The Neuropsychological Assessment of Justice-Involved Men: Descriptive Analysis, Preliminary Data, and a Case for Group-Specific Norms.

OBJECTIVE: Neuropsychological expertise has played an increasing role in legal decision-making in criminal contexts. Valid neuropsychological evidence in criminal forensic contexts requires normative data that are representative of justice-involved individuals. Unfortunately, existing normative data appear unlikely to represent justice-involved individuals due to significant demographic and clinical factors specific to this population. As a result, the interpretation of neuropsychological performance with justice-involved individuals using existing normative data may increase the risk of inaccurate description, invalid clinical conceptualization, misdiagnosis of impairment, and misattribution of deficits in functional-legal capacities. The current study aimed to examine the use of neuropsychological assessment with justice-involved men. METHOD: A sample of incarcerated men (N = 95) was assessed using a battery of demographic, clinical, and neuropsychological measures. RESULTS: Descriptive analyses showed the demographic and clinical diversity of justice-involved men. Inferential statistical analyses, effect size calculations, and clinical analyses demonstrated that a sample of justice-involved men performed significantly differently and was more impaired than commonly referenced normative samples across multiple measures of intellectual functioning, attention, verbal fluency, and executive functioning. Preliminary data are provided to aid the use of the selected neuropsychological measures with justice-involved men. CONCLUSIONS: Justice-involved men appear to represent a distinct neuropsychological population. Group-specific normative data will be useful to help ensure that opinions about these individuals are relevant, valid, and admissible within legal decision-making in criminal contexts. The current data can guide future efforts to develop substantive normative data on neuropsychological measures likely to be used in the assessment of justice-involved men.

Red flags in the clinical interview may forecast invalid neuropsychological testing.

OBJECTIVE: Evaluating assessment validity is expected in neuropsychological evaluation, particularly in cases with identified secondary gain, where malingering or somatization may be present. Assessed with standalone measures and embedded indices, all within the testing portion of the examination, research on validity of self-report in the clinical interview is limited. Based on experience with litigation-involved examinees recovering from mild traumatic brain injury (mTBI), it was hypothesized that inconsistently reported date of injury (DOI) and/or loss of consciousness (LOC) might predict invalid performance on neurocognitive testing. METHOD: This archival study examined cases of litigation-involved mTBI patients seen at an outpatient neuropsychological practice in Philadelphia, PA. Coded data included demographic variables, performance validity measures, and consistency between self-report and medicolegal records. RESULTS: A significant relationship was found between the consistency of examinees' self-report with records and their scores on performance validity testing, X2 (1, N = 84) = 24.18, p < .01, Φ = .49. Post hoc testing revealed significant between-group differences in three of four comparisons, with medium to large effect sizes. A final post hoc analysis found significance between the number of performance validity tests (PVTs) failed and the extent to which an examinee incorrectly reported DOI r(83) = .49, p < .01. Using inconsistently reported LOC and/or DOI to predict an examinee's performance as invalid had a 75% sensitivity and a 75% specificity. CONCLUSION: Examinees whose reported DOI or LOC differs from records may be more likely to fail one or more PVTs, suggesting possible symptom exaggeration and/or under performance on cognitive testing.s.

Cognitively-based methods of enhancing and maintaining functioning in those at risk of Alzheimer's disease.

Projections indicate that the prevalence of Alzheimer's disease (AD) and other dementias will increase two to three fold in the coming decades. As a result, there has been considerable interest in identifying methods that maintain or enhance cognitive functioning in these older adults. Existing pharmacological agents are limited in this respect and disease-modifying agents are years away from being available. Cognitively based interventions (i.e., cognitive training, cognitive rehabilitation) hold particular promise for maximizing patients' functioning, are relatively inexpensive, and have virtually no side effects. Everyday life is complex and multifaceted, which means that a personalized approach is essential for maximizing and prolonging functioning in each patient. Unfortunately, little is known about the factors contributing to such an approach. The current review first identifies several lifestyle factors that have been shown to be neuroprotective as well as risk factors that may ultimately contribute to the efficacy of different cognitive intervention techniques. There is a critical need to understand the conditions under which individual techniques are effective; an issue examined through characteristic examples across the AD spectrum. While limited at this time, there is some evidence of the long-term benefits of cognitive intervention. We conclude by describing several critical areas of investigation and proposing a clinically oriented framework for both furthering cognitive intervention research and providing patient-centered care.

Utility of the Rey-15 recognition trial to detect invalid performance in a forensic neuropsychological sample.

The current study sought to address the utility of the Rey Fifteen Item Test (Rey-15), with the use of a combined score [recall correct + (recognition correct - false positives)], to distinguish between valid and invalid performance among a sample of litigating persons referred for neuropsychological evaluation. Scores on the Rey-15 were analyzed across four comparison groups: (1) litigating persons with evidence of invalid performance (n = 29), (2) litigating persons with valid performance (n = 63), (3) learning-disabled patients (n = 36), and (4) a mixed clinical neuropsychological sample not involved in litigation (n = 54). A Rey-15 combined cutoff score of < 21 yielded the highest sensitivity (70%) and specificity (92.8%) rates. If the Rey-15 is to be used in clinical practice to detect invalid performance, the recognition trial with combined score < 21 should be used. Findings support the use of the combined Rey-15 score in place of the previously used recall Rey-15 score to improve sensitivity and specificity rates for detection of invalid performance in litigating neuropsychological referrals.

Temporal order memory differences in Alzheimer's disease and vascular dementia.

Determining the order of events is essential for accurate memory recollection: an ability previously linked to both frontal and medial temporal functioning. Frontal-subcortical and medial temporal dysfunction typify vascular dementia (VaD) and Alzheimer's disease (AD), respectively. Therefore, we assessed patients' ordering abilities using a novel sequencing task that progressively increased memory load. VaD patients made more errors and selected more previously encountered stimuli than did AD. Curve analysis revealed a general decline in ordering for VaD whereas error production in AD is more dependent on memory load. These findings generally support the role of frontal-subcortical functioning in temporal order memory.

Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting.

It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory-III (MCMI-III), were examined. TOMM and RDS scores were uncorrelated with MCMI-III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting.

Personality disorder symptomatology and neuropsychological functioning in closed head injury.

Despite an emerging literature characterizing the neuropsychological profiles of borderline, antisocial, and schizotypal personality disorders, relations between personality disorder traits and neurocognitive domains remain unknown. The authors examined associations among Millon Clinical Multiaxial Inventory-III personality disorder scales and eight neuropsychological domains in 161 patients referred for neuropsychological evaluation following closed head injury. Most personality disorder scales were associated with some decrement in cognitive function, particularly speeded processing, executive function, and language, while histrionic and narcissistic scales had positive relations with neuropsychological functioning. Results suggest that many personality disorder traits are related to neurocognitive function, particularly those functions subserved by frontal and temporal regions.

Assessing personality and psychopathology after traumatic brain injury with the Millon Clinical Multiaxial Inventory-III.

PURPOSE: Despite the widespread use of objective personality inventories as part of neuropsychological assessments of traumatic brain injury (TBI) patients, little research exists to support the use of these instruments with TBI populations. The purpose of the present study is two-fold: first, to examine the prevalence and extent of personality and psychopathological disturbance in TBI patients compared with a general psychiatric sample and, secondly, to determine whether personality profiles of TBI patients fall within a pathological range relative to normative psychiatric and non-psychiatric populations. METHODS: Age-, gender- and ethnically-matched TBI and psychiatric patients (n = 462) completed the Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS: TBI patients had more frequent elevations on histrionic, compulsive and somatoform scales compared with the matched psychiatric sample. Most scales for TBI patients fell outside of the range of the test's normative psychiatric population. CONCLUSIONS: Implications for interpretation of MCMI-III profiles of TBI patients are discussed.