Evaluating Decision-Making: Validation and Regression-Based Normative Data of the Judgment Assessment Tool.

OBJECTIVE: This study presents the results of the development and validation of the Judgment Assessment Tool (JAT). The JAT measures two core aspects of judgment, namely generation of solutions (G) and assessment of options (A), the two first stages of decision-making process. METHOD: During the test development phase (study 1), a preliminary version of the JAT was evaluated by 14 experts and tested on 30 healthy controls (HC). One hundred and twenty HC (20-84 years old) and 24 participants with mild Alzheimer's disease (AD) were subsequently tested on the final version of the JAT (study 2). HC participants aged 60 and over and AD participants underwent a neuropsychological evaluation. RESULTS: The internal consistency of the final version of the JAT assessed by Cronbach's a was 0.71 for the HC group and 0.85 for the AD group. Performance on the JAT was normally distributed both in the HC and AD groups. The test correlated with abstract reasoning, verbal fluency, and working memory. Results revealed adequate test-retest reliability and excellent interrater reliability (k coefficient was 0.92 for the G section and 0.93 for the A section). Demographically adjusted normative data were generated based on a regression analysis and results showed that AD participants performed worse than HC with a large effect size (Cohen's d = 1.79). CONCLUSION: Overall, these results provide evidence of the reliability and strong construct validity of the JAT to evaluate judgment.

Neuropsychological performance before and after partial or complete insulectomy in patients with epilepsy.

Resection of the insular cortex is becoming more frequent as it is increasingly recognized that a nonnegligible proportion of surgical candidates with drug-resistant epilepsy have an epileptogenic zone that involves the insula. In the last decades, however, the insula has been proposed to be involved in several neuropsychological functions, and there is a lack of documentation on whether partial or complete insulectomy results in permanent cognitive impairments in this clinical population. In this study, we conducted standard preoperative and postoperative neuropsychological assessments in 18 patients undergoing epilepsy surgery that included the removal of the insula in the right (n=13) or the left (n=5) hemisphere. Postoperative testing was conducted at least five months after surgery. Cognitive impairments were common and heterogeneous prior to surgery, with language and verbal memory impairments being especially frequent among patients in whom epileptic seizures originated from the left hemisphere. After surgery, declines and improvements occurred on a variety of outcomes, although new deficits were relatively infrequent among patients who had obtained normal performance at baseline. Statistical comparisons between preoperative and postoperative assessments revealed significant deterioration of only one outcome - the color naming condition of the Stroop test - which relies on oro-motor speed and lexical access. These findings suggest that partial or complete resection of the insular cortex in patients with drug-refractory epilepsy can be conducted without major permanent neuropsychological impairments in a vast majority of patients. However, small decrements in specific cognitive functions can be expected, which should also be taken into account when considering the surgical option in this clinical population.

Ecological prospective memory assessment in patients with traumatic brain injury.

PRIMARY OBJECTIVE: Prospective memory (PM) impairments are often observed after traumatic brain injury (TBI). Although PM is crucial for daily functioning, few sensitive, valid and ecological clinical tests are available. To address these concerns, the authors developed a PM task, the TEMP, using naturalistic stimuli, in which each PM phase and component is evaluated independently in time- and event-based conditions. MAIN OUTCOMES AND RESULTS: The results show that moderate and severe TBI patients (n = 30), evaluated after spontaneous neurological recovery, experienced problems in learning the delayed intentions content and retrieving these intentions in the right context (prospective component), especially in the time-based condition. They also recalled fewer associated actions (retrospective component), but only in the time-based condition. Correlations revealed that the retrospective component was mainly supported by episodic retrospective memory processes, while the prospective component was supported by episodic retrospective memory processes, along with attentional and executive functions. Moreover, there was a significant correlation between performance on the TEMP and results on a questionnaire assessing PM functioning in daily living completed by participants' relatives. CONCLUSIONS: The TEMP therefore appears to be a sensitive tool for assessing PM problems that combines internal and ecological validity.

The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.

OBJECTIVES: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. DESIGN: Validation study. SETTING: A community clinic and an academic center. PARTICIPANTS: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). MEASUREMENTS: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. RESULTS: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). CONCLUSION: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.