Reliability and Factor Structure of the Saint Louis University Mental Status (SLUMS) Examination.

OBJECTIVES: Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. METHODS: We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. RESULTS: At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. CONCLUSIONS: The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. CLINICAL IMPLICATIONS: The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.

Evaluation of teleneuropsychology services in veterans during COVID-19.

This study evaluated the quality of direct-to-home teleneuropsychology (teleNP) services that offered patients choice of service modality. We conducted a quality assurance project in a sample of Veterans (N = 143) referred for a variety of referral reasons from a Midwestern Veteran Affairs Hospital. Neuropsychological evaluations were conducted between February and June 2021 during the second wave of the COVID-19 pandemic. We evaluated teleNP rate of use, factors influencing acceptability and feasibility, and cost savings. Approximately 40% of our scheduled patients completed full direct-to-home teleNP, with about 80% of our sample choosing at least one telehealth encounter as part of their evaluation. Age was a significant factor in predicting full teleNP use, with older adults preferring in-person testing. Digital divide consults (i.e., loaned tablets) led to an increase in teleNP use. Those utilizing full teleNP (interview, assessment, feedback) benefited from cost and travel distance savings. Most Veterans in our Midwestern Veteran Affairs Hospital used teleNP services during the second wave of the COVID-19 pandemic, with utilization influenced by specific patient demographics (i.e., age) and access to technology. Offering Veteran choice of assessment modality (in-person or video teleNP) was associated with significant cost reduction due to mileage savings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Montreal Cognitive Assessment: Norms and Reliable Change Indices for Standard and MoCA-22 Administrations.

OBJECTIVE: The Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations. METHOD: Data were obtained from 18,410 participants using the National Alzheimer's Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test-retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach's alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change. RESULTS: Strong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level. CONCLUSIONS: MoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores.

Classification statistics of the Montreal Cognitive Assessment (MoCA): Are we interpreting the MoCA correctly?

OBJECTIVE: The Montreal Cognitive Assessment (MoCA) is a common cognitive screener for detecting mild cognitive impairment (MCI). However, previously suggested cutoff scores of 26/30 and above is often criticized and lacks racial diversity. The purpose of this study is to investigate the potential influence of race on MoCA classification cutoff score accuracy. METHOD: Data were obtained from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set and yielded 4,758 total participants. Participants were predominately White (82.8%) and female (61.7%) with a mean age of 69.3 years (SD = 10.3) and education level of 16.3 years (SD = 2.6). Based on NACC's classification, participants were either cognitively normal (n = 3,650) or MCI (n = 1,108). RESULTS: Sensitivity and specificity analyses revealed that when using the cutoff score of ≤26/30, the MoCA correctly classified 73.2% of White cognitively normal participants and 83.1% of White MCI participants. In contrast, this criterion correctly classified 40.5% of Black cognitively normal participants and 90.8% of Black MCI participants. Our sample was highly educated; therefore, we did not observe significant differences in scores when accounting for education across race. Classification statistics are presented. CONCLUSIONS: Black participants were misclassified at a higher rate than White participants when applying the ≤26/30 cutoff score. We suggest cutoff scores of ≤25/30 be applied to White persons and ≤22/30 for Black persons. These findings highlight the need for racially stratified population-based norms given the high misclassification of Black participants without such adjustment.

Examining the item composition of the RBS in veterans undergoing neuropsychological evaluation.

The Response Bias Scale (RBS) is a measure of protocol validity that is composed of items from the Minnesota Multiphasic Personality Inventory - 2. The RBS has been successfully cross-validated as a whole, but the composition of the scale has not been reexamined until recently when three types of items were identified. In this study we sought to examine the reliability of the scale as a whole, as well as the items that are (a) empirically supported and conceptually similar (ES/CS), (b) empirically supported but not conceptually similar (ES/NS), and (c) not empirically supported (NES). Participants included 56 veterans undergoing neuropsychological evaluation for suspected traumatic brain injury. Results generally replicated Ratcliffe et al. finding that removing key NES items improved the internal consistency of the RBS from 0.706 to 0.747. Examined separately, ES/CS and ES/NS had internal consistencies of 0.629 and 0.605, respectively. One of the nine NES items had strong internal consistency, but none of the remaining eight had corrected item-total correlations above 0.194. NES items had an internal consistency of 0.177. Although the RBS is well-validated in detecting non-credible cognitive presentations, it may prove even more valuable after further item refinement whereby items detracting from its reliability and validity are excised.

Preliminary findings from reevaluating the MMPI Response Bias Scale items in veterans undergoing neuropsychological evaluation.

The Response Bias Scale (RBS) was developed to predict non-credible cognitive presentations among disability claimants without head injury. Developers used empirical keying, which is independent of apparent content, to select items from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) item pool that distinguished between individuals passing or failing performance validity tests (PVTs). No study has examined which of these items would have psychometric value when used in clinical neuropsychological evaluations. This study reexamined items comprising RBS with reference to manifest item content, internal consistency, PVTs, and a symptom validity test (SVT) in a sample of 173 predominately White male veterans (MAGE = 50.70, MEDU = 13.73) in a VA outpatient neuropsychology clinic. Participants completed the MMPI-2 Restructured Form (MMPI-2-RF), PVTs, and an SVT. The 28-item RBS appears to contain three types of items: those that manifestly address cognitive functioning, those that are supported but do not appear to address cognitive functioning, and nine items that were unrelated to cognition and not statistically supported. The 19 empirically supported items, or RBS-19, predicted PVT and SVT failures marginally better than the RBS. Both the RBS and RBS-19 had stronger relationships with SVTs relative to PVTs. Although the removal of the nine problematic items improved the diagnostic accuracy of the scale, it still did not reach the level that is generally considered to be clinically optimal. The RBS-19 offers a measure with improved internal consistency and predictive validity compared to the RBS and warrants additional research.