Cross-validation of the Trail Making Test as a non-memory-based embedded performance validity test among veterans with and without cognitive impairment.

OBJECTIVE: This study cross-validated multiple Trail Making Test (TMT) Parts A and B scores as non-memory-based embedded performance validity tests (PVTs) for detecting invalid neuropsychological performance among veterans with and without cognitive impairment. METHOD: Data were collected from a demographically and diagnostically diverse mixed clinical sample of 100 veterans undergoing outpatient neuropsychological evaluation at a Southwestern VA Medical Center. As part of a larger battery of neuropsychological tests, all veterans completed TMT A and B and four independent criterion PVTs, which were used to classify veterans into valid (n = 75) and invalid (n = 25) groups. Among the valid group 47% (n = 35) were cognitively impaired. RESULTS: Among the overall sample, all embedded PVTs derived from TMT A and B raw and demographically corrected T-scores significantly differed between validity groups (ηp2 = .21-.31) with significant areas under the curve (AUCs) of .72-.78 and 32-48% sensitivity (≥91% specificity) at optimal cut-scores. When subdivided by cognitive impairment status (i.e., valid-unimpaired vs. invalid; valid-impaired vs. invalid), all TMT scores yielded significant AUCs of .80-.88 and 56%-72% sensitivity (≥90% specificity) at optimal cut-scores. Among veterans with cognitive impairment, neither TMT A or B raw scores were able to significantly differentiate the invalid from the valid-cognitively impaired group; however, demographically corrected T-scores were able to significantly differentiate groups but had poor classification accuracy (AUCs = .66-.68) and reduced sensitivity of 28%-44% (≥91% specificity). CONCLUSIONS: Embedded PVTs derived from TMT Parts A and B raw and T-scores were able to accurately differentiate valid from invalid neuropsychological performance among veterans without cognitive impairment; however, the demographically corrected T-scores generally were more robust and consistent with prior studies compared to raw scores. By contrast, TMT embedded PVTs had poor accuracy and low sensitivity among veterans with cognitive impairment, suggesting limited utility as PVTs among populations with cognitive dysfunction.

Cognitive Stimulation Therapy in a Veteran Sample: A Program Evaluation Study.

OBJECTIVES: Cognitive stimulation therapy (CST) is an evidence-based intervention for dementia. This program evaluation examined the outcomes of a modified CST program in a veteran sample. METHODS: Twenty-five veterans who participated in a once-weekly, 7-week CST program and completed pre/post-group assessments were selected for inclusion in this chart review study. In this diverse sample (Mage = 74.40; 44% White, 44% Hispanic/Latinx, 8% Black, 4% multiracial), most had a suspected neurodegenerative etiology. Paired-samples t-test examined QoL and cognitive pre/post-intervention scores. RESULTS: Statistically significant improvements were observed in RBANS total index scores (Cohen's d = 0.46). Although there was not a statistically significant change in MoCA scores or patient QoL-AD ratings, there were small effects in the predicted direction (Cohen's d = 0.29 and 0.30, respectively). There was no significant change or effect on caregiver QoL-AD ratings (Cohen's d = .09). CONCLUSIONS: A modified, once-weekly 7-week CST program for veterans was feasible and demonstrated positive outcomes. Improvements were observed in global cognition and there was a small, positive effect on patient-rated QoL. Given that dementia is often progressive, stability of cognition and QoL are suggestive of the protective effects of CST. CLINICAL IMPLICATIONS: CST is feasible and beneficial as a once-weekly brief group intervention for veterans with cognitive impairment.

Subcortical lesions impact confrontation naming in bilinguals with later age of acquisition: An exploratory study.

The bilingual experience is believed to impact brain development and, possibly, cognitive performance. Subcortical structures, including the striatum and white matter, are believed related to confrontation naming performance among bilingual individuals with later age of acquisition (AoA) and lower proficiency of a second language (L2). However, these findings are primarily derived from healthy adult samples, although there is clinical significance for the interpretation of naming performance. The present study examined whether striatal and white matter lesions were associated with naming tasks in clinic-referred bilingual veterans (n = 29) and whether L2 AoA moderated this relationship. Clinically rated lesions, without regard for AoA, were not consistently correlated with naming performance. Moderation models (lesion × AoA) were significant across naming tasks (i.e., naming scores were negatively correlated with striatal lesions with increasing AoA). Effect sizes were higher among striatal models as compared to white matter models. Results extend prior neuroimaging findings with healthy bilinguals that AoA moderates the relationship between subcortical lesions and naming performance in bilingual patients, and suggests that clinicians should consider specifics of bilingual experience when interpreting test scores.

Validation of alternative dot counting test E-score cutoffs based on degree of cognitive impairment in veteran and civilian clinical samples.

OBJECTIVE: This study examined Dot Counting Test (DCT) performance among patient populations with no/minimal impairment and mild impairment in an attempt to cross-validate a more parsimonious interpretative strategy and to derive optimal E-Score cutoffs. METHOD: Participants included clinically-referred patients from VA (n = 101) and academic medical center (AMC, n = 183) settings. Patients were separated by validity status (valid/invalid), and subsequently two comparison groups were formed from each sample's valid group. Namely, Group 1 included patients with no to minimal cognitive impairment, and Group 2 included those with mild neurocognitive disorder. Analysis of variance tested for differences between rounded and unrounded DCT E-Scores across both comparison groups and the invalid group. Receiver operating characteristic curve analyses identified optimal validity cut-scores for each sample and stratified by comparison groups. RESULTS: In the VA sample, cut scores of ≥13 (rounded) and ≥12.58 (unrounded) differentiated Group 1 from the invalid performers (87% sensitivity/88% specificity), and cut scores of ≥17 (rounded; 58% sensitivity/90% specificity) and ≥16.49 (unrounded; 61% sensitivity/90% specificity) differentiated Group 2 from the invalid group. Similarly, in the AMC group, a cut score of ≥13 (rounded and unrounded; 75% sensitivity/90% specificity) differentiated Group 1 from the invalid group, whereas cut scores of ≥18 (rounded; 43% sensitivity/94% specificity) and ≥16.94 (unrounded; 46% sensitivity/90% specificity) differentiated Group 2 from the invalid performers. CONCLUSIONS: Different cut scores were indicated based on degree of cognitive impairment, and provide proof-of-concept for a more parsimonious interpretative paradigm than using individual cut scores derived for specific diagnostic groups.

Comparing the Independent and Aggregated Accuracy of Trial 1 and the First 10 TOMM Items for Detecting Invalid Neuropsychological Test Performance Across Civilian and Veteran Clinical Samples.

Previous studies support using two abbreviated tests of the Test of Memory Malingering (TOMM), including (a) Trial 1 (T1) and (b) the number of errors on the first 10 items of T1 (T1e10), as performance validity tests (PVTs). In this study, we examined the independent and aggregated predictive utility of TOMM T1 and T1e10 for identifying invalid neuropsychological test performance across two clinical samples. We employed cross-sectional research to examine two independent and demographically diverse mixed samples of military veterans and civilians (VA = 108; academic medical center = 234) of patients who underwent neuropsychological evaluations. We determined validity groups by patient performance on four independent criterion PVTs. We established concordances between passing/failing the TOMM T1e10 and T1, followed by logistic regression to determine individual and aggregated accuracy of T1e10 and T1 for predicting validity group membership. Concordance between passing T1e10 and T1 was high, as was overall validity (87-98%) across samples. By contrast, T1e10 failure was more highly concordant with T1 failure (69-77%) than with overall invalidity status (59-60%) per criterion PVTs, whereas T1 failure was more highly concordant with invalidity status (72-88%) per criterion PVTs. Logistic regression analyses demonstrated similar results, with T1 accounting for more variance than T1e10. However, combining T1e10 and T1 accounted for the most variance of any model, with T1e10 and T1 each emerging as significant predictors. TOMM T1 and, to a lesser extent, T1e10 were significant predictors of independent criterion-derived validity status across two distinct clinical samples, but they did not offer improved classification accuracy when aggregated.

Assessment of differential neurocognitive performance based on the number of performance validity tests failures: A cross-validation study across multiple mixed clinical samples.

Objective: This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample (n = 76) and academic medical sample (AMC; n = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. Method: All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs. Neurocognitive test performance differences were examined based on number of PVT failures (0, 1, 2+) for both samples, and effect of number of criterion failures on embedded PVT performance was analyzed among the AMC sample. Results: Both groups with 0 or 1 PVT failures performed better than those with ≥2 PVT failures across most cognitive tests. There were nonsignificant differences between those with 0 or 1 PVT failures except for one test in the AMC sample. Receiver operator characteristic curve analyses found no differences in optimal cut score based on number of PVT failures when retaining/excluding one PVT failure. Conclusion: Findings support the use of ≥2 PVT failures as indicative of performance invalidity. These findings strongly support including those with one PVT failure with those with zero PVT failures in diagnostic accuracy studies, given that their inclusion reflects actual clinical practice, does not reduce sample sizes, and does not artificially deflate neurocognitive test results or inflate PVT classification accuracy statistics.

Removing the noose item from the Boston naming test: A step toward antiracist neuropsychological assessment.

Objective: The Boston Naming Test-Second Edition (BNT-2), the "gold-standard" assessment of confrontation naming used to diagnosis disorders such as dementia, includes aculturally insensitive item, the noose. Given calls to stop structural racism in psychology, this study examined changes in scores and performance classification if the noose item were omitted from the BNT-2. Methods: Participants were 291 Black, White, and Latinx adults who were administered the BNT-2 within a comprehensive neuropsychological evaluation. Ethnoracial differences in BNT-2 scores with and without the noose item and percentages of participants answering the noose item incorrectly were investigated. Results: Significant differences were found between ethnoracial groups in BNT-2 raw scores, T-scores, and percentage of participants incorrectly answering the noose item. Follow-up analyses revealed White participants obtained significantly higher raw scores and had significantly fewer participants answer the noose item incorrectly than Black and Latinx groups, who did not differ significantly. For T-scores, Black participants obtained significantly higher scores than White participants who obtained significantly higher scores than Latinx participants. Despite these differences, giving credit for the omitted noose item changed performance classification for only 10 participants (3.4%). Conclusions: Performance classification did not change significantly for the vast majority of a large ethnoculturally diverse sample when giving credit for the noose item as if it were not administered. Therefore, the non-noose BNT-2remains accurate while reducing cultural insensitivity towards Black populations, emphasizing a step in working towards anti-racism and fostering culturally-competent services within psychology.

When Time is of the Essence: Preliminary Findings for a Quick Administration of the Dot Counting Test.

OBJECTIVE: Performance validity research has emphasized the need for briefer measures and, more recently, abbreviated versions of established free-standing tests to minimize neuropsychological evaluation costs/time burden. This study examined the accuracy of multiple abbreviated versions of the Dot Counting Test ("quick" DCT) for detecting invalid performance in isolation and in combination with the Test of Memory Malingering Trial 1 (TOMMT1). METHOD: Data from a mixed clinical sample of 107 veterans (80 valid/27 invalid per independent validity measures and structured criteria) were included in this cross-sectional study; 47% of valid participants were cognitively impaired. Sensitivities/specificities of various 6- and 4-card DCT combinations were calculated and compared to the full, 12-card DCT. Combined models with the most accurate 6- and 4-card combinations and TOMMT1 were then examined. RESULTS: Receiver operator characteristic curve analyses were significant for all 6- and 4-card DCT combinations with areas under the curve of .868-.897. The best 6-card combination (cards, 1-3-5-8-11-12) had 56% sensitivity/90% specificity (E-score cut-off, ≥14.5), and the best 4-card combination (cards, 3-4-8-11) had 63% sensitivity/94% specificity (cut-off, ≥16.75). The full DCT had 70% sensitivity/90% specificity (cut-off, ≥16.00). Logistic regression revealed 95% classification accuracy when 6-card or 4-card "quick" combinations were combined with TOMMT1, with the DCT combinations and TOMMT1 both emerging as significant predictors. CONCLUSIONS: Abbreviated DCT versions utilizing 6- and 4-card combinations yielded comparable sensitivity/specificity as the full DCT. When these "quick" DCT combinations were further combined with an abbreviated memory-based performance validity test (i.e., TOMMT1), overall classification accuracy for identifying invalid performance was 95%.

Evaluation of the classification accuracy of multiple performance validity tests in a mixed clinical sample.

The Test of Memory Malingering (TOMM) and Word Memory Test (WMT) are among the most well-known performance validity tests (PVTs) and regarded as gold standard measures. Due to the many factors that impact PVT selection, it is imperative that clinicians make informed clinical decisions with respect to additional or alternative PVTs that demonstrate similar classification accuracy as these well-validated measures. The present archival study evaluated the agreement/classification accuracy of a large battery consisting of multiple other freestanding/embedded PVTs in a mixed clinical sample of 126 veterans. We examined failure rates for all standalone/embedded PVTs using established cut-scores and calculated pass/fail agreement rates and diagnostic odds ratios for various combinations of PVTs using the TOMM and WMT as criterion measures. TOMM and WMT demonstrated the best agreement, followed by Word Choice Test (WCT). The Rey Fifteen Item Test had an excessive number of false-negative errors and reduced classification accuracy. The Digit Span age-corrected scaled score (DS-ACSS) had highest agreement. Findings lend further support to the use of a combination of embedded and standalone PVTs in identifying suboptimal performance. Results provide data to enhance clinical decision making for neuropsychologists who implement combinations of PVTs in a larger clinical battery.

Examination of the reliability and validity of the NAB Naming Test in a diverse clinical sample.

Objective: The Boston Naming Test, Second Edition (BNT-2) and the Neuropsychological Assessment Battery (NAB) Naming Test are common measures to assess visual confrontation naming ability. The comparably newer NAB Naming Test is a potential alternative to the BNT-2, given the latter's history of criticism. A recent psychometric investigation of the NAB Naming Test demonstrated sufficient reliability and validity in a large clinical sample; however, their study was limited by a lack of ethnic, racial, and language diversity, all of which can impact scores on naming tests.Method: The present study examined convergent and discriminant validity and internal consistency of the NAB Naming Test in a diverse clinical sample comprised of 225 veterans (87.6% men, 51.1% White/Caucasian, 29.3% bilingual, 64.0% with cognitive impairment). All but three participants identified as White/Caucasian, Hispanic/Latino or Black/African American. These psychometric properties were examined for the overall sample and for monolingual (English) and bilingual (English/Spanish) participants separately.Results: As expected, the NAB Naming Test demonstrated sufficient internal consistency and a negatively skewed distribution for the overall sample and monolingual and bilingual participants. Evidence for adequate convergent and discriminative validity was also established for monolingual and bilingual participants separately.Conclusion: In a diverse clinical sample with differing levels of self-reported language status, the NAB Naming Test demonstrated adequate psychometric properties. Although it represents a viable option in neuropsychological practice, continued awareness of patient-specific factors that could impact performance is recommended.

Comparison of models of premorbid IQ estimation using the TOPF, OPIE-3, and Barona equation, with corrections for the Flynn effect.

OBJECTIVE: Premorbid estimates of intellectual functioning are a key to assessment. This study aimed to compare 3 common measures and assess their accuracy: the Test of Premorbid Functioning (TOPF), Oklahoma Premorbid Intelligence Estimate (OPIE-3), and what is commonly referred to as the Barona equation. We also sought to provide appropriate adjustment considering the Flynn effect. METHOD: The sample consisted of a cross-section of 189 outpatient veterans receiving neuropsychological assessment including the TOPF and Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV). Paired sample t tests assessed differences between IQ models. Correlations for all models and actual WAIS-IV Full Scale IQ (FSIQ) to establish which model best predicted variance in current IQ. Mean differences were evaluated to establish how closely the models approximated WAIS-IV FSIQ. RESULTS: The Barona equation estimated higher premorbid IQ than TOPF Simple Demographics Model; however, differences between the models were nonsignificant after a Flynn effect correction for the Barona equation (.23 IQ points per year). The OPIE-3 correlated with FSIQ but overestimated the FSIQ, demonstrating the Flynn effect. TOPF performance models (include word reading) characterized the variance of IQ scores best, but the Flynn-adjusted Barona equation had the smallest mean difference from the actual WAIS-IV FSIQ of any prediction model. CONCLUSION: Demographic models for premorbid IQ accurately estimate IQ in adult populations when normed on the test used to measure IQ, or when adjusted for the Flynn effect. A Flynn-corrected Barona score provided a more accurate estimation of WAIS-IV FSIQ than the TOPF or the OPIE-3. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Validity of early-onset dementia diagnoses in VA electronic medical record administrative data.

OBJECTIVE: To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs). METHOD: A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists. RESULTS: Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis. CONCLUSIONS: A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.

Evaluating the accuracy of the Wechsler Memory Scale-Fourth Edition (WMS-IV) logical memory embedded validity index for detecting invalid test performance.

Embedded performance validity tests (PVTs) allow for continuous assessment of invalid performance throughout neuropsychological test batteries. This study evaluated the utility of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LM) Recognition score as an embedded PVT using the Advanced Clinical Solutions (ACS) for WAIS-IV/WMS-IV Effort System. This mixed clinical sample was comprised of 97 total participants, 71 of whom were classified as valid and 26 as invalid based on three well-validated, freestanding criterion PVTs. Overall, the LM embedded PVT demonstrated poor concordance with the criterion PVTs and unacceptable psychometric properties using ACS validity base rates (42% sensitivity/79% specificity). Moreover, 15-39% of participants obtained an invalid ACS base rate despite having a normatively-intact age-corrected LM Recognition total score. Receiving operating characteristic curve analysis revealed a Recognition total score cutoff of < 61% correct improved specificity (92%) while sensitivity remained weak (31%). Thus, results indicated the LM Recognition embedded PVT is not appropriate for use from an evidence-based perspective, and that clinicians may be faced with reconciling how a normatively intact cognitive performance on the Recognition subtest could simultaneously reflect invalid performance validity.

Cognitive impairment does not cause invalid performance: analyzing performance patterns among cognitively unimpaired, impaired, and noncredible participants across six performance validity tests.

Objective: Performance validity tests (PVTs) are essential in neuropsychological evaluations; however, it has been questioned how PVTs function in the context of cognitive impairment, and whether cognitive impairment alone is sufficient to cause PVT failure. Further, there is concern that some clinicians will disregard failed PVTs due to their perception that failures represent false-positive errors secondary to cognitive impairment. This study examined patterns associated with cognitively impaired versus noncredible performance across a battery of PVTs and neuropsychological tests. Additionally, the impact of VA service-connection and disability-seeking status on test validity was investigated. Method: A mixed-clinical sample of 103 veterans were administered six PVTs and neuropsychological tests. Performance was compared across three groups: valid-cognitively unimpaired, valid-cognitively impaired, and noncredible. Results: Significant PVT score differences and failure rates emerged across the three groups, with nonsignificant to small differences between valid-unimpaired and valid-impaired groups, and large differences between impaired and noncredible groups. In contrast, there were nonsignificant to small differences on neuropsychological tests between the valid-impaired and noncredible groups, indicating that impaired participants performed significantly better on PVTs despite comparable neurocognitive test scores. Service-connection rating itself was not associated with PVT failure, but an active disability claim to increase and/or establish service connection was associated with worse PVT performance. Conclusion: This study supports the use of multiple PVTs during evaluations of patients with varied cognitive abilities. Results indicated increased risk of PVT failure in patients who were seeking initiation/increase in service-connected payments, and shows that cognitive impairment does not cause PVT failure.

Relative impacts of mild and major neurocognitive disorder on rate of verbal learning acquisition.

OBJECTIVE: The California Verbal Learning Test-second edition (CVLT-II) learning slope index may signal the presence of cognitive impairment, though the relative impacts of mild (MiND) and major (MaND) neurocognitive disorders on the rate of verbal learning acquisition remain unknown. METHODS: Latent intercept-only, linear, quadratic, and exponential models were fit to raw scores for the five CVLT-II learning trials of 197 veterans. Dummy-coded variables reflecting MiND and MaND predicted the growth factors. RESULTS: Quadratic growth best fit the data. MiND and MaND predicted reduced recall on each trial. MaND predicted reduced rate of learning acquisition (i.e., word gains per trial) over-and-above MiND, even after controlling for age, sex, education, race/ethnicity, and mono/bilingualism. CONCLUSIONS: Nonlinear growth-with continuous but diminishing gains over trials-best characterized verbal learning acquisition. Reduced word recall each trial may help differentiate MiND from no neurocognitive disorder, while reduced rate of verbal learning acquisition may help differentiate MaND from MiND.

Verbal fluency in a national sample: Telephone administration methods.

OBJECTIVES: Describe novel methods for ascertaining verbal fluency in a large national sample of adults, examine demographic factors influencing performance, and compare scores to studies using in-person assessment. METHODS/DESIGN: Participants were from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study of stroke in adults aged 45 years and older. Letter and semantic fluency were gathered, using Letter "F" and Animal Naming, via a telephone-based assessment with computer-assisted scoring of digital recordings. RESULTS: Initial letter and semantic fluency scores were obtained on 18 505 and 18 072 participants, respectively. For both fluency tests, scores were normally distributed. Younger age and more years of education were associated with better performances (p < 0.0001). The mean and standard deviation for matched subgroups, based on age, gender, and education, were quite comparable with scores reported out of samples using an in-person administration format. Telephone-based assessment also allowed for a level of quality control not available via in-person measurement. CONCLUSIONS: Telephone-based assessment of verbal fluency and computer-assisted scoring programs designed for this study facilitated large-scale data acquisition, storage, and scoring of protocols. The resulting scores have similar characteristics to those obtained by traditional methods. These findings extend validation of cognitive assessment methods, using survey research staff and computer-assisted technology for test administration.

An Evaluation of the Texas Functional Living Scale's Latent Structure and Subscales.

OBJECTIVE: Performance-based functional assessment is a critical component of neuropsychological practice. The Texas Functional Living Scale (TFLS) has promise given its brevity, nationally representative norms, and co-norming with Wechsler scales. However, its subscale structure has not been evaluated. The purpose of this study was to evaluate the TFLS in a mixed clinical sample (n = 197). METHOD: Reliability and convergent and discriminant validity coefficients were calculated with neurocognitive testing and collateral reports and factor analysis was performed. RESULTS: The Money and Calculation subscale had the best psychometric properties of the subscales. The evidence did not support solitary interpretation of the Time subscale. A three-factor latent structure emerged representing memory and semantic retrieval, performance and visual scanning, and financial calculation. CONCLUSIONS: This study added psychometric support for interpretation of the TFLS total score and some of its subscales. Study limitations included sample characteristics (e.g., gender ratio) and low power for collateral report analyses.

Slow and Steady Does Not Always Win the Race: Investigating the Effect of Processing Speed across Five Naming Tests.

OBJECTIVE: This retrospective study investigated the effect of processing speed on confrontation naming performance via five naming tests with varying time components. METHOD: The effect of processing speed, as measured by the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index (PSI), and cognitive impairment were examined using Boston Naming Test, Neuropsychological Assessment Battery Naming Test, Visual Naming Test (VNT), Auditory Naming Test (ANT), and Woodcock-Johnson III Rapid Picture Naming (RPN) performance among a mixed clinical sample of 115 outpatient veterans. RESULTS: PSI scores accounted for 5%-26% of the total variance in naming test performances. Comparison of cognitively impaired versus unimpaired participants found significant differences and medium to large effect sizes (η2 = .08-.20) for all naming measures except ANT tip-of-the-tongue responses. After controlling for the effect processing speed, VNT tip-of-the-tongue responses also became non-significant, whereas significant group differences remained present for all other naming test scores, albeit with notably smaller effects sizes (η2 = .06-.10). CONCLUSIONS: Confrontation naming test performance is related to cognitive processing speed, although the magnitude of this effect varies by the demands of each naming test (i.e., largest for RPN; smallest for VNT). Thus, results argue that processing speed is important to consider for accurate clinical interpretation of naming tests, especially in the context of cognitive impairment.

The effect of perceptual reasoning abilities on confrontation naming performance: An examination of three naming tests.

INTRODUCTION: Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual-perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy. METHOD: A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation. RESULTS: Multiple regression indicated that PRI accounted for 23%, 13%, and 15% of the variance in BNT, VNT, and NAB scores, respectively, but dropped out as a significant predictor once VCI was added. Follow-up bootstrap mediation analyses revealed that PRI had a significant indirect effect on naming performance after controlling education, primary language, and severity of cognitive impairment, as well as the mediating effect of general verbal abilities for the BNT (B = 0.13; 95% confidence interval, CI [.07, .20]), VNT (B = 0.01; 95% CI [.002, .03]), and NAB (B = 0.03; 95% CI [.01, .06]). CONCLUSIONS: Findings revealed a complex relationship between perceptual reasoning abilities and confrontation naming that is mediated by general verbal abilities. However, when verbal abilities were statistically controlled, perceptual reasoning abilities were found to have a significant indirect effect on performance across all three confrontation naming measures with the largest effect noted with the BNT relative to the VNT and NAB Naming Test.

Predictors of cognition in adults with HIV: implications for nursing practice and research.

The objective of this study was to identify predictors of cognitive performance among adults with HIV. Participants completed demographic, psychosocial, and mental and physical health questionnaires as well as cognitive measures of speed of processing, psychomotor ability and visuomotor coordination, attention and working memory, reasoning, and executive function. Hierarchical regression analyses were used to examine predictors of cognitive performance for each cognitive measure. Possible predictors included age, gender, socioeconomic status, Wide Range Achievement Test 3 Reading score (quality of education), social networks score, hardiness score, mood disturbance score, medical problems composite score, psychoactive drug use composite score, HIV chronicity, CD4+ lymphocyte cell count, and HIV medication usage. Model 1 examined demographic factors, and model 2 examined the contribution of the remaining variables on cognitive performance. Results revealed that several factors were predictive of cognitive functioning, with the individual regression models for each measure explaining 8% to 48% of the variability in performance. Overall, this study posits that among adults with HIV, the most consistent predictors of poorer cognition included older age, poorer reading ability, more depressed mood, CD4+ lymphocyte cell count less than 200, and lack of HIV medication usage. Results suggest that those aging with HIV are subject to decreases in cognitive functioning.