Long-Term Cognitive and Psychological Functioning in Post-Electroconvulsive Therapy Patients.

OBJECTIVE: Electroconvulsive therapy (ECT) is associated with positive outcomes for treatment-resistant mood disorders in the short term. However, there is limited research on long-term cognitive or psychological changes beyond 1 year after -ECT. This study evaluated long-term outcomes in cognitive functioning, psychiatric symptoms, and quality of life for individuals who had undergone ECT. METHODS: Eligible participants (N = 294) who completed a brief pre-ECT neuropsychological assessment within the last 14 years were recruited for a follow-up evaluation; a limited sample agreed to follow-up testing (n = 34). At follow-up, participants were administered cognitive measures (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS], Wide Range Achievement Test-4 Word Reading, Trail Making Test, Wechsler Adult Intelligence Scale-Fourth Edition Letter Number Sequence and Digit Span, and Controlled Oral Word Association Test), along with emotional functioning measures (Beck Depression Inventory-Second Edition [BDI-II] and Beck Anxiety Inventory) and the World Health Organization Quality of Life-BREF quality of life measure. Follow-up-testing occurred on average (SD) 6.01 (3.5) years after last ECT treatment. RESULTS: At follow-up, a paired t test showed a large and robust reduction in mean BDI-II score. Scores in cognitive domains remained largely unchanged. A trend was observed for a mean reduction in RBANS visual spatial scores. Lower BDI-II scores were significantly associated with higher RBANS scores and improved quality of life. CONCLUSIONS: For some ECT patients, memory, cognitive functioning, and decreases in depressive symptoms can remain intact and stable even several years after ECT. However, the selective sampling at follow-up makes these results difficult to generalize to all post-ECT patients. Future research should examine what variables may predict stable cognitive functioning and a decline in psychiatric symptoms after ECT.

Neuropsychological feedback services improve quality of life and social adjustment.

OBJECTIVE: In more recent years, studies have begun to examine levels of satisfaction of individuals or family members of individuals who undergo neuropsychological evaluation. However, to date there have been only a handful of formal studies that have specifically examined the role and contribution of neuropsychological assessment in patient care and management. This study sought to examine one specific component of neuropsychological assessment, namely the impact of patient feedback regarding neuropsychological testing on patient outcome. METHOD: Participants included 218 patients who were recruited from a neuropsychological outpatient clinic at a Midwest academic medical center. This study examined potential differences between outcome measures for patients who attended feedback sessions versus those who did not receive direct feedback. RESULTS: Results indicated that compared with the No Feedback group, the Feedback group reported greater improvement in quality of life, increased understanding of their condition, and an increased ability to cope with their condition at follow-up. There were no significant demographic differences between the Feedback and No Feedback group. CONCLUSIONS: These findings suggest that there is benefit for the individuals who chose to engage in feedback sessions. Feedback sessions can be utilized to assist with integral decision-making processes and assisting in treatment planning among other areas. It also allows time for patients and family members to discuss their concerns regarding important test findings and recommendations. Given the current climate of value-based services and clinical outcomes, the findings from this study lend support to the utility of neuropsychological assessments and, in particular, the role of feedback within neuropsychological evaluations.

Verbal Fluency: Language or Executive Function Measure?

Measures of phonemic and semantic verbal fluency, such as FAS and Animal Fluency (Benton, Hamsher, & Sivan, 1989), are often thought to be measures of executive functioning (EF). However, some studies (Henry & Crawford, 2004a , 2004b , 2004c ) have noted there is also a language component to these tasks. The current exploratory factor-analytic study examined the underlying cognitive structure of verbal fluency. Participants were administered language and EF measures, including the Controlled Oral Word Association Test (FAS version), Animal Fluency, Boston Naming Test (BNT), Vocabulary (Wechsler Adult Intelligence Scale-III), Wisconsin Card-Sorting Test (WCST, perseverative responses), and Trail-Making Test-Part B (TMT-B). A 2-factor solution was found with the 1st factor, language, having significant loadings for BNT and Vocabulary, while the second factor was labeled EF because of significant loading from the WCST and TMT-B. Surprisingly, FAS and Animal Fluency loaded exclusively on to the language factor and not EF. The current results do not exclude EF as a determinant of verbal fluency, but they do suggest that language processing is the critical component for this task, even without significant aphasic symptoms. Thus, the results indicated that both letter (phonemic) and category (semantic) fluency are related to language, but the relationship to EF is not supported by the results.

Derivation of a Cross-Domain Embedded Performance Validity Measure in Traumatic Brain Injury.

OBJECTIVE: Performance validity assessment is increasingly considered standard practice in neuropsychological evaluations. The current study extended research on logistically derived performance validity tests (PVTs) by utilizing neuropsychological measures from multiple cognitive domains instead of from a single measure or a single cognitive domain. METHOD: A logistic-derived PVT was calculated using several measures from multiple cognitive domains, including verbal memory (California Verbal Learning Test-II Trial 5, Total Hits, and False Positives), attention (Brief Test of Attention Total score), and language (Boston Naming Test T-score, and Animal Fluency T-score). Due to its cross-domain nature, the cross-domain logistic-derived embedded PVT was hypothesized to have excellent classification accuracy for non-credible performance. Participants included 224 patients who completed all measures and were moderate to severe traumatic brain injury (STBI) patients (N = 66), possible mild TBI (MTBI-FAIL) patients who failed at least 2 independent PVTs (N = 67), and possible mild TBI patients who passed all PVTs (MTBI-PASS; N = 91). Logistic regression and ROC analyses were conducted on the MTBI-FAIL group and the STBI group. RESULTS: Multivariate analysis of variance indicated that the MTBI-FAIL group was significantly lower on all measures than the MTBI-PASS and the STBI groups. Using logistic regression, CVLT Total Hits, BTA, and the CVLT False Positives best differentiated between the MTBI-FAIL and STBI groups. The logistically derived PVT had excellent classification accuracy (area under the curve [AUC] = .84), with sensitivity at .54 when specificity was set at .90, higher than any individual variable. CONCLUSIONS: Findings support the use of this logistical-derived variable as an embedded PVT and support further research with this type of methodology.