Validation of a Bayesian Diagnostic and Inferential Model for Evidence-Based Neuropsychological Practice.

OBJECTIVE: Evidence-based diagnostic methods have clinical and research applications in neuropsychology. A flexible Bayesian model was developed to yield diagnostic posttest probabilities from a single person's neuropsychological score profile by utilizing sample descriptive statistics of the test battery across diagnostic populations of interest. METHODS: Three studies examined the model's performance. One simulation examined estimation accuracy of true z-scores. A diagnostic accuracy simulation utilized descriptive statistics from two popular neuropsychological tests, the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The final simulation examined posterior predictive accuracy of scores to those reported in the WAIS manual. RESULTS: The model produced minimally biased z-score estimates (root mean square errors: .02-.18) with appropriate credible intervals (95% credible interval empirical coverage rates: .94-1.00). The model correctly classified 80.87% of simulated normal, mild cognitive impairment, and Alzheimer's disease cases using a four subtest WAIS-IV and the RBANS compared to accuracies of 60.67-65.60% from alternative methods. The posterior predictions of raw scores closely aligned to percentile estimates published in the WAIS-IV manual. CONCLUSION: This model permits estimation of posttest probabilities for various combinations of neuropsychological tests across any number of clinical populations with the principal limitation being the accessibility of applicable reference samples. The model produced minimally biased estimates of true z-scores, high diagnostic classification rates, and accurate predictions of multiple reported percentiles while using only simple descriptive statistics from reference samples. Future nonsimulation research on clinical data is needed to fully explore the utility of such diagnostic prediction models.

Impact of word properties on list learning: An explanatory item analysis.

OBJECTIVE: A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual words on list learning. METHOD: Item-response data from 1,219 participants, Mage = 74.41 (SD = 7.13), Medu = 13.30 (SD = 2.72), in the Harmonized Cognitive Assessment Protocol were used. A Bayesian generalized (non)linear multilevel modeling framework was used to specify the measurement and explanatory item-response theory models. Explanatory effects on items due to learning over trials, serial position of words, and six word properties obtained through the English Lexicon Project were modeled. RESULTS: A two parameter logistic (2PL) model with trial-specific learning effects produced the best measurement fit. Evidence of the serial position effect on word learning was observed. Robust positive effects on word learning were observed for body-object integration while robust negative effects were observed for word frequency, concreteness, and semantic diversity. A weak negative effect of average age of acquisition and a weak positive effect for the number of phonemes in the word were also observed. CONCLUSIONS: Results demonstrate that list learning performance depends on factors beyond the repetition of words. Identification of item factors that predict learning could extend to a range of test development problems including translation, form equating, item revision, and item bias. In data harmonization efforts, these methods can also be used to help link tests via shared item features and testing of whether these features are equally explanatory across samples. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Borderline personality features influence treatment response to suicide prevention.

BACKGROUND: Suicide is a notable risk for individuals with features of borderline personality disorder. Given the centrality of interpersonal difficulties in this disorder, we proposed that the negative interpersonal cognitions (perceived burdensomeness and thwarted belongingness) identified by the Interpersonal Theory of Suicide (IPTS) may explain the associations between suicidal ideation and borderline personality features. METHOD: Participants were 322 suicidal youth (74% girls) aged 11-18 years (M, SD = 14.74, 1.6) in an intensive outpatient program in the southwest United States. Youth completed measures assessing borderline personality features at program entry, and suicidal ideation and IPTS variables at entry and exit. RESULTS: Borderline personality features did not moderate associations of IPTS variables and suicidal ideation. For the entire sample, changes in suicidal ideation from entry to discharge occurred in tandem with changes in perceived burdensomeness and depressive symptoms, but not thwarted belongingness. Youth with elevated borderline personality features entered with greater suicidal ideation, but improved more from treatment entry to exit. Regardless of level of borderline personality features, changes in negative interpersonal cognitions over treatment were associated with changes in suicidal ideation. LIMITATIONS: Self-report measures and lack of sample diversity are study limitations. CONCLUSIONS: This research highlights the clinical utility of the IPTS variables and the importance of promoting competence and interpersonal connectedness when treating this population. Findings indicate that the IPTS variables carry the same fundamental information for contributing to suicidal ideation, regardless of level of borderline personality features.

Psychometric Equivalence of the Computerized and Original Halstead Category Test Using a Matched Archival Sample.

Objective: Investigate the equivalence of several psychometric measures between the traditional Halstead Category Test (HCT-Original Version [OV]) and the computer-based Halstead Category Test (HCT-Computerized Version [CV]). Method: Data were from a diagnostically heterogeneous, archival sample of 211 adults administered either the HCT by computer (n = 105) or cabinet (n = 106) as part of a neuropsychological evaluation. Groups were matched on gender, race, education, Full Scale Intelligence Quotient, and Global Neuropsychological Deficit Score. Confirmatory factor analysis was used to examine structural equivalence. Score, variability, and reliability equivalency were also examined. Differential item and test functioning under a Rasch model were examined. Results: An identified factor structure from research of the HCT-OV fit the HCT-CV scores adequately: χ2(4) = 8.83, p = .07; root mean square error of approximation = 0.10 [0.00, 0.20]; standardized root mean residual = 0.03; comparative fit index = 0.99. Total scores and variability of subtest scores were not consistently equivalent between the two administration groups. Reliability estimates were, however, similar and adequate for clinical practice: 0.96 for HCT-OV and 0.97 for HCT-CV. About 17% of items showed possible differential item functioning, though just three of these items were statistically significant. Differential test functioning revealed expected total score differences of <1% between versions. Conclusion: The results of this study suggest that the HCT-CV functions similar to the HCT-OV with there being negligible differences in expected total scores between these versions. The HCT-CV demonstrated good psychometric properties, particularly reliability and construct validity consistent with previous literature. Further study is needed to generalize these findings and to further examine the equivalency of validity evidence between versions.

A meta-analysis of the accuracy of embedded performance validity indicators from the repeatable battery for the assessment of neuropsychological status.

Objective: Meta-analyze the embedded performance validity tests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), emphasizing two topics: diagnostic accuracy and relationships with demographics. Method: Literature was identified through a review of PsycINFO, PubMed, and Google Scholar. Bivariate linear mixed models were used for diagnostic accuracy analyses. Random-effects analysis of correlations with demographic variables was also used for the Effort Index. Results: Diagnostic accuracy analyses utilized 12 studies of the Effort Index (EI; N = 1469) and 6 studies of the Effort Scale (ES; N = 854). The EI was found to have a sensitivity of .44 (95% CI: .28 - .62), specificity of .87 (95% CI: .78 - .93), and diagnostic odds ratio (DOR) of 5.41 (95% CI: 3.74 - 7.58). The ES produced a sensitivity of .67 (95% CI: .50 - .81), specificity of .72 (95% CI: .53 - .85), and DOR of 5.97 (95% CI: 1.70 - 15.30). Meta-analysis of correlations utilized 14 samples of the EI (N = 3781), but insufficient data were available for the ES. Correlations between the EI and age (r = .10, 95% CI: .05 - .16), education (r = -.11, 95% CI: -.18 to -.04), and the RBANS Total Scale (r = -.45, 95% CI: -.62 to -.24) were significant. These results appeared to be robust to publication bias. Conclusion: Results support use of the EI over the ES; however, the latter is comparatively less studied and did not have similar variability in reported cut-off scores. ES accuracy statistics were significantly predicted by sample variables, which may be related to its relatively fewer studies. Both measures should be used cautiously in the context of genuine cognitive impairment.

Examination of Regression-based Discrepancy Scores for the RBANS in Detecting Cognitive Impairment from an Archival Sample.

OBJECTIVE: The purpose of this study was to evaluate the clinical utility of regression-based formulas for the RBANS indexes in screening for cognitive impairment. METHOD: A database of neuropsychological test results was created from archival records in a memory assessment clinic. The sample consisted of 83 individuals (37 males/46 females) with an average age of 70.1 (SD = 9.8) and 14.6 years of education (SD = 2.8). Diagnostic accuracy of regression-based predictions provided by Duff and Ramezani (2015) (Duff, K., & Ramezani, A. (2015). Regression-based normative formulae for the Repeatable Battery for the Assessment of Neuropsychological Status for older adults. Archives of Clinical Neuropsychology, 30, 600-604.) and from regression of WTAR standard score were examined via receiver operator characteristic curves. Preliminary generalizability investigation was completed using two additional datasets. RESULTS: The WTAR was found to mediate the relationship between education and all RBANS index scores. The WTAR standard score was also found to contribute uniquely and significantly to the prediction of RBANS performance. Results of diagnostic accuracy analyses showed similar discriminating accuracy for all scores. There was limited support for using the WTAR over demographic variables alone in the estimation of RBANS performance; however, the WTAR was found to be more predictive than education, indicating potential clinical utility to using the word-reading score over just years of attained education. CONCLUSIONS: Use of these derived Total Scale score variants is recommended for the screening of cognitive impairment, particularly in individuals with superior or poor educational quality. Further research is required to evaluate the utility of these variations in more diverse samples.

The relationship between smell identification and neuropsychological domains: Results from a sample of community-dwelling adults suspected of dementia.

OBJECTIVE: This study aimed to test the theoretical relationships between smell identification and cognitive tasks based on existing neuroimaging and anatomical findings. METHOD: Utilizing data collected from a memory assessment clinic, theory-derived mediation and moderation models were tested. The sample used in this study consisted of 103 (39 male, 64 female) individuals referred for memory assessments. The sample's mean education was 12.4 years (SD = 3.2), and the mean age of the sample was 77.2 years (SD = 6.3). RESULTS: The University of Pennsylvania Smell Identification Test (UPSIT) was a significant, partial mediator of the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Immediate and Delayed Memory indexes. Olfactory identification did not mediate list learning and retrieval; however, olfactory identification was a significant partial mediator of the relationship between story encoding and later memory retrieval of the story. Olfactory identification also fully mediated the relationship between a visuospatial construction task and its reconstruction from memory after a short delay. The relationship between processing speed and the olfactory identification was significantly mediated by semantic memory. Finally, the UPSIT moderated the relationship between a measure of premorbid ability, the Wechsler Test of Adult Reading, and current global cognitive functioning. CONCLUSIONS: Our results support theoretical relationships between olfaction and neuropsychological domains. Additionally, our results suggest that the UPSIT may serve as a proxy for cerebral integrity and is likely related to the duration of neurodegeneration.

Relationship Between the Mini-Mental State Examination and the Repeatable Battery for the Assessment of Neuropsychological Status in Patients Referred for a Dementia Evaluation.

The current study examined the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Mini-Mental State Examination (MMSE) in a large, heterogeneous sample of patients referred for dementia assessment (N = 495; 37% males, 63% females; M age = 76.8 years, SD = 7.0). The MMSE showed a significant moderate correlation with the RBANS Total Scale score (r = .65). Moderate significant correlations were found between the MMSE and the RBANS indexes (r = .41 to .49). The MMSE demonstrated moderate correlations with RBANS factor scores of .63 for Factor 1 (memory/learning) and .58 for Factor 2 (visuospatial/attention). These correlations suggest that the MMSE is best considered a measure of global cognitive functioning with the strongest correlations between broader measures.