Predictive utility of the Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) in differentiating psychogenic nonepileptic seizures and epileptic seizures in male veterans.

OBJECTIVE: While psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) often present similarly, they are etiologically distinct, and correct diagnosis is essential for ensuring appropriate treatment and improving outcomes. The Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) may assist in differential diagnosis, but prior investigations have been limited by disproportionately female samples, inconsistent accounting for profile invalidity, and limited intra-scale variability from dichotomizing variables. The current investigation addressed these gaps by assessing diagnostic utility of the MMPI-2-RF in differentiating PNES and ES in a male sample of veterans while conservatively accounting for profile invalidity and using a statistical approach that allows for consideration of continuous independent variables to better appreciate intra-scale variance. METHOD: One hundred and forty-four veterans completed the MMPI-2-RF and were diagnosed with PNES (57.6%) or ES (42.4%) by a board-certified neurologist following continuous video-EEG monitoring. Participants with validity scores falling in the definitely or likely invalid ranges were excluded to ensure construct validity among clinical/substantive scales. Independent samples t-tests assessed differences in MMPI-2-RF variables by diagnostic groups. Hierarchical stepwise logistical regressions assessed predictive utility of MMPI-2-RF indices. A clinical calculator was derived from regression findings to help with diagnostic prediction. RESULTS: Males with PNES endorsed significantly higher scores on F-r, FBS-r, RBS, RC1, RC7, HPC, and NUC (medium to large effect sizes). The regression block that contained validity, restructured clinical (RC1), and substantive scales (GIC, SUI) had a hit rate of 75.69%, which was an improvement from the baseline model hit rate of 57.64%. Higher endorsement on RC1 and lower reporting on GIC significantly predicted PNES diagnosis for males. CONCLUSIONS: Minnesota Multiphasic Personality Inventory-2-RF improved diagnostic accuracy of PNES versus ES among male veterans, and RC1 (somatic complaints) emerged as a significant predictor for males with PNES, in line with hypotheses. Several clinical/substantive scales assisted with differential diagnosis after careful accounting for profile validity. Future studies can validate findings among males outside of veteran samples.

Predictors of rate of cognitive decline in patients with amnestic mild cognitive impairment.

OBJECTIVE: Amnestic mild cognitive impairment (MCI) is a known risk factor for conversion to Alzheimer's disease (AD). Although substantial research has been conducted on the general profile of amnestic MCI subjects and predictors of conversion to AD, research on predictors of rate of decline has been considerably less extensive. The present study sought to more systematically and comprehensively examine predictors of rate of cognitive decline in a longitudinal sample of individuals with MCI, including age, genetic vulnerability, baseline cognitive performance, and baseline neuropsychiatric severity. METHOD: Participants with single or multi-domain amnestic MCI (N = 151) were assessed at baseline and for a mean of 1.32 follow-up visits (mean interval from baseline to last follow-up = 1.61 years). RESULTS: Results showed that carriers of the ApoE ε4 allele declined more quickly on all three dementia severity measures compared to non-carriers. Older individuals did not decline more rapidly in dementia severity. Participants with lower executive functions composite scores and greater memory impairment severity at baseline predicted faster decline on dementia severity measures. Contrary to hypotheses, those with lower levels of depression at baseline declined more rapidly on dementia severity measures compared to those with higher levels of depression. CONCLUSION: Identifying potential predictors of rate of decline from amnestic MCI to AD could be clinically meaningful for prognostic purposes, understanding risk and protective factors, as well as guiding future treatments and clinical trials that could aim to target and delay progression among those patients who are vulnerable to more quickly convert to AD.

Benefit of phonemic cueing on confrontation naming in Alzheimer's disease.

Objective: Deficits in confrontation naming vary among persons with Alzheimer's disease (AD), including the extent to which phonemic cueing is helpful in generating the target word. This study examined neuropsychological correlates of phonemic cueing benefit and the influential effects of AD severity, estimated premorbid intellectual functioning, and apolipoprotein E genotype status.Method: Participants were 1104 individuals with mild to moderate AD who were administered the Boston Naming Test (BNT) as part of their initial neuropsychological evaluation.Results: Mild AD subjects benefited from phonemic cues significantly more than moderate AD subjects. Individuals with higher estimated premorbid IQ benefited more from phonemic cueing. Differences in phonemic cueing benefit between carriers and noncarriers of the ApoE ε4 allele were accounted for by naming ability, with carriers performing better on naming tasks compared to noncarriers. Phonemic cueing benefit uniquely contributed to cognitive performance on some semantic measures, phonemic fluency, and one nonsemantic visuospatial task.Conclusion: Individuals with probable AD who benefit more from phonemic cueing during confrontation naming tend to have higher estimated premorbid IQ and are milder in dementia severity. There is a positive association between phonemic cueing benefit and performance on select semantic measures and verbal fluency. Differences in phonemic cueing benefit between carriers and noncarriers of APOE ε4 allele can be explained by spontaneous naming performance. Results suggest complexity of underlying mechanisms involving confrontation naming, phonemic cueing, and lexical access and the factors that influence them.