The relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and olfaction in patients referred for a dementia evaluation.

The current study examined the relationship between a standardized dementia battery (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]) and a test of olfactory discrimination (University of Pennsylvania Smell Identification Test [UPSIT]) in a heterogeneous sample of patients referred for a dementia assessment (N = 103). Significant moderate correlations were found between the UPSIT and each of the RBANS indexes, with the strongest correlation for Total Scale score, followed by the Delayed Memory Index and the Language Index. Significant moderate correlations were also found between the UPSIT and 11 of the 12 subtests of the RBANS. While the major RBANS indexes demonstrated significant correlations with education and the Wechsler Test of Adult Reading, a measure of premorbid IQ, the UPSIT did not. This suggests the UPSIT may be sensitive to decline in dementia and largely unaffected by premorbid cognitive functioning. As a result, the UPSIT may provide neuropsychologists with an efficient, cost-effective, and sensitive supplement to a standard dementia battery.

Factor analysis of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a large sample of patients suspected of dementia.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998) is a popular neuropsychological assessment instrument with research supporting its clinical utility. However, the index structure of the RBANS was derived theoretically and was not based on factor analysis. The purpose of this study was to examine the factor structure in a large heterogeneous sample of patients referred for a dementia evaluation, using exploratory factor analysis. Results suggest a two-factor solution, the first factor defined predominantly as a memory factor and the second as predominantly a visuospatial factor. This study also sought to validate the obtained factors by examining their relationship with external neuropsychological variables. Correlations between the external variables provide further support for Factor 1 as a memory factor. Correlations with Factor 2 support its visuospatial features, although this factor may also be associated with other cognitive domains such as attention and general ability.

Dichotomous scoring of Trails B in patients referred for a dementia evaluation.

The Trail Making Test is a popular neuropsychological test and its interpretation has traditionally used time-based scores. This study examined an alternative approach to scoring that is simply based on the examinees' ability to complete the test. If an examinee is able to complete Trails B successfully, they are coded as "completers"; if not, they are coded as "noncompleters." To assess this approach to scoring Trails B, the performance of 97 diagnostically heterogeneous individuals referred for a dementia evaluation was examined. In this sample, 55 individuals successfully completed Trails B and 42 individuals were unable to complete it. Point-biserial correlations indicated a moderate-to-strong association (r(pb)=.73) between the Trails B completion variable and the Total Scale score of the Repeatable Battery for the Assessment of Neurological Status (RBANS), which was larger than the correlation between the Trails B time-based score and the RBANS Total Scale score (r(pb)=.60). As a screen for dementia status, Trails B completion showed a sensitivity of 69% and a specificity of 100% in this sample. These results suggest that dichotomous scoring of Trails B might provide a brief and clinically useful measure of dementia status.

Correlation between the Bicycle Drawing Task and neuropsychological variables in patients referred for a dementia evaluation.

The objective of this study was to examine the relationship between the Bicycle Drawing Task and a number of neuropsychological variables, including the Repeatable Battery for the Assessment of Neuropsychological Status, in a heterogeneous group of older adults referred for a dementia evaluation. The sample consisted of 91 participants with a mean age of 77.0 yr. (SD = 6.4). The correlations between scores on the Bicycle Drawing Task and the Repeatable Battery for the Assessment of Neuropsychological Status and supplemental cognitive measures were generally in the moderate range. The Bicycle Drawing Task was not significantly related to premorbid IQ or education. As a neuropsychological measure, the task is brief, easily explained, easily scored, and well-tolerated by patients. Results suggest the Bicycle Drawing Task may be a useful screening procedure for cognitive impairment that is not significantly related to education or premorbid ability.

MMPI--2 Code-Type Congruence of Injured Workers.

In this study, the authors examined the stability of Minnesota Multiphasic Personality Inventory--2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) code types in a sample of 94 injured workers with a mean test-retest interval of 21.3 months (SD = 14.1). Congruence rates for undefined code types were 34% for high-point codes, 22% for 2-point codes, and 22% for 3-point codes. The data provide tentative evidence suggesting that defined code types are more stable than undefined code types. Cohen's kappa, a statistic that controls for chance agreement, was calculated for each clinical scale for both 2-point and 3-point code types. Only 2 of the 20 kappa coefficients were not significant at the p = .05 level.

Neuropsychological performance of a patient suspected of dementia taking lorazepam and retested 1 year later following titration.

The effects of medication on neuropsychological performance have yet to be fully investigated, particularly in older patients. As such, the present case study was undertaken to examine the specific impact of benzodiazepine use on neuropsychological performance by providing a comparison of the test-retest data of an 81-year-old patient taking lorazepam. A comprehensive neuropsychological evaluation was conducted: (a) during the initial referral, while the patient had been taking high doses of lorazepam for approximately 3 years; and (b) 6 months after complete titration, which was 1 year after the initial evaluation. Normative scores derived from the 2 trials were compared via calculation of Reliable Change Indexes. Neuropsychological performance during both evaluations was indicative of dementia, including similar degrees of impairment in delayed memory, verbal fluency, and olfaction. However, scores obtained during the second evaluation were somewhat higher, with significant improvements observed in immediate memory, visuospatial/construction abilities, language function, abstract concept formation, and set shifting. Results of the current case study suggest that several neuropsychological domains may be particularly sensitive to chronic benzodiazepine use. Although the overall diagnostic picture in the present study remained unaltered, clinicians should be cognizant of such medication effects and the potential for these neuropsychological alterations to obscure differential diagnosis.

Relationship Between the Mini-Mental State Examination and the Repeatable Battery for the Assessment of Neuropsychological Status in Patients Referred for a Dementia Evaluation.

The current study examined the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Mini-Mental State Examination (MMSE) in a large, heterogeneous sample of patients referred for dementia assessment (N = 495; 37% males, 63% females; M age = 76.8 years, SD = 7.0). The MMSE showed a significant moderate correlation with the RBANS Total Scale score (r = .65). Moderate significant correlations were found between the MMSE and the RBANS indexes (r = .41 to .49). The MMSE demonstrated moderate correlations with RBANS factor scores of .63 for Factor 1 (memory/learning) and .58 for Factor 2 (visuospatial/attention). These correlations suggest that the MMSE is best considered a measure of global cognitive functioning with the strongest correlations between broader measures.

Multivariate analyses of the profile stability of intelligence tests: high for IQs, low to very low for subtest analyses.

Profile stability involves the consistency of a set of scores over time. That is, does a profile of scores change on retesting and does this change affect clinical decisions? While psychologists routinely examine the reliability of individual scores, little research has examined the stability of a profile or set of scores. The first study described in this paper examined potential measures of profile stability using a simulation computer program. The results suggest that several measures show promise in this context, particularly Cattell's coefficient of pattern similarity (r(p)), salient variable similarity index (S), and the D(2) coefficient. In the second study, selected measures of profile stability were applied to Wechsler test-retest data. The results suggest that profiles composed of IQ and index scores demonstrate acceptable stability and can be usefully interpreted in clinical and research situations. However, subtest score profiles are inherently less stable and provide little useful clinical information.

Two sets of twins with selective mutism: neuropsychological findings.

Neuropsychological data are reviewed from two sets of dizygotic twins presenting with selective mutism characterized by situation specific anxiety, extreme passive behavior, lack of responsivity, lack of peer interaction, and a chronic course of selective mutism. Both sets of twins had a history of prematurity and delayed speech development. One set of twins presented with normal intelligence and normal receptive language skills but with expressive language and oral motor sequencing difficulties. The second set of twins presented with Verbal IQ deficits and significant receptive and expressive language deficits. A summary of current conceptualizations regarding etiology and treatment of selective mutism is provided.