Reliable Change on Neuropsychological Tests in the Uniform Data Set.

Longitudinal normative data obtained from a robust elderly sample (i.e., believed to be free from neurodegenerative disease) are sparse. The purpose of the present study was to develop reliable change indices (RCIs) that can assist with interpretation of test score changes relative to a healthy sample of older adults (ages 50+). Participants were 4217 individuals who completed at least three annual evaluations at one of 34 past and present Alzheimer's Disease Centers throughout the United States. All participants were diagnosed as cognitively normal at every study visit, which ranged from three to nine approximately annual evaluations. One-year RCIs were calculated for 11 neuropsychological variables in the Uniform Data Set by regressing follow-up test scores onto baseline test scores, age, education, visit number, post-baseline assessment interval, race, and sex in a linear mixed effects regression framework. In addition, the cumulative frequency distributions of raw score changes were examined to describe the base rates of test score changes. Baseline test score, age, education, and race were robust predictors of follow-up test scores across most tests. The effects of maturation (aging) were more pronounced on tests related to attention and executive functioning, whereas practice effects were more pronounced on tests of episodic and semantic memory. Interpretation of longitudinal changes on 11 cognitive test variables can be facilitated through the use of reliable change intervals and base rates of score changes in this robust sample of older adults. A Web-based calculator is provided to assist neuropsychologists with interpretation of longitudinal change.

The Neuropsychological Assessment Battery Driving Scenes Test in a Dementia Clinic.

OBJECTIVE: In dementia research, the Driving Scenes test from the Neuropsychological Assessment Battery has been shown to relate to memory, dementia diagnosis, and functional impairment. The aim of the current study was to examine Driving Scenes and its component scores, and their relationships with cognition and daily functioning, in a mixed dementia clinic sample. METHOD: One hundred U.S. military veterans between the ages of 55 and 88 were administered a full neuropsychological protocol that included Driving Scenes. RESULTS: The Driving Scenes score and its subscores were strongly related to memory skills, and there were additional subscore associations with language and visuospatial functions. Driving Scenes uniquely predicted reported bill payment difficulties and tendency to get lost while driving, which were not predicted by other performances across cognitive domains. CONCLUSION: Driving Scenes is a clinically and functionally relevant measure of memory. Although the Driving Scenes total score remains useful in dementia evaluations, component scores and error scores contribute additional practical information.

When is it appropriate to infer cognitive impairment on the basis of premorbid IQ estimates? A simulation study.

Whether an individual meets psychometric criteria for cognitive impairment is dictated by the comparison criterion, which is typically either a normative mean or a known or estimated previous level of ability. This study investigated the conditions under which adjusting normative expectations based on estimated premorbid intelligence would be appropriate. A simulated data set was derived and several parameters were systematically varied: the correlation between premorbid intelligence and the cognitive test score, the cutoff used to classify a score as "normal" or "abnormal", and the population base rate of cognitive impairment. Simulation results demonstrated that the correlation between premorbid intelligence and the cognitive score was the only parameter to substantially influence the trade-off between the two normative approaches, with correlations above ρ = .35 signifying greater advantage to adjusting normative expectations by premorbid intelligence. These findings inform common neuropsychological practices regarding the application of premorbid intelligence estimates to the detection of cognitive impairment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Decision rules for an abbreviated administration of the Test of Memory Malingering.

The present study investigated abbreviation methods for the Test of Memory Malingering (TOMM) in relation to traditional manual-based test cutoffs and independently derived more stringent cutoffs suggested by recent research (≤48 on Trial 2 or 3). Consecutively referred outpatient U.S. military veterans (n = 260) were seen for neuropsychological evaluation for mild traumatic brain injury or possible attention-deficit/hyperactivity disorder. Performance on TOMM Trial 1 was evaluated, including the total score and errors on the first 10 items (TOMMe10), to determine correspondence and redundancy with Trials 2 and 3. Using the traditional cutoff, valid performance on Trials 2 and 3 was predicted by zero errors on TOMMe10 and by Trial 1 scores greater than 41. Invalid performance was predicted by commission of more than three errors on TOMMe10 and by Trial 1 scores less than 34. For revised TOMM cutoffs, a Trial 1 score above 46 was predictive of a valid score, and a TOMMe10 score of three or more errors or a Trial 1 score below 36 was associated with invalid TOMM performance. Conditional abbreviation of the TOMM is feasible in a vast majority of cases without sacrificing information regarding performance validity. Decision trees are provided to facilitate administration of the three trials.

The Rey 15-Item Memory Test in US veterans.

INTRODUCTION: The Rey 15-item Test is a public-domain, memory-based performance validity test, frequently used in clinical settings. Various efforts have been made to modify the test to make it more sensitive and more robust to effects of lower education and intelligence. The most promising of these is the addition of a recognition trial to the existing free recall paradigm. METHOD: The present study explored the use of the Rey-15 + Recognition Trial in a sample of 155 younger U.S. military veterans seen for evaluation of mild traumatic brain injury or attention deficit hyperactivity disorder (50 cases classified as invalid, 105 classified as valid). RESULTS: Optimal classification accuracy was obtained on the Combination index (cutoff ≤23, sensitivity = 50%, specificity = 95%) and the Recognition Hits score (cutoff ≤11, sensitivity = 52%, specificity = 93%). The Free Recall score had somewhat lower sensitivity when a similar 95% specificity threshold was set (cutoff ≤11, 38% sensitivity). A qualitative error score used in previous studies did not improve classification accuracy. CONCLUSIONS: The Rey-15 + Recognition Trial proved to be effective, with particular advantage bestowed by the recognition trial. Implications of these findings in the context of the study's clinical sample of military veterans and in the broader literature are discussed.

Motor tests and cognition in healthy older adults.

UNLABELLED: The Finger Tapping Test (FTT) and Grooved Pegboard Test (GPT) are commonly used in neuropsychological assessments. The performance of healthy older adults on these tasks has not been well characterized in the existing literature. The present study examines FTT and GPT performance in a sample of 307 community-dwelling older individuals (ages 55-74) with no neurological or psychiatric history. RESULTS: FTT performance was influenced by age, gender, and education, while GPT performance was influenced by age and gender. Findings are presented for both hands, as well as dominant-to-non-dominant hand ratio score, on each test. Correlations with other neuropsychological measures demonstrated that the GPT is more strongly correlated with measures of most domains (memory, processing speed, executive functioning, and spatial organization) than the FTT. CONCLUSIONS: While the FTT can be used to measure upper extremity motor ability, the GPT may be more strongly associated with general cognitive functioning in healthy adults. The FTT and GPT results presented will improve the utility of these tasks in clinical assessments of older adults.

Neurobehavioral symptom validity in U.S. Department of Veterans Affairs (VA) mild traumatic brain injury evaluations.

INTRODUCTION: The use of the Neurobehavioral Symptom Inventory (NSI) by U.S. Department of Defense and Veterans Affairs (VA) providers for all mild traumatic brain injury (mTBI) evaluations led to the development of methods to screen for symptom exaggeration. The present study was designed to explore the clinical utility of three metrics-the Validity-10 scale, the NSI total score, and the mild Brain Injury Atypical Symptoms Scale (mBIAS)-relative to the results of several different criterion measures of symptom validity. METHOD: Participants in this study were 82 U.S. military veterans referred for evaluations by a VA polytrauma clinic in the context of a history of mTBI. All participants were administered the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF), NSI, and mBIAS. RESULTS: None of the three scales displayed adequate accuracy at predicting failure on cognitive performance validity tests or on the MMPI-2-RF Fp-r scale. For the remaining MMPI-2-RF overreporting indices (F-r, Fs, FBS-r, RBS) and for an index based on elevation of any single MMPI-2-RF overreporting index, both the NSI total score and Validity-10 displayed high positive predictive power with adequate to good sensitivity values (39% to 76%). CONCLUSION: These findings support the use of Validity-10 and NSI total score as symptom validity tests (SVTs) that can be used to assess for neurobehavioral symptom exaggeration.

Rey Auditory Verbal Learning Test and Rey-Osterrieth Complex Figure Test performance validity indices in a VA Polytrauma sample.

Objective: Performance validity assessment is a crucial component of any neuropsychological evaluation, particularly in settings where potential exaggeration of complaints and deficits is heightened. Standalone performance validity measures can be time-consuming, so many investigations have explored embedded indices within existing measures. The Rey Auditory Verbal Learning Test (RAVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) each have a number of available embedded performance validity tests (PVTs). This investigation sought to evaluate several of these indices and to identify the most effective within a VA mild traumatic brain injury (mTBI)/Polytrauma sample. Method: A sample of 100 U.S. military veterans underwent clinical neuropsychological evaluation. There were 37 individuals whose test results were considered invalid based on failure of 2 or more independent PVTs, 47 whose results were valid, and 16 whose results were equivocal (failure on one PVT). The classification accuracies of published PVTs from the RAVLT and ROCF were evaluated. Results: Several indices had sensitivity values above 50% and strong positive predictive power with specificity held over 90%. Conclusions: The results demonstrated that there are multiple effective RAVLT & ROCF PVTs available for use in mTBI evaluations with veterans.

Tobacco Use and Cognitive Functioning in Veterans of the Conflicts in Iraq and Afghanistan.

Tobacco use is a prevalent problem in the general population as well as among military veterans. Despite the fact that tobacco users are at an increased risk of many medical and psychiatric comorbidities, the risk of cognitive impairment in younger active tobacco users is less studied. Military veterans from the conflicts in Iraq and Afghanistan (n = 113) were administered a neuropsychological protocol. Even after controlling for the severity of PTSD symptoms, tobacco use was negatively related to performance on measures of processing speed, memory, and executive functioning. The current findings have implications for the neuropsychological evaluation of tobacco users.

Trail Making Test errors in normal aging, mild cognitive impairment, and dementia.

The objective of the present study was to provide normative data for Trail Making Test (TMT) time to completion and performance errors among cognitively normal older adults, and to examine TMT error rates in conjunction with time scores for pre-clinical and clinical Alzheimer's disease (AD) diagnostic decision-making. A sample of 526 individuals was classified into three diagnostic groups (normal controls, N=269; mild cognitive impairment, MCI, N=200; AD, N=57) by a multidisciplinary consensus conference. Results indicated that performance differed among the three groups for TMT A and B time scores as well as TMT B error rate. Diagnostic classification accuracy (i.e., sensitivity, specificity, and positive and negative predictive powers) is described for various combinations of the diagnostic groups. The findings show that TMT B time and errors are independently meaningful scores, and both therefore have clinical utility in assessing individuals referred for dementia evaluations.

Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia.

OBJECTIVE: Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia. METHODS: The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol. RESULTS: ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance. CONCLUSIONS: NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.

Performance validity and processing speed in a VA Polytrauma sample.

OBJECTIVE: While recognition memory has been the primary tool for the assessment of performance validity in neuropsychological evaluations, some consideration has also been given to embedded measures from other cognitive domains, including processing speed. The present study evaluated the classification accuracy of several speed-based measures in a Veterans Affairs Medical Center Polytrauma sample. METHOD: The present sample consisted of 114 military veterans (Mean age = 35.5, SD = 9.4) referred for a suspected history of mild traumatic brain injury who were administered a full neuropsychological protocol that included several validity checks. Veterans were assigned to Valid (n = 80) or Invalid (n = 34) groups based on outcomes of performance validity measures (PVMs). RESULTS: Several processing speed measures yielded acceptable or excellent classification accuracy; sensitivity values ranged from 29 to 53% with specificity values above 90%. Efforts to identify an improved algorithm that would collapse across multiple processing speed PVMs were unsuccessful compared to classification based on single measures. CONCLUSIONS: Processing speed measures can serve as efficient performance validity assessment tools.

Evaluation of performance validity using a Rey Auditory Verbal Learning Test forced-choice trial.

OBJECTIVE: Forced-choice (FC) recognition memory is a common performance validity assessment methodology. This study introduces and evaluates the classification accuracy of a FC recognition trial for the Rey Auditory Verbal Learning Test (RAVLT). METHOD: The present sample of 122 military veterans (Mean age = 35.4, SD = 9.3) were all administered the RAVLT along with the FC procedure as part of a full neuropsychological protocol. Veterans were assigned to valid (n = 94) or invalid (n = 28) groups based on outcomes of performance validity measures. RESULTS: The FC procedure was found to have strong sensitivity (67.9%) and specificity (92.6%) in predicting validity group status based on a cutoff score of ≤ 13. The FC trial outperformed RAVLT recognition hits (sensitivity = 46.4%, specificity = 91.5%) as a predictor of invalid performance. CONCLUSIONS: The RAVLT FC is demonstrated to be an effective measure of performance validity and is recommended for use as an adjunctive trial for the RAVLT.

Is poor performance on recognition memory effort measures indicative of generalized poor performance on neuropsychological tests?

The detection of suboptimal effort has become crucial in clinical neuropsychological practice in order to make accurate diagnoses, prognoses, and referrals. Symptom Validity Testing (SVT) has been the most commonly utilized model for assessing effort, and frequently includes recognition memory tasks. Some conflicting views on this model purport, however, that measures of effort gathered from a recognition memory paradigm do not necessarily extend to effort in other cognitive domains and other areas of performance. The present study sought to investigate whether performance on an SVT measure, which utilizes recognition memory, the TOMM, could predict performance on other measures that do not evaluate recognition memory or just memory per se in a group of mildly traumatic brain-injured litigants. Results indicated that poor performance on the TOMM was significantly correlated with poorer performance on the WAIS-R and the HRNB-A. Further, experimental exploration of these results indicated that the overall neuropsychological performance of litigants with suboptimal effort was poorer than what is generally expected from mild TBI individuals, and was also lower than the other mild TBI examinees in the study, who were not classified by the TOMM as exhibiting suboptimal effort. These findings support the proposition that poor effort as measured by recognition memory effort measures is not restricted to recognition and memory measures. In fact, in the present study it appears that a poor performance on the TOMM is predictive of a generalized poorer performance on standardized measures such as the WAIS-R and the HNRB-A.

Abbreviating the Finger Tapping Test.

The Finger Tapping Test (FTT) has a strong empirical base but its procedures are inconsistent and the test can be time-consuming. To simplify and abbreviate administration procedures, several potential abbreviated procedures were evaluated using a sample of 71 individuals presenting to a VA Hospital for neuropsychological evaluation. A short version using the mean score of Trials 3-5 for each hand was found to be a strong predictor of full-test performance. The abbreviated version also had stronger reliability than the full version, and it accurately predicts impairment and performance validity classification based on the full version. This abbreviated version appears to be more efficient and sufficiently accurate to be considered for use in lieu of the traditional and potentially longer version of the FTT.

The effect of depression and anxiety on the TOMM in community-dwelling older adults.

Tests of possible malingering are in increasing demand among neuropsychologists. The Test of Memory Malingering (TOMM) is resistant to many neurological conditions, including traumatic brain injury, dementia, and aphasia. Less clear is the impact of psychological conditions on TOMM performance. This study examined a sample of community-based older adults (55-75) to determine whether scores on the TOMM are influenced by the presence of symptoms of depression or anxiety, as measured by the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), respectively. The results indicate that, regardless of BDI or STAI scores, all subjects scored above 45 correct out of 50 on TOMM Trial 2. These findings demonstrate that depression and anxiety levels in an older community-dwelling sample do not negatively affect performance on the TOMM.

Edith Kaplan and the Boston Process Approach.

The history including some of the intellectual origins of the Boston Process Approach and some misconceptions about the Boston Process Approach are reviewed. The influence of Gestalt psychology and Edith Kaplan's principal collaborators regarding the development of the Boston Process Approach is discussed.

Impact of diagnosis threat on academic self-efficacy in mild traumatic brain injury.

The current study examined the effect of diagnosis threat on self-efficacy and neuropsychological performance in mild traumatic brain injury (TBI). Forty-nine participants with a history of mild TBI were randomized to a diagnosis threat or control group. The diagnosis threat group were told they were selected based on their history of TBI, while control group participants were told to perform their best. Individuals in the diagnosis threat group reported significantly lower academic self-efficacy than control participants. The groups performed differently on only one neuropsychological measure. These results suggest that diagnosis threat may have a greater impact on psychological factors than on cognitive performance.

An exploratory study of the use of the Wechsler Digit-Symbol Incidental Learning procedure with the WAIS-IV.

The Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) does not include the optional Incidental Learning procedure for the Digit-Symbol subtest (now simply called Coding) that had been available in the WAIS-Third Edition (WAIS-III). However, the procedure itself has been shown to have some utility in assessment of incidental memory processes. The current study of a mixed clinical outpatient sample (n = 75) sought to identify salient characteristics of the Incidental Learning tasks as applied to WAIS-IV Coding. Findings showed that the Pairing procedure, when applied to the WAIS-IV, has different characteristics than it did with the WAIS-III; it is more difficult overall, and different items tend to be more prominently recalled than others. The Free Recall procedure for the WAIS-IV is comparable to the WAIS-III version in overall difficulty. Implications and implementation of the current findings are discussed.

Test-retest stability on the WRAT-3 reading subtest in geriatric cognitive evaluations.

The primary goal of this study was to establish the stability of the Wide Range Achievement Test (WRAT-3) Reading score across two annual assessments of aging individuals. Participants were classified as controls (n = 200), mild cognitive impairment (MCI; n = 137), or possible or probable Alzheimer's disease (AD; n = 41). Test-retest stability was acceptable to high for all diagnostic groups. The descriptive classification (e.g., "average") remained consistent for only 74% of participants. Results indicated that WRAT-3 Reading scores are appropriate for use with older adults, though the use of categorical descriptors to describe premorbid ability based on these scores is not supported.