A Comparison of Performance Validity Measures in Predicting MMPI-2 Lie Scale Results.

Objective: This study examined the relationship between tests of performance validity (PVT) and symptom validity (SVT) among claimants undergoing independent neuropsychological evaluations. Previous research comparing PVTs with SVTs has examined symptom validity with respect to overreporting impairment, whereas the current study focused on how PVTs predict underreporting of psychological symptoms and minimization of negative personality characteristics.Method: The sample included 99 claimants presenting with psychological and cognitive complaints who were assessed in a private practice setting. Participants were administered several SVTs (MMPI-2 Lie Scale (L), Superlative Self Presentation Scale (S), Correction Scale (K)) and PVTs, including Reliable Digit Span (RDS), California Verbal Learning Test forced choice recognition, the Victoria Symptom Validity Test (VSVT), and the Test of Memory Malingering (TOMM).Results: Analyses revealed moderate yet significant (p<.001) negative correlations between the L Scale and PVTs with exception of the VSVT. These relationships were substantiated by moderate to large effect sizes (d = 0.56-0.81) when comparing L Scale scores in above and below PVT cutoff conditions. Significant relationships between PVTs and the K and S Scales were not observed. Exploratory analyses revealed that PVT/L Scale relationships were not significantly moderated by presenting concern.Conclusions: Claimants exhibiting invalid PVT performance were more likely to endorse virtuous personality characteristics on the L Scale, supporting the idea that PVT and SVT constructs are interrelated, particularly in the domain of underreporting moral flaws.

D2/D3 dopamine receptor binding with [F-18]fallypride correlates of executive function in medication-naïve patients with schizophrenia.

Converging evidence indicates that the prefrontal cortex is critically involved in executive control and that executive dysfunction is implicated in schizophrenia. Reduced dopamine D2/D3 receptor binding potential has been reported in schizophrenia, and the correlations with neuropsychological test scores have been positive and negative for different tasks. The aim of this study was to examine the relation between dopamine D2/D3 receptor levels with frontal and temporal neurocognitive performance in schizophrenia. Resting-state 18F-fallypride positron emission tomography was performed on 20 medication-naïve and 5 previously medicated for brief earlier periods patients with schizophrenia and 19 age- and sex-matched healthy volunteers. Striatal and extra-striatal dopamine D2/D3 receptor levels were quantified as binding potential using fallypride imaging. Magnetic resonance images in standard Talairach position and segmented into gray and white matter were co-registered to the fallypride images, and the AFNI stereotaxic atlas was applied. Two neuropsychological tasks known to activate frontal and temporal lobe function were chosen, specifically the Wisconsin Card Sorting Test (WCST) and the California Verbal Learning Test (CVLT). Images of the correlation coefficient between fallypride binding and WCST and CVLT performance showed a negative correlation in contrast to positive correlations in healthy volunteers. The results of this study demonstrate that lower fallypride binding potential in patients with schizophrenia may be associated with better performance. Our findings are consistent with previous studies that failed to find cognitive improvements with typical dopamine-blocking medications.

Application of the Brixton spatial anticipation test in stroke: ecological validity and performance characteristics.

Executive dysfunction predicts functional recovery post-stroke. However, traditional neuropsychological tests have limitations with this population due to required verbal response, complex motor response, and lengthy administration time. This study examined the ecological validity and performance characteristics of a relatively new measure of executive function, the Brixton Spatial Anticipation Test, which does not place the aforementioned demands on these patients. A total of 57 ischemic stroke patients with frontal lobe and subcortical lesions were administered the Brixton, on average 2 weeks post-stroke, during inpatient rehabilitation and assessed using the Functional Independence Measure (FIM) upon discharge. Brixton performance was significantly correlated with the FIM Total and FIM Cognitive Subtotal at discharge but unrelated to FIM Motor Subtotal. After controlling for global ability measured by the RBANS, Brixton performance accounted for additional variance in predicting FIM Total score at discharge. Interestingly, patients with subcortical strokes in the thalamus and basal ganglia performed significantly worse than patients with strokes in the frontal cortex on the Brixton, supporting the role of subcortical structures in the frontal lobe circuitry and executive function. Based on the present findings, the Brixton is a sensitive measure conducive to the stroke population and has strong ecological validity for identifying cognitive functional outcomes post-stroke.

Inhibitory control and affective valence processing in dementia of the Alzheimer type.

Emotional and traditional Stroop effects were contrasted in individuals with Alzheimer's disease (AD) and age-equated, non-demented individuals to examine (a) differences in the speed of processing emotional versus neutral words; and (b) the extent to which the emotional valence influences interference effects. Individuals with moderate AD experienced larger traditional Stroop interference effects than did healthy elderly or individuals with mild AD. Emotional Stroop effects were evident among individuals with moderate AD and significantly greater than elderly and individuals with mild AD who exhibited minimal effects. For negative words, significant differences were only observed between individuals with moderate AD and healthy elderly. Emotional Stroop effects among individuals with AD were not statistically different for positive and negative words. The impact of stimulus intensity level and AD-associated changes to the prefrontal cortex and amygdala on emotional Stroop effects requires further investigation.

Prevalence of neurocognitive dysfunction and other clinical manifestations in disabled patients with systemic lupus erythematosus.

OBJECTIVE: While work disability is common in patients with systemic lupus erythematosus (SLE), it is not known which lupus disease characteristics predispose toward work disability. We examined demographic, clinical, serological, and neuropsychological factors in a group of disabled and nondisabled patients with SLE. METHODS: Fifty patients meeting American College of Rheumatology criteria for SLE were assessed for work status, disease characteristics, fatigue, anxiety, depressive symptoms, and quality of life. All subjects underwent an abbreviated panel of neuropsychological tests. Subjects who had formal work disability (social security or longterm disability, n = 16) and subjects who self-reported work disability without formal recognition (n = 8) were compared to subjects denying work disability from lupus (n = 26). RESULTS: Education level, African-American race, and SLICC Damage Index score were significantly associated with formal work disability relative to other subjects. Neurocognitive impairment (OR 14.44, 95% CI 3.01, 68.20; p = 0.001), nephritis (OR 3.75, 95% CI 1.01, 13.9; p = 0.048), and discoid lupus (OR 19.93, 95% CI 3.51, 113.3; p = 0.001) were all associated with formal disability. Formally disabled patients had higher fatigue and anxiety scores and more impaired quality of life in many domains relative to nondisabled subjects. Subjects with self-reported work disability also had neurocognitive dysfunction, high fatigue scores, and poor quality of life, but in other respects appeared to have milder disease than formally disabled subjects. CONCLUSION: Neurocognitive dysfunction and fatigue are 2 manifestations that may contribute materially to work disability in lupus. Other associated factors include low education levels, SLICC Damage Index scores, discoid lupus, nephritis, and possibly African-American race.

Neuropsychologic functioning and health status in systemic lupus erythematosus: does ethnicity matter?

BACKGROUND: Despite increased severity of lupus in blacks, including more frequent neuropsychiatric manifestations, there is sparse data on neuropsychologic function in black patients with lupus. METHODS: Neuropsychologic functioning and health-related variables were examined among blacks (n = 34) and whites (n = 14) fulfilling American College of Rheumatology criteria for systemic lupus erythematosus. RESULTS: Blacks and whites performed comparably on measures of verbal and visual memory, working memory, and motor speed after controlling for estimates of premorbid cognitive ability. Blacks trended towards poorer performance on specific attention/processing speed measures. Pain, fatigue, depression, anxiety, physical and emotional well-being were unrelated to ethnicity. Blacks exhibited a trend towards greater impairment of physical functioning. Ethnicity-related differences in overall damage, noncognitive neuropsychiatric manifestations, and prevalence of nephritis revealed greater severity among blacks. CONCLUSIONS: Initial differences in premorbid cognitive function possibly contribute to disparate clinical outcomes, including a greater proportion of blacks exhibiting subnormal neurocognitive performance. Blacks evidencing lower premorbid ability may be at greater vulnerability for poorer functional outcomes (eg, coping skills, medical compliance and employment) if they experience disease-related cognitive dysfunction.

Factors influencing cognitive function, sleep, and quality of life in individuals with systemic lupus erythematosus: a review of the literature.

Cognitive dysfunction represents one of several neurological and psychiatric complications of Systemic Lupus Erythematosis (SLE). Additional manifestations of nervous system involvement subsumed under the term neuropsychiatric SLE (NPSLE) include cerebrovascular disorder, seizures, psychosis, acute confusional state, anxiety and mood disorders. Neuropsychological investigations have facilitated the identification and description of cognitive impairment in SLE and NPSLE. Salient findings from studies of SLE-related cognitive dysfunction are reviewed with respect to neuroimaging procedures, indices of disease activity, and potential moderator variables. Data on cognitive functioning are also discussed in reference to other disease aspects including fatigue, sleep disturbance, and impact on health-related quality of life (HRQL). To date, neuropsychological functioning has been studied extensively, albeit separately from other commonly reported SLE-related symptoms. Future research may profit from investigating relationships between cognitive impairment, sleep disturbance and fatigue and their collective impact on functional capacity and quality of life.