Quantitative measures of memory malingering on the Wechsler Memory Scale--Third edition in mild head injury litigants.

Wechsler Memory Scale-Third edition (WMS-III) performance in 25 mild traumatic brain injury (TBI) litigants who met the criteria for probable malingered neurocognitive dysfunction (MND) was compared with 50 nonmalingering subjects. The base rate for probable MND in the population studied was 27%. Overall, malingerers showed globally depressed memory function. They returned significantly poorer scores than nonmalingerers on all WMS-III indexes and subtests, and on selected WMS-III index difference scores and intelligence-memory difference scores. Using the minimum score returned in the nonmalingerers as the cut-off for malingering, the delayed auditory recognition memory tasks were highly effective in detecting malingering. Raw scores below 43 on the auditory recognition-delayed (AR-D) subtest or below 18 on word list II-recognition, identified around 80% of the malingerers. In a group of 50 severe TBI litigants, only a very small proportion (i.e., <10%) returned scores below the cut-offs for malingering for the mild TBI subjects.

Utility of the Addenbrooke's Cognitive Examination--Revised for the diagnosis of dementia syndromes.

AIM: To evaluate the utility of the Addenbrooke's Cognitive Examination--Revised (ACE-R) as a screening tool for dementia. METHOD: Prospective audit of 122 patients (82 with dementia, 40 with no dementia) referred to a Sydney cognition clinic. RESULTS: An ACE-R cut-off score of 84/100 provided an optimal balance of sensitivity, specificity and positive predictive value (0.85, 0.80 and 0.90, respectively) in identifying patients with dementia. In our sample, the ACE-R was a superior dementia screening tool to the Mini-Mental State Examination in patients with higher levels of education (≥ 10 years of formal schooling), but not in patients with lower levels of education. Patients misclassified by the instrument had evidence of high levels of education, focal executive dysfunction, medical comorbidities, significant vascular disease and polypharmacology. CONCLUSIONS: The ACE-R is a useful screening tool for detecting the presence of dementia in a cognition clinic setting. Caution may be warranted in some patient populations.

Factors associated with functional psychosocial status in first-episode psychosis.

AIM: This study aimed to determine which of demographic/premorbid, psychiatric or neuropsychological variables are most closely associated with functional status around the time of diagnosis of first-episode psychosis. This was with a view to determining factors that should be the focus of intervention in these early stages of illness. METHODS: The Western Sydney First Episode Psychosis Project collected data on young persons (aged 13-25) with newly diagnosed psychosis (n=92). Psychosocial functional status was measured using the Role Functioning Scale (RFS). Multiple regression analyses were carried out to identify predictors of RFS score from a wide range of predictor variables. RESULTS: Psychiatric variables accounted for the most variance in RFS score. Positive and Negative Syndrome Scale (PANSS) Negative subscale and Young Mania Rating Scale score were found to be significant individual predictors, with variables from the other domains failing to contribute to the overall model. In separate models, demographic/premorbid and neuropsychological factors weakly related to functional status. CONCLUSIONS: Psychiatric factors were the main influence on psychosocial functioning in first-episode psychosis at baseline. Evidence suggests the relationships between symptoms, cognition and demographics with function might change over time, depending on the stage of illness being examined.

WMS-III findings in litigants following moderate to extremely severe brain trauma.

Published information pertaining to the clinical utility of the WMS-III in assessing memory impairment in traumatic brain injury (TBI) remains inadequate. WMS-III findings are reported for 180 litigants with post-acute moderate to extremely severe TBI, classified into three groups according to injury severity, and a healthy control group. A significant "dose-response" relationship was found between memory impairment and TBI severity for most of the WMS-III indexes and subtests. Effect sizes were large for the Immediate and General Memory Indexes and medium for the Working Memory Index. In general, TBI had a greater effect on the Visual than Auditory Indexes. Effect sizes were greatest for Family Pictures and least for the auditory recognition and working memory tasks. Group findings indicate the immediate memory tasks to be clinically useful in relation to a severe or extremely severe TBI, but not for less severe trauma. Delayed memory tasks do not provide information additional to that obtained from immediate memory measures. The revised Tulsky indexes are no more sensitive to the effects of TBI than the original ones. Differences between WMS-III memory indexes are unlikely to be of diagnostic utility although memory-intelligence discrepancies may be.

Wechsler Adult Intelligence Scale-Third Edition findings in relation to severity of brain injury in litigants.

WAIS-III findings were reported for 150 litigants, classified into three groups according to severity of traumatic brain injury (TBI), and a general population control group. There was a significant "dose response" relationship between TBI severity and all Index/IQ scores. Effect size was greatest for the Processing Speed Index (PSI). Between group differences were significant on all subtests except Information and Digit Span. Effect sizes were greatest for Digit Symbol, Symbol Search, Similarities, and Picture Arrangement. Relative to the control group, there was a significant difference for the Severe and Extremely Severe TBI groups on all IQ/Index scores and most subtests. The Moderate TBI group differed significantly on one Index (the PSI) and none of the subtests. Clinical implications of the findings are discussed in relation to the utility of the WAIS-III in assessing the cognitive sequelae of TBI, the use of current WAIS-III IQ scores to assess intelligence-memory discrepancies, WAIS-III short forms, and estimation of premorbid intelligence.

Evaluation of two methods for estimating Premorbid Intelligence on the WAIS-III in a clinical sample.

Two methods of predicting premorbid WAIS-III Full Scale IQ, namely a demographic measure (DP IQ) and the Oklahoma Premorbid Intelligence Estimate-3 (OPIE-3), were assessed in three traumatic brain injury (TBI) groups of varying injury severity and normal controls. On the DP IQ, average scores were in keeping with the general population mean across all groups but range was severely restricted. OPIE-3 IQ scores were not subject to severe range restriction and were comparable with the general population mean in the control and least severely brain injured group. They were significantly lower relative to controls in the severe and extremely severe TBI groups, with differences averaging around 7 and 10 points, respectively. OPIE-3 (Best) proved particularly robust in more severely injured subjects. Effect sizes for the combined TBI sample relative to controls were greatest for OPIE-3 measures that included two non-verbal subtests and were least for that involving vocabulary only. Implications of the findings for clinical practice and further research are discussed.