented by the Visual Organization Index (VOI). Though untimed, the Professional Manual indicates administration takes ~10 minutes in the standardization sample. We examined Identi-Fi time of completion (TOC) in a mixed clinical sample and explored whether T...

Objective The CVLT-3 is a measure of verbal learning and memory used extensively in clinical and research settings that contains an embedded performance validity indicator, a forced choice recognition trial (CVLT-3-FCR). The CVLT-2-FCR was modified for the CVLT-3-FCR, replacing abstract with concrete distractor words. To date, no one has reported i...

Objective Insomnia symptoms are prevalent among individuals with post-acute sequelae of COVID-19 (PASC) and may, to some extent, reflect virally-mediated neurological changes. Mood disturbance and cognitive impairment, including weaknesses in attention and processing speed, are also observed. There is limited research examining the association betw...

Objective Patients with Parkinson’s disease (PD) commonly experience neuropsychiatric symptoms, often garnered through informant interview, that may be associated with poorer cognitive functioning. Recently, the Neuropsychiatric Inventory Questionnaire (NPI-Q) was found to have three factors with differential association to cognition in patients wi...

Objective People with epilepsy (PWE) commonly have executive functioning (EF) difficulties on objective testing. However, less is known about subjective EF difficulties in everyday life. We examined self- and informant-rated EF in PWE using the Behavior Rating Inventory of Executive Function for Adults-2 (BRIEF-2A). We hypothesized that PWE and the...

Objective Children with developmental disorders including attention deficit/hyperactivity disorder (ADHD), autism (ASD), and learning disabilities (LD) often exhibit different profiles of everyday executive function (EF) strengths and weakness. This has not been tested in adults. We examined profiles of self- and informant-reported EF in adults wit...

Objective Adults with persisting symptoms after mild (mTBI) or moderate-to-severe (msTBI) TBI may show problems with executive functions (EF) on testing and, in some studies, in everyday life. We examined self- and informant-report EF in mTBI and msTBI using the BRIEF2A. Method Participants were 62 patients with persisting symptoms after mTBI (57...

Objective: Severe acute respiratory syndrome coronavirus 2 may result in persistent physical, psychological, and/or cognitive symptoms, termed postacute sequelae of COVID-19 (PASC). A growing literature has documented the presence of cognitive deficits in individuals diagnosed with PASC; however, the use of performance validity tests (PVTs) has var...

Background Cognitive symptoms are often reported by those with a history of COVID-19 infection. No comprehensive meta-analysis of neurocognitive outcomes related to COVID-19 exists despite the influx of studies after the COVID-19 pandemic. This study meta-analysed observational research comparing cross-sectional neurocognitive outcomes in adults wi...

Background and Hypothesis Up to 43% of people with schizophrenia have a lifetime cannabis use disorder (CUD). Tetrahydrocannabinol (THC) has been shown to exacerbate psychosis in a dose-dependent manner, but little research has assessed its effects on schizophrenia and co-occurring CUD (SCZ-CUD). In this double-dummy, placebo-controlled trial (tota...

Fuermaier et al. (Applied Neuropsychology: Adult, 2023) reported that the Beck Depression Inventory–Second Edition (BDI-II; Beck et al. in Beck Depression Inventory – (2nd ed.), Psychological Corporation, 1996) can also serve as symptom validity test (SVT) in a compensation seeking Austrian sample. This study was designed to replicate their finding...

The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults...

Objective Anterior temporal lobectomy is a common surgical approach for medication-resistant temporal lobe epilepsy (TLE). Prior studies have shown inconsistent findings regarding the utility of presurgical intracarotid sodium amobarbital testing (IAT; also known as Wada test) and neuroimaging in predicting postoperative seizure control. In the pre...

Objective Patients with Post-Acute COVID Syndrome (PACS) are reported to commonly experience a variety of cognitive, physical, and neuropsychiatric symptoms well beyond the acute phase of the illness. Notably, concerns involving mood, fatigue, and physical symptoms (e.g., pain, headaches) following COVID-19 appears to be especially prevalent. It is...

Objective Mild cognitive impairment (MCI) is characterized by subjective and objective memory concerns, though additional cognitive concerns are commonly reported, including changes in executive functions (EF). Rabin et al. (2006) showed that a sample of research participants with MCI endorsed problems with their EFs, especially working memory. Sim...

Objective Patients with Parkinson’s disease (PD) commonly show deficits on tests of visuospatial functioning. The Identi-Fi is a new measure of visual organization and recognition composed of two components. The Visual Recognition (VR) subtest asks persons to identify an object that has been broken its pieces and rearranged, akin to the Hooper Visu...

Objective Patients with temporal lobe epilepsy (TLE) commonly show memory deficits on neuropsychological tests. The BVMT-R is a widely used test of visual learning and memory that involves accurately reproducing an array of figures in the correct special location. The present study examined performance processes of visual memory in presurgical pati...

Objective: This study was designed to replicate previous research on the clinical utility of the Verbal Paired Associates (VPA) and Visual Reproduction (VR) subtests of the WMS-IV as embedded performance validity tests (PVTs) and perform a critical item (CR) analysis within the VPA recognition trial. Method: Archival data were collected from a mixe...

Objective Neuropsychological evaluation with Deaf individuals is of increasing interest in light of the recent SCOTUS decision in Perez v Sturgis. We describe an evaluation approach with a Deaf patient and his wife (who is deaf blind) using consecutive sign language interpretation and a remote consultant. Method A 76-year-old Deaf man with 8 years...

Objective Coronavirus anxiety (CA) is associated with depression, general anxiety, and subjective cognitive dysfunction (SCD) in community samples. Furthermore, individuals with SARS-CoV-2 infection (acute & post-acute) report greater CA and SCD. No study to date has examined CA in patients diagnosed with post-acute sequelae of COVID-19 (PASC). We...

Objective: To compare multiple dimensions of executive function between children with attention-deficit/hyperactivity disorder (ADHD) with and without comorbid obesity. Method: Participants were 90 Iranian children (ages 8–13, 50% female) who were equally dispersed across three study groups: typically developing (TD), ADHD with obesity (ADHD+O), a...

The Conners’ Continuous Performance Test – Second Edition (CPT-II) has demonstrated utility as a performance validity test (PVT). Early research also identified several benefits of repeat administration. This study was designed to evaluate the potential of repeat administrations of the CPT-II to enhance its clinical utility in detecting ADHD or non...

Purpose: Persons with epilepsy (PWE) report memory deficits as one of the most distressing aspects of their disorder. Recently, a long-term memory deficit known as Accelerated Long-Term Forgetting (ALF) has been described in PWE. ALF is characterized by the initial retention of learned information, followed by an accelerated rate of memory decay....

This study was designed to expand on a recent meta-analysis that identified ≤42 as the optimal cutoff on the Word Choice Test (WCT). We examined the base rate of failure and the classification accuracy of various WCT cutoffs in four independent clinical samples (N = 252) against various psychometrically defined criterion groups. WCT ≤ 47 achieved a...

Objective: This study was designed to compare different versions of the letter fluency test (FAS/CFL), evaluate the effect of repeat administration and the classification accuracy of traditional and novel cutoffs as performance validity tests (PVTs). Method: Archival data were collected from a mixed clinical sample (n = 64) of patients physician-re...

Objective: The Behavior Rating Inventory of Executive Function (BRIEF) captures perceptions of an individual’s executive functioning in their everyday environment. Two self-report forms span late adolescence into early adulthood: BRIEF2 (ages 11-18) and BRIEF-Adult (ages 18-90). We compared responses on these forms in young adults to evaluate their...

Objective The study was designed to expand on the results of previous investigations on the D-KEFS Stroop as a performance validity test (PVT), which produced diverging conclusions. Method The classification accuracy of previously proposed validity cutoffs on the D-KEFS Stroop was computed against four different criterion PVTs in two independent sa...

Background: This study investigated the psychometric properties of a Persian translation of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Self-Report form. Method: Participants were 589 typically developing adolescents (336 girls and 253 boys), ages 11-18 years old (M=15.16; SD=2.04), in Iran. They completed the Per...

Objective: This study was designed to replicate previous research on critical item analysis within the Word Choice Test (WCT). Method: Archival data were collected from a mixed clinical sample of 119 consecutively referred adults (Mage = 51.7, Meducation = 14.7). The classification accuracy of the WCT was calculated against psychometrically defi...

There is a paucity of research examining multivariate base rates (MBRs) of elevated scores in pediatric rating scales of cognition. We present novel MBR information on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) for several clinical groups: Attention-Deficit/Hyperactivity Disorder Combined Presentation (ADHD-C); ADH...

Objective: Multivariate base rates (MBRs) reflect probability information based on multiple variables (e.g., frequency of ≥4 low/high scores within a battery of 10 possible scores). There is sparse research examining MBRs in rating scales of cognition. We provide novel MBR information on the Behavior Rating Inventory of Executive Function, Second...

Objectives HIV‐associated neurocognitive disorders (HAND) remain prevalent in people living with HIV (PLWH) despite widespread use of combined antiretroviral therapy (ART). Vascular disease contributes to the pathogenesis of HAND, but traditional vascular risk factors do not fully explain the relation between vascular disease and HAND. A more direc...

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) is a standardized rating (self, parent, and teacher) scale of executive functioning in children and adolescents. Here, we provide multivariate base rate (MBR) information (for the Self, Parent, and Teacher forms), which is not included in the BRIEF2 Professional Manual. Pa...

The Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range ( T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual. Pa...

Objective : Replicate previous research on Logical Memory Recognition (LMRecog) and perform a critical item analysis. Method : Performance validity was psychometrically operationalized in a mixed clinical sample of 213 adults. Classification of the LMRecog and nine critical items (CR-9) was computed. Results : LMRecog ≤20 produced a good combinat...

This study was designed to determine the clinical utility of embedded performance validity indicators (EVIs) in adults with intellectual disability (ID) during neuropsychological assessment. Based on previous research, unacceptably high (>16%) base rates of failure (BRFail) were predicted on EVIs using on the method of threshold, but not on EVIs ba...

Prior research has found that individuals with a pre-injury psychiatric history report greater difficulty with executive functioning after mild traumatic brain injury (mTBI). The present study examined self-rated executive functioning after the acute phase of recovery in individuals with mTBI having no prior psychiatric history. Participants includ...

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants i...

Rationale Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improveme...

Objective Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modify...

Deep brain stimulation (DBS) of the subcallosal cingulate has emerged as a promising therapy for treatment-resistant depression (TRD). To date, all studies have employed bilateral stimulation; however, the physiology of affect and pathophysiology of depression are known to be asymmetric across hemispheres. Unilateral stimulation may provide efficac...

Objective Subjective memory concerns are characteristic of individuals with amnestic mild cognitive impairment (aMCI) and subjective cognitive decline (SCD), though subjective changes in executive functions have also been reported. In a cohort study, we examined the temporal stability of subjective report of executive functioning in a high educatio...

Antipsychotics that are potent dopamine (DA) D2 receptor antagonists have been linked to elevated levels of nicotine dependence in smokers with schizophrenia. Because activation of D2 receptors mediates motivation for nicotine, we examined whether potent D2 antagonists would diminish nicotine's ability to stimulate reward processing-a mechanism tha...

Cognitive reserve could mask the deleterious effects of neurodegenerative disorders in older adults with high premorbid functioning, resulting in false negatives on cognitive screening tests. Failing to detect early signs of cognitive decline may result in missing a critical period of intervention with disease modifying drugs or making informed dec...

Objective: To determine the antidepressant mechanism of action for repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) in healthy women. Our primary hypothesis was that a single session of left DLPFC rTMS, compared with a session of right DLPFC rTMS, would result in better (reduced) negative nonaf...

Lenient scoring of spatial orientation errors (SOE) on the Mini-Mental State Exam (MMSE) is common practice, even though it deviates from standard protocol and may compromise its diagnostic power. This study was designed to empirically evaluate the effect of lenient scoring on the MMSE’s classification accuracy. Participants were 113 community dwel...

This study was designed to develop performance validity indicators embedded within the Delis-Kaplan Executive Function Systems (D-KEFS) version of the Stroop task. Archival data from a mixed clinical sample of 132 patients (50% male; MAge= 43.4; MEducation= 14.1) clinically referred for neuropsychological assessment were analyzed. Criterion measure...

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that persists into adulthood for many individuals. Research on the disorder, however, has largely focused on childhood or on adulthood but spanning a very broad age range. Emerging adulthood, conceptualized as the period between 18 and 29 years of age, has been identified a...

A link between noncredible responding and low scores on the Grooved Pegboard Test (GPB) is well documented in the clinical literature. However, no specific validity cutoffs have emerged in previous research. This study was designed to examine the classification accuracy of various demographically adjusted cutoffs on the GPB against established meas...

Nearly half of patients with schizophrenia (SCZ) have co-occurring cannabis use disorder (CUD), which has been associated with decreased treatment efficacy, increased risk of psychotic relapse, and poor global functioning. While reports on the effects of cannabis on cognitive performance in patients with SCZ have been mixed, study of brain networks...

This study was designed to examine the clinical utility of critical items within the Recognition Memory Test (RMT) and the Word Choice Test (WCT). Archival data were collected from a mixed clinical sample of 202 patients clinically referred for neuropsychological testing (54.5% male; mean age ¼ 45.3 years; mean level of education ¼ 13.9 years). The...

Cutoffs on performance validity tests (PVT) may have to be adjusted based on demographic factors to minimize bias. Although research in this area is minimal, previous work found a gender effect on the Recognition Memory Test (RMT; Kim et al., 2010). The current study aimed to replicate these gender differences on the WCT, as well as examine the eff...

The Stroop paradigm has many variants. Due to its potential to function as an embedded validity indicator, this study was designed to develop performance validity indicators embedded within the Delis-Kaplan Executive Function Systems (D-KEFS) version of the Stroop task.

Depression negatively impacts quality of life and is associated with high mortality rates. Recent research has demonstrated that improvement in depression symptoms with transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) may involve changes in the cognitive control network, a regulatory system modulating the functi...

Introduction: The Recognition Memory Test (RMT) and Word Choice Test (WCT) are structurally similar, but psychometrically different. Previous research demonstrated that adding a time-to-completion cutoff improved the classification accuracy of the RMT. However, the contribution of WCT time-cutoffs to improve the detection of invalid responding has...

Neuropsychological studies of psychopathy have yielded inconsistent findings with respect to executive functions (EF). This may be due to heterogeneity of psychopathy, with some studies using performance-based tests showing a stronger association between EF and Antisocial-Impulsivity (AI) than Fearless-Dominance (FD) traits. Variability in findings...

Elevations on certain Conners? CPT-II scales are known to be associated with invalid responding. However, scales and cutoffs vary across studies. In addition, the methodology behind developing performance validity tests (PVTs) has been challenged for mistaking true impairment for noncredible presentation. Using ability-based tests as a PVT makes cl...

Objectives: The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test, 2nd edition, was designed as an embedded performance validity test (PVT). To our knowledge, this is the first systematic review of classification accuracy against reference PVTs. Methods: Results from peer-reviewed studies with FCR data published since...

Objectives: Subjective cognitive decline is considered to be a core feature of pre-Alzheimer's disease (AD) conditions, the vast majority of literature having focused on memory concerns. Neuropsychological studies have implicated executive dysfunction on objective performance measures in AD, but no research has evaluated whether individuals with AD...

Objective: The primary objective for this study was to assess social cognition in patients with focal epilepsy using a naturalistic task, which accurately models complex real-world social interaction. Methods: We conducted an observational study of social cognition in 43 patients with focal epilepsy and in 22 controls. Patients and controls comp...

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Fu...

Subjective executive functioning (EF) measures provide valuable information about real-world difficulties, although it is unclear what variables actually associate with subjective EF scores. We investigated subjective EF in 245 nondemented, community-dwelling older adults (aged 70 and above) from the Einstein Aging Study. Partial correlational anal...

Scores on the Complex Ideational Material (CIM) were examined in reference to various performance validity tests (PVTs) in 106 adults clinically referred for neuropsychological assessment. The main diagnostic categories, reflecting a continuum between neurological and psychiatric disorders, were epilepsy, psychiatric disorders, postconcussive disor...

Introduction: Episodic memory complaints are commonly reported after traumatic brain injury (TBI). The contributions of specific memory subprocesses (encoding, consolidation, and retrieval), however, are not well understood in mild TBI (mTBI). In the present study, we evaluated subprocesses of episodic memory in patients with mTBI using the item-s...

Research suggests that select processing speed measures can also serve as embedded validity indicators (EVIs). The present study examined the diagnostic utility of Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests as EVIs in a mixed clinical sample of 205 patients medically referred for neuropsychological assessment (53.3% female,...

Complex Ideational Material (CIM) is a sentence comprehension task designed to detect pathognomonic errors in receptive language. Nevertheless, patients with apparently intact language functioning occasionally score in the impaired range. If these instances reflect poor test taking effort, CIM has potential as a performance validity test (PVT). Ind...

Objective: Cognitive difficulties in epilepsy are common and add to disability beyond seizures alone. A self-management intervention targeting cognitive dysfunction was developed and assessed for whether it improves quality of life, objective memory, and mood in adults with epilepsy. Methods: The HOme Based Self-management and COgnitive Training...

Apathy is prevalent in schizophrenia, but its etiology has received little investigation. The ventral striatum (VS), a key brain region involved in motivated behavior, has been implicated in studies of apathy. We therefore evaluated whether apathy is associated with volume of the VS on MRI in 23 patients with schizophrenia using voxel-based morphom...

Objectives: People with chronic pain may experience impairments in high-level cognitive skills, particularly executive functions. Such impairments are not adequately measured in most clinical pain management settings yet could be a key influence on everyday functioning. We administered a well-validated, well-normed self-report measure to determine...