Personality in Autism Spectrum Disorder: Associations With Face Memory Deficit and Theory of Mind.

OBJECTIVE: To examine the personality profiles of adults with autism spectrum disorder (ASD) using a standard personality assessment and to investigate the association between personality, ASD-related face memory deficit (FMD), and theory of mind (ToM). In a broader context, to examine whether there are distinct clinical phenotypes in the ASD population that have implications for personality development and treatment. METHOD: Fifty-five adults with ASD and 22 neurotypical (NT) adults underwent a battery of neuropsychological tests, including measures of personality, face memory, and ToM. We compared ASD and NT groups in terms of their Personality Assessment Inventory (PAI) profiles. Additional analyses focused on the association between specific PAI scales and FMD. Performance on the Eyes Test was compared across groups and was examined in relation to FMD. RESULTS: Adults with ASD demonstrated significant elevations on several PAI scales compared with NT adults. The presence of FMD was associated with differing PAI profiles among the ASD adults. The ASD adults with FMD scored significantly higher on scales that are sensitive to positive impression management and treatment rejection and significantly lower on scales that are sensitive to borderline personality, anxiety, depression, schizophrenia, and stress. There was a significant association between performance on the Eyes Test and FMD in the ASD group. CONCLUSION: Adults with ASD have a unique personality profile. Further, ASD adults with FMD have reduced insight into their difficulties with emotional processing and may not be as sensitive as ASD adults without FMD to the emotions of others.

Transient News Events Test: feasibility in assessment of post-temporal lobectomy remote memory deficits.

Although anterograde memory deficits are well documented in patients with epilepsy, the extent to which remote memory deficits occur is less clear. This is due in part to a lack of reliable methods for assessment. The present study examined the feasibility of using the Transient News Events Test (TNET) to assess remote memory in subjects status post anterior temporal lobectomy (ATL) for the treatment of refractory seizures. Results indicated significantly poorer performance of the patient group compared to healthy controls. The decrement in performance within the patient group was evident only for items from more recent time periods. Reasons for an apparent stability of the most remote memories with ATL and implications regarding hippocampal function are reviewed. In conclusion, the TNET provides a feasible method for assessment of remote memory function in patients with epilepsy, with decrements in performance noted in comparison to a healthy control group in this retrospective study.

Gray matter volumes and cognitive ability in the epileptogenic brain malformation of periventricular nodular heterotopia.

Periventricular nodular heterotopia (PNH) is a brain malformation clinically characterized by the triad of epilepsy, normal intelligence, and dyslexia. We investigated the structure-function relationship between cerebral volumes and cognitive ability in this disorder by studying 12 subjects with PNH and 6 controls using volumetric analysis of high-resolution anatomical MRI and neuropsychological testing. Total cerebral volumes and specific brain compartment volumes (gray matter, white matter, and cerebrospinal fluid) in subjects with PNH were comparable to those in controls. There was a negative correlation between heterotopic gray matter volume and cortical gray matter volume. Cerebral and cortical volumes in PNH did not correlate with Full Scale IQ, unlike in normal individuals. Our findings support the idea that heterotopic nodules contain misplaced neurons that would normally have migrated to the cortex, and suggest that structural correlates of normal cognitive ability may be different in the setting of neuronal migration failure.

Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests.

OBJECTIVES: To examine the association between performance on subtests of the Mini-Mental State Examination (MMSE) and driving competence in people with cognitive impairment (CI) as well as those with no cognitive impairment (NCI). DESIGN: Retrospective observational study. SETTING: Participants referred for a DriveWise evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts, were included in the study. PARTICIPANTS: A total of 419 participants referred for a DriveWise evaluation was studied. The average age of the sample was 77.69 years. In this study, people with an MMSE score lower than 25 were included in the CI group; 41% of participants had CI. MEASUREMENTS: All participants underwent mental status screening with the MMSE, and all underwent a 45-minute road test modeled after the Washington University Road Test adapted for use in Boston streets. RESULTS: In both groups, poor road test performance was associated with low scores on the MMSE. In drivers with CI, MMSE total score and performance on the attention subtest were significantly lower for those who failed the road test. In drivers with NCI, the MMSE total score and orientation subtests were significantly lower for those who failed the road test. CONCLUSIONS: Clinicians working with older people should know that the MMSE is an effective tool to screen for driving safety, but MMSE subtests are differentially sensitive to driving safety in people with and without CI. Poor performance on specific MMSE subtests may prompt further evaluation of driving competence with a road test. J Am Geriatr Soc 67:790-793, 2019.

Mild cognitive impairment: a neuropsychological perspective.

Mild cognitive impairment (MCI) is a clinical diagnosis in which deficits in cognitive function are evident but not of sufficient severity to warrant a diagnosis of dementia. For the majority of patients, MCI represents a transitional state between normal aging and mild dementia, usually Alzheimer's disease. Multiple subtypes of MCI are now recognized. In addition to presentations featuring memory impairment, symptoms in other cognitive domains (eg, executive function, language, visuospatial) have been identified. Neuropsychological testing can be extremely useful in making the MCI diagnosis and tracking the evolution of cognitive symptoms over time. A comprehensive test battery includes measures of baseline intellectual ability, attention, executive function, memory, language, visuospatial skills, and mood. Informant-based measures of neuropsychiatric symptoms, behaviors, and competency in instrumental activity are also included. Careful assessment can identify subtle deficits that may otherwise elude detection, particularly in individuals of superior baseline intellectual ability. As we move closer to disease-modifying therapy for Alzheimer's disease, early identification becomes critical for identifying patients who have an opportunity to benefit from treatment.

DriveWise: an interdisciplinary hospital-based driving assessment program.

Health care professionals working with the elderly have opportunities through research and clinical practice to shape public policy affecting the older driver. This article describes DriveWise, an interdisciplinary hospital-based driving assessment program developed in response to clinical concerns about the driving safety of individuals with medical conditions. DriveWise clinicians use evidence-based, functional assessments to determine driving competence. In addition, the program was designed to meet the emotional needs of individuals whose driving safety has been called into question. To date, approximately 380 participants have been assessed through DriveWise. The following report details the DriveWise mission, DriveWise team members, and road test results. We continue to refine the assessment process to promote safety and support the dignity and independence of all participants. The DriveWise interdisciplinary approach to practice is a concrete example of how gerontological education across professions can have direct benefits to the older adult.

Errors versus speed on the trail making test: Relevance to driving performance.

BACKGROUND/OBJECTIVES: Many studies have demonstrated that speed to complete items on the Trail Making Tests (TMT A and TMT B) is useful in the prediction of driving safety. However, there is no consensus regarding optimal "cut scores" to discriminate between safe and unsafe drivers. In this study, we examine TMT speed and errors in drivers referred for a road test. DESIGN: Retrospective analysis. SETTING: Patients referred for a DriveWise® evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts. PARTICIPANTS: Drivers age 65 or older were included (total n = 373). Forty-five percent of the sample had been diagnosed with Cognitive Impairment (CI) whereas the remaining participants were in the No Cognitive Impairment (NCI) group. MEASUREMENTS: TMT Parts A & B, Folstein Mini Mental Status Examination, Washington University Road Test. RESULTS: CI drivers with TMT A speed exceeding 46 s were more likely to fail the road test whereas TMT B speed was not a sensitive metric in this group. In the No Cognitive Impairment (NCI) group, TMT B speed exceeding 131 s predicted driving impairment whereas TMT A speed was not sensitive. Error scores were not useful in the determination of driving fitness for either group. CONCLUSIONS: This study provides useful criteria for health providers working with older people in the determination of driving fitness. Results suggest that TMT speed, but not error rate, is associated with road test performance. Based on our work, we advocate that pre-existing dementia should be taken into consideration when using TMT performance as a screen for driving.

The use of the Color Trails Test in the assessment of driver competence: preliminary report of a culture-fair instrument.

Studies have shown that the Trail Making Test (TMT) predicts real-world driving performance in individuals who have cognitive deficits. However, because this test requires knowledge of the Latin alphabet, the TMT may not be appropriate for individuals who are illiterate or for those whom English is not their primary language. Because the Color Trails Test (CTT) is not influenced by knowledge of the alphabet, the CTT may be a culture-fair alternative to the TMT. To date, the utility of the CTT in the evaluation of driver competence has not been established. In the current study, individuals referred for a comprehensive driving assessment underwent testing with the TMT and CTT. The results suggest that the CTT and the TMT provide similar information regarding road-test outcome. Thus, the CTT may be a culture-fair alternative to the TMT in the assessment of driver competence.

Validity of the mini-mental state examination and the montreal cognitive assessment in the prediction of driving test outcome.

OBJECTIVES: To evaluate the effectiveness of two cognitive screening measures, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in predicting driving test outcome for individuals with and without cognitive impairment. DESIGN: Retrospective cohort study. SETTING: A clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: Adult drivers who underwent assessment with the MMSE and MoCA as part of a comprehensive driving evaluation between 2010 and 2014 (N=92). MEASUREMENTS: MMSE and MoCA total scores were independent variables. The outcome measure was performance on a standardized road test. RESULTS: A preestablished diagnosis of cognitive impairment enhanced the validity of cognitive screening measures in the identification of at-risk drivers. In individuals with cognitive impairment there was a significant relationship between MoCA score and on-road outcome. Specifically, an individual was 1.36 times as likely to fail the road test with each 1-point decrease in MoCA score. No such relationship was detected in those without a diagnosis of cognitive impairment. CONCLUSION: For individuals who have not been diagnosed with cognitive impairment, neither the MMSE nor the MoCA can be reliably used as an indicator of driving risk, but for individuals with a preestablished diagnosis of cognitive impairment, the MoCA is a useful tool in this regard. A score on the MoCA of 18 or less should raise concerns about driving safety.