Misleading conclusions about word memory test results in multiple sclerosis (MS) by Loring and Goldstein (2019).

Loring and Goldstein presented a case of a woman with Multiple Sclerosis (MS) who failed the traditional performance validity criteria of the WMT. Scoring lower than the mean from patients with Alzheimer's Disease on extremely easy subtests, the patient carried on to produce a WMT profile which is typical of someone with invalid test results, based on the usual interpretation, which is standardized within the Advanced Interpretation Program. Statements were made that are incorrect, including the claim there are no available data on the WMT in MS patients, that the minor tranquilizer Lorazepam can explain WMT failure even in healthy adults and that this patient produced a neuropsychological profile that is credible and typical of MS. We report data from MS patients given comprehensive neuropsychological assessment, including the WMT. Loring and Goldstein's interpretation of this case does not fit the facts.

Functional Somatic Syndrome: Assessment and Management.

Functional somatic syndrome (FSS) occurs in as many as 30% of patients in general medical practice, but it is infrequently a topic of formal instruction. Many physicians feel uncomfortable with medically unexplained symptoms and are unfamiliar with how to assess or manage them. Traditional medical approaches can be ineffective and can contribute to iatrogenic or adverse physiologic effects in patients. Physicians treating patients with FSS should not only consider standard medical tests, but they should also try to gain a deeper behavioral understanding of the mind-body connections that underlie the presenting symptoms. Osteopathic physicians, with their emphasis on holistic patient care, are in a key position to treat patients with FSS. This review provides a brief recapitulation of the literature and illustrates key factors in the assessment and management of FSS.

An investigation of impaired scores on the frontal assessment battery in a VA population.

In a population of inpatients, individuals were observed to continually score in the impaired range on the Frontal Assessment Battery (FAB) without exhibiting other signs of frontal-lobe damage. Investigations were undertaken to determine if the subtest structure, demographic factors, or general cognitive functioning may be responsible for patients' poor performance on the FAB overall. Participants were inpatients at the Ann Arbor Veterans Hospital who were administered a standard neuropsychological screening battery. This battery included the FAB, among other tests, as part of regular clinical care. Included in these study analyses were 292 patients with a mean age of 67.27 years (SD = 12.41). Descriptive analyses revealed that 63.7% of patients scored in the impaired range on the FAB based on the criteria set forth by Dubois, Slachevsky, and Litvan ( 2000 ). Analyses of individual subtest performance failed to find any single test that would characterize participants' poor performance overall. Nonetheless, the total FAB score was related to age, general cognitive functioning, and premorbid estimates of intellectual functioning. The internal reliability also was found to be lower than that reported previously. While the FAB may measure frontal-lobe functions, it appears to be influenced by a multitude of other demographic and neuropsychological factors.

Neuropsychological evaluation in primary care.

Referring a patient to a neuropsychologist for evaluation provides a level of rigorous assessment of brain function that often cannot be obtained in other ways. The neuropsychologist integrates information from the patient's medical history, laboratory tests, and imaging studies; an in-depth interview; collateral information from the family and other sources; and standardized assessment instruments to draw conclusions about diagnosis, prognosis, and response to therapy. Family physicians can use this information in the diagnosis and treatment of patients with depression, dementia, concussion, and similar conditions, as well as to address concerns about decision-making capacity. Certain assessment instruments, such as the Mini-Mental State Examination and Patient Health Questionnaire-9, are readily available and easily performed in a primary care office. Distinguishing among depression, dementia, and other conditions can be challenging, and consultation with a neuropsychologist at this level can be diagnostic and therapeutic. The neuropsychologist typically helps the patient, family, and primary care team by establishing decision-making capacity; determining driving safety; identifying traumatic brain injury deficits; distinguishing dementia from depression and other conditions; and detecting malingering. Neuropsychologists use a structured set of therapeutic activities to improve a patient's ability to think, use judgment, and make decisions (cognitive rehabilitation). Repeat neuropsychological evaluation can be invaluable in monitoring progression and treatment effects.

Results from the cognitive changes and retirement among senior surgeons self-report survey.

BACKGROUND: The Cognitive Changes and Retirement among Senior Surgeons (CCRASS) study suggested that although subjective cognitive awareness may play a role in surgeons' retirement decisions, self-perceived cognitive decline did not predict objective cognitive performance. This article summarizes results from all participants who completed the survey portion of the CCRASS study. STUDY DESIGN: A survey examining subjective cognitive changes, changes in caseload, involvement in new technology, and retirement decisions, was administered to 995 surgeons at annual meetings of the Clinical Congress of the American College of Surgeons between 2001 and 2006. RESULTS: Forty-five percent reported increased caseload volume and 48% reported increased caseload complexity during the previous 5 years. In addition, 75% and 73% denied any recent changes in memory recall or name recognition, respectively. Increasing age was associated with decreases in clinical caseload and complexity. The majority of respondents across all age groups reported active participation in either learning (64%) or contributing (13%) to new technology in the field. Among surgeons with no imminent plans for retirement, 58% reported that a retirement decision will be based on skill level. CONCLUSIONS: Increasing age was associated with decreases in caseload and case complexity. But a steady proportion of surgeons, even in the oldest age group, are active in new surgical innovations and challenging cases. Most reported no changes in perceived cognitive abilities. The majority of surgeons who had made no decision to retire reported that their decision will be based on skill level rather than age.

Cognitive changes and retirement among senior surgeons (CCRASS): results from the CCRASS Study.

BACKGROUND: Because individuals age cognitively at different rates, there is considerable interest in ways to assure that older surgeons have the physical and mental stamina, coordination, reaction time, and judgment to provide appropriate care. To clarify potential relationships between cognitive changes related to aging, the decision to retire, and changes in patterns of surgical practice, this study aimed to identify specific parameters of cognitive change among senior surgeons. STUDY DESIGN: Computerized cognitive tasks measuring sustained attention, reaction time, visual learning, and memory were administered to 359 surgeons at the annual meetings of the American College of Surgeons over a 6-year period. A self-report survey was also administered to assess subjective cognitive changes and the status of surgical practice and retirement decisions. RESULTS: Expected age-related cognitive decline was demonstrated on all measures, although measured reaction time was notably better than age-appropriate norms. There was a marked relationship between self-reported subjective cognitive change and retirement status, but not to changes in surgical practice. There was no notable relationship, however, between subjective cognitive change and objective cognitive measures. There were marked relationships between age and retirement decision or status and between age and changes in surgical practice. CONCLUSIONS: These results suggest that although self-perceived cognitive changes play a role in the decision to retire, they are not related to objective measures of cognitive change, and are not reliable in the decision to retire. The development of readily accessible measures of cognitive changes related to aging may serve to assist decisions either to continue surgical practice or to retire.

Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists.

BACKGROUND: The present study was undertaken to determine if psychomotor and visual-spatial abilities improve as a result of surgical training or are enhanced at baseline in those individuals choosing a surgical career. METHODS: Medical students entering a surgical field and practicing surgeons performed a series of neuropsychologic tests. Performance was compared between surgeon groups, as well as with normative aged-matched controls. RESULTS: An age-related decline was noted in the performance of all exercises, with the medical student group outperforming the midcareer surgeons, who in turn outperformed the senior surgeons. Interestingly, however, all 3 groups significantly outperformed their normative control groups on some or all tasks. CONCLUSIONS: Improved visual memory and psychomotor performance compared with normative controls appears to be present at baseline rather than resulting from surgical training. Decline in performance with age is observed, however, and this should be considered when an older surgeon is learning new visually complex procedures.

Neuropsychological effects of stress on social phobia with and without comorbid depression.

BACKGROUND: The influence of stress on neuropsychological functioning was assessed in socially phobic (SP), comorbid socially phobic/major depression (CM), and asymptomatic control subjects (AC) under baseline and stressor conditions. METHODS: Subjects were 33 clinically diagnosed undergraduates aged 18 to 41 years. Neuropsychological measures included the Trail Making Test, Wisconsin Card Sorting Test (WCST), Spatial Span, and Digit Span administered during a baseline condition and a psychosocial stress condition (videotaping). RESULTS: Spatial Span scores were reduced for SP during stress, improved for AC, and showed no change for CM. TMT B times showed an interaction effect, with completion time improving significantly less for SP than for AC and CM during stress. Analyses of the normative data for WCST total errors indicated that AC and CM improved significantly during stress, while SP performance declined during stress. CONCLUSIONS: The present findings suggest that comorbid depressed versus non-depressed SP subjects respond uniquely to stress in terms of their neuropsychological functioning and self-reported mood and experiences; generalized social phobia may be associated with spatial working memory disturbance during social stress. Therefore, situations involving potential social and personal evaluation (e.g., examinations or presentations) may have a significant impact on the neuropsychological functioning of SP individuals.