Prodromal Dementia With Lewy Bodies: Evolution of Symptoms and Predictors of Dementia Onset.

BACKGROUND: Research criteria for prodromal dementia with Lewy bodies (DLB) were published in 2020, but little is known regarding prodromal DLB in clinical settings. METHODS: We identified non-demented participants without neurodegenerative disease from the National Alzheimer's Coordinating Center Uniform Data Set who converted to DLB at a subsequent visit. Prevalence of neuropsychiatric and motor symptoms were examined up to 5 years prior to DLB diagnosis. RESULTS: The sample included 116 participants clinically diagnosed with DLB and 348 age and sex-matched (1:3) Healthy Controls. Motor slowing was present in approximately 70% of participants 3 years prior to DLB diagnosis. In the prodromal phase, 50% of DLB participants demonstrated gait disorder, 70% had rigidity, 20% endorsed visual hallucinations, and over 50% of participants endorsed REM sleep behavior disorder. Apathy, depression, and anxiety were common prodromal neuropsychiatric symptoms. The presence of 1+ core clinical features of DLB in combination with apathy, depression, or anxiety resulted in the greatest AUC (0.815; 95% CI: 0.767, 0.865) for distinguishing HC from prodromal DLB 1 year prior to diagnosis. The presence of 2+ core clinical features was also accurate in differentiating between groups (AUC = 0.806; 95% CI: 0.756, 0.855). CONCLUSION: A wide range of motor, neuropsychiatric and other core clinical symptoms are common in prodromal DLB. A combination of core clinical features, neuropsychiatric symptoms and cognitive impairment can accurately differentiate DLB from normal aging prior to dementia onset.

Neuropsychological Evaluations in Adults.

Neuropsychologists provide detailed assessments of cognitive and emotional functioning that often cannot be obtained through other diagnostic means. They use standardized assessment tools and integrate the findings with other data to determine whether cognitive decline has occurred, to differentiate neurologic from psychiatric conditions, to identify neurocognitive etiologies, and to determine the relationship between neurologic factors and difficulties in daily functioning. Family physicians should consider referring patients when there are questions about diagnostic decision making or planning of individualized management strategies for patients with mild cognitive impairment, dementia, traumatic brain injury, and other clinical conditions that affect cognitive functioning. Neuropsychological testing can differentiate Alzheimer dementia from nondementia with nearly 90% accuracy. The addition of neuropsychological testing to injury severity variables (e.g., posttraumatic amnesia) increases predicted accuracy in functional outcomes. A neuropsychological evaluation can be helpful in addressing concerns about functional capacities (e.g., ability to drive or live independently) and in determining a patient's capacity to make decisions about health care or finances. Most patients who underwent neuropsychological evaluation and their significant others reported that they found the evaluation helpful in understanding and coping with cognitive problems.

Selection of Normative Group Affects Rates of Mild Cognitive Impairment in Parkinson's Disease.

OBJECTIVE: The objective of this study was to examine the impact of different methods of standardizing cognitive data in the Parkinson's Progression Marker Initiative. METHODS: Cognitive data from 423 participants with Parkinson's disease were included (age = 61.7 [9.7], education = 15.6 [3.0]). Internal norms were calculated using the group mean and standard deviation of the healthy control group. Published norms were compared to the overall group mean of and to age-stratified norms from healthy controls for each neuropsychological test over 4 visits. Rates of mild cognitive impairment were calculated using established criteria. RESULTS: The use of internal norms resulted in lower standardized scores than published norms on all tests with the exception of memory and processing speed (P ≤ .001). Individuals were 1.5 to 2.1 times more likely to be diagnosed with mild cognitive impairment using internal norms than published norms. CONCLUSIONS: Standardization approaches with cognitive data are not interchangeable. Selection of a normative comparison group impacts research and clinical interpretations of cognitive data. © 2018 International Parkinson and Movement Disorder Society.

Neuropsychological Test Performance in Parkinsonism Without Dopaminergic Deficiency on [123I]-FP-CIT SPECT Imaging.

OBJECTIVES: To examine neuropsychological test performance among individuals clinically diagnosed with Parkinson's disease (PD) without evidence of dopaminergic deficiency on [123]I-CIT single photon emission computed tomography imaging. METHODS: Data were obtained from the Parkinson's Progression Marker Initiative. The sample included 59 participants with scans without evidence of dopaminergic deficiency (SWEDD), 412 with PD, and 114 healthy controls (HC). Tests included Judgment of Line Orientation, Letter-Number Sequencing, Symbol Digit Modalities, Hopkins Verbal Learning Test-Revised, and Letter and Category Fluency. Multivariate analysis of variance was used to compare standardized scores between the groups. RESULTS: There was a statistically significant difference in performances between the groups, F(14,1155)=5.04; p<.001; partial η2=.058. Pairwise comparisons revealed significant differences in Category Fluency between SWEDD (M=0.22; SD=1.08) and HC (M=0.86; SD=1.15) and in Symbol Digit Modalities Test performance between SWEDD (M=45.09; SD=11.54) and HC (M=51.75; SD=9.79). No significant differences between SWEDD and PD were found. Using established criteria, approximately one in four participants in the SWEDD and PD groups met criteria for mild cognitive impairment (MCI). CONCLUSIONS: Individuals with SWEDD demonstrate significantly worse mental processing speed and semantic fluency than HC. The neuropsychological test performances and rates of MCI were similar between the SWEDD group and PD groups, which may reflect a common pathology outside of the nigrostriatal pathway. (JINS, 2018, 24, 646-651).

Diagnostic Accuracy and Confidence in the Clinical Detection of Cognitive Impairment in Early-Stage Parkinson Disease.

BACKGROUND/AIMS: Mild cognitive impairment (MCI) is present in up to 34% of patients with early-stage Parkinson disease (PD); however, it is difficult to detect subtle impairment without objective cognitive testing. METHODS: Data were obtained from the Parkinson Progression Marker Initiative. All 341 participants were administered the Montreal Cognitive Assessment (MoCA) and a brief neuropsychological battery. Participants were classified as PD-MCI if MoCA was <26 or if they scored ≥1 standard deviation below the normative mean in 2 or more domains, based upon established criteria. The sensitivity/specificity for the clinical detection of PD-MCI was determined. RESULTS: Overall accuracy for clinical detection of PD-MCI was 67.4%. Although clinical determination was highly specific (96.3%; 95% confidence interval [CI]: 0.92-0.98), sensitivity was poor (32.0%; 95% CI: 0.25-0.40). CONCLUSION: Identifying MCI in early-stage PD based on clinical interview alone appears to be insufficient. The inclusion of objective cognitive tests allowing for normative sample comparisons is needed to increase the detection of cognitive impairment in this population.

Cognition in Patients With a Clinical Diagnosis of Parkinson Disease and Scans Without Evidence of Dopaminergic Deficit (SWEDD): 2-Year Follow-Up.

OBJECTIVE AND BACKGROUND: More than 10% of patients clinically diagnosed with Parkinson disease demonstrate normal dopamine uptake on dopamine transporter single-photon emission computed tomography (DaTscan), but little is known about how cognitive function differs between patients with dopamine deficiency on DaTscan and patients with scans without evidence of dopaminergic deficit (SWEDD). We compared the cognitive function of these two groups of patients over 2 years. METHODS: We retrospectively analyzed data obtained from the Parkinson's Progression Markers Initiative on 309 participants clinically diagnosed with idiopathic Parkinson disease who had scored in the normal range on the Montreal Cognitive Assessment at baseline and had completed 1- and 2-year follow-up visits. We compared the Montreal Cognitive Assessment scores at 1 and 2 years between the 42 participants with SWEDD and the 267 with dopamine deficiency. RESULTS: Mean cognitive scores did not differ significantly between groups at 1 year, but at 2 years the participants with SWEDD performed more poorly. At 2 years, 31% of the participants with SWEDD versus 15% of those with dopamine deficiency had statistically reliable cognitive impairment. CONCLUSIONS: This study provides evidence that some individuals clinically diagnosed with idiopathic Parkinson disease but with SWEDD demonstrate early cognitive decline. The results also suggest that recently diagnosed patients with SWEDD may be at even greater risk for cognitive decline than patients with DaTscan-confirmed early-stage Parkinson disease. While patients with SWEDD likely represent a heterogeneous group of etiologies, our results highlight the need to monitor these patients' cognitive function over time.

Performance validity in the dementia clinic: Specificity of validity tests when used individually and in aggregate across levels of cognitive impairment severity.

OBJECTIVE: This study examined the specificity of both individual PVTs and three different PVT batteries in individuals undergoing neuropsychological evaluation for dementia in order to establish both appropriate individual test cutoffs and multiple-PVT failure criterion. METHODS: Participants were 311 validly performing patients with no cognitive impairment (n = 24), mild cognitive impairment (MCI; n = 115), mild dementia (n = 122), or moderate dementia (n = 50). Cutoffs associated with ≥90% specificity were established for 11 individual PVTs across impairment severity groups. Aggregate false positive rates according to number of PVTs failed were examined for two 4-PVT batteries and one 7-PVT battery. One-way ANOVAs with post-hoc comparisons were conducted for each PVT. RESULTS: Performance on 9 of 11 PVTs significantly differed according to impairment severity. PVT cutoffs achieving ≥90% specificity also generally varied by group. For PVTs previously validated in non-dementia samples, slight adjustments from established cutoffs were generally required to maintain adequate specificity in MCI and mild dementia groups, with greater modifications required in the moderate dementia group. A criterion of ≥2 PVT failures resulted in ≥90% specificity in both 4-PVT batteries across groups. In the 7-PVT battery, adequate specificity was achieved with ≥2 failures in MCI and ≥3 failures in the mild dementia group. CONCLUSIONS: The incorporation and interpretation of several easily assimilated multiple-PVT batteries in dementia evaluations are explored. Additionally, data regarding individual PVT performance according to cognitive impairment severity are provided to aide validity assessment of both patients undergoing dementia evaluation and examinees who are less impaired.

Base rates of invalidity when patients undergoing routine clinical evaluations have social security disability as an external incentive.

Objective: Social Security Disability is a common external incentive in neuropsychological evaluations. This study determined base rates of invalidity when patients referred for routine clinical evaluations have Social Security Disability as an external incentive. Method: Patients (n = 242) were grouped as validly or invalidly performing based on the use of multiple performance validity tests. Frequency analyses were then conducted. Results: As a whole, 46.0% of clinically referred patients with Social Security Disability as an external incentive produced invalid data. When divided by disability pursuit status, 58.6% of individuals already receiving Social Security Disability, 44.6% of individuals actively seeking Social Security Disability, and 39.3% of individuals considering seeking Social Security Disability produced invalid data. By comparison, only 8.5% of clinically referred patients without known external incentives produced invalid data. Conclusions: Beyond establishing base rates, these data indicate that the external incentive, not necessarily the evaluation setting, increases the rate of invalidity, as obtained base rates mirror those observed in independent medical examinations. In addition, this study highlights that even patients who report that they are considering but have not committed themselves to pursuing an external incentive frequently invalidate testing.

Feedback with patients who produce invalid testing: Professional values and reported practices.

OBJECTIVE: Providing feedback to clinical patients who produce invalid neuropsychological test data presents with several potential challenges. Given the limited guidance available on the topic, neuropsychologists most likely utilize approaches that idiosyncratically incorporate professional values related to both assessment and patient care to address overarching feedback goals. The current article discusses professional values believed to inform feedback decisions and presents survey results regarding how neuropsychologists would approach feedback across various clinical scenarios where testing is invalid. METHOD: Participants were 209 adult-focused clinical neuropsychologists recruited via professional listservs, the majority of whom reported being board certified. Respondents were provided three case vignettes of clinical patients who produced invalid test data and were asked how they would provide feedback to each patient. Open-ended responses were coded to determine the relative frequency of feedback approaches, explicit statements, and implied goals. RESULTS: Nearly all respondents (98%) indicated that feedback would include some description of the invalid findings, and most respondents indicated that they would provide explanations for the reasons of invalidity (67%) and statements regarding the impact of invalidity on test interpretation (75%). There was little agreement across respondents, however, regarding specific feedback approach. Feedback goals included to Inform, Investigate, Treat, Educate, and Correct, with the presence of these implied goals also varying across respondents. CONCLUSIONS: The findings indicate that there is minimal consensus regarding feedback approaches provided to patients who produce invalid test data and underscore a need for further development and validation of specific feedback methods. The results are discussed within the context of the potentially competing professional values of evidence-based assessment, patient-doctor collaboration, and aspirational principles of beneficence and fidelity.

Cross-validation of the Invalid Forgetting Frequency Index (IFFI) from the Test of Memory Malingering.

OBJECTIVE: To increase sensitivity of the Test of Memory Malingering (TOMM), adjustments have been proposed, including adding consistency indices. The Invalid Forgetting Frequency Index (IFFI) is the most recently developed consistency index. While strong classification accuracy rates were originally reported, it currently lacks cross-validation. METHOD: A sample of 184 outpatients was utilized. Valid performers passed all criterion performance validity tests (PVTs) and invalid performers failed two or more PVTs. Classification accuracy statistics were calculated. RESULTS: AUC for the IFFI was 0.80, demonstrating adequate discrimination between valid and invalid groups. A score of 3 or more inconsistent responses resulted in sensitivity and specificity rates of 63% and 92%, respectively. CONCLUSIONS: This is the first article to cross-validate the IFFI. In both the original IFFI study and the current study, the same cut-off was found to maintain at least 90% specificity while producing higher sensitivity rates than those achieved by traditional TOMM indices.

How Much Education and Training Do Residents Across Specialties Receive in Neuropsychology?

INTRODUCTION: Neuropsychologists play an important role on multidisciplinary teams with physicians from multiple specialties. The extent of residency training on the use of neuropsychological services is unclear. Medical residents across multiple specialties throughout the United States were surveyed to assess resident education, training, and understanding of neuropsychological services, along with their intent to consult neuropsychologists in the future. METHODS: A survey was sent to residents in accredited psychiatry, neurology, family medicine, and internal medicine programs. After data were collected, chi-square group level analyses with post-hoc pairwise comparisons were used to analyze the data. RESULTS: A total of 434 residents took the survey. The proportion of residents exposed to neuropsychology during residency varied significantly according to specialty (χ2 (3, N = 419) = 51.4, p < 0.001), with more psychiatry and neurology residents reporting exposure than residents in family medicine or internal medicine. Similarly, the proportion of psychiatry and neurology residents who 'agree' or 'strongly agree' that they understand the nature of neuropsychological services differed significantly from family medicine and internal medicine residents (χ2 (3, N = 415) = 40.4, p < 0.001). The majority of residents across all specialties (85.7%) reported they are likely to consult/order neuropsychological services in future practice. CONCLUSIONS: The majority of residents in all specialties reported exposure to neuropsychological services in some manner, but forms of exposure varied. Results indicated a need for increased education and training in neuropsychological services, especially within family medicine and internal medicine programs.

Normal cognitive test scores cannot be interpreted as accurate measures of ability in the context of failed performance validity testing: A symptom- and detection-coached simulation study.

Introduction: While use of performance validity tests (PVTs) has become a standard of practice in neuropsychology, there are differing opinions regarding whether to interpret cognitive test data when standard scores fall within normal limits despite PVTs being failed. This study is the first to empirically determine whether normal cognitive test scores underrepresent functioning when PVTs are failed.Method: Participants, randomly assigned to either a simulated malingering group (n = 50) instructed to mildly suppress test performances or a best-effort/control group (n = 50), completed neuropsychological tests which included the North American Adult Reading Test (NAART), California Verbal Learning Test - 2nd Edition (CVLT-II), and Test of Memory Malingering (TOMM).Results: Groups were not significantly different in age, sex, education, or NAART predicted intellectual ability, but simulators performed significantly worse than controls on the TOMM, CVLT-II Forced Choice Recognition, and CVLT-II Short Delay Free Recall. The groups did not significantly differ on other examined CVLT-II measures. Of simulators who failed validity testing, 36% scored no worse than average and 73% scored no worse than low average on any of the examined CVLT-II indices.Conclusions: Of simulated malingerers who failed validity testing, nearly three-fourths were able to produce cognitive test scores that were within normal limits, which indicates that normal cognitive performances cannot be interpreted as accurately reflecting an individual's capabilities when obtained in the presence of validity test failure. At the same time, only 2 of 50 simulators were successful in passing validity testing while scoring within an impaired range on cognitive testing. This latter finding indicates that successfully feigning cognitive deficits is difficult when PVTs are utilized within the examination.

Base Rates of Invalid Test Performance Across Clinical Non-forensic Contexts and Settings.

OBJECTIVE: Base rates of invalidity in forensic neuropsychological contexts are well explored and believed to approximate 40%, whereas base rates of invalidity across clinical non-forensic contexts are relatively less known. METHODS: Adult-focused neuropsychologists (n = 178) were surveyed regarding base rates of invalidity across various clinical non-forensic contexts and practice settings. Median values were calculated and compared across contexts and settings. RESULTS: The median estimated base rate of invalidity across clinical non-forensic evaluations was 15%. When examining specific clinical contexts and settings, base rate estimates varied from 5% to 50%. Patients with medically unexplained symptoms (50%), external incentives (25%-40%), and oppositional attitudes toward testing (37.5%) were reported to have the highest base rates of invalidity. Patients with psychiatric illness, patients evaluated for attention deficit hyperactivity disorder, and patients with a history of mild traumatic brain injury were also reported to invalidate testing at relatively high base rates (approximately 20%). Conversely, patients presenting for dementia evaluation and patients with none of the previously mentioned histories and for whom invalid testing was unanticipated were estimated to produce invalid testing in only 5% of cases. Regarding practice setting, Veterans Affairs providers reported base rates of invalidity to be nearly twice that of any other clinical settings. CONCLUSIONS: Non-forensic clinical patients presenting with medically unexplained symptoms, external incentives, or oppositional attitudes are reported to invalidate testing at base rates similar to that of forensic examinees. The impact of context-specific base rates on the clinical evaluation of invalidity is discussed.

A Systematic Review and Meta-Analysis of the Utility of the Test of Memory Malingering in Pediatric Examinees.

OBJECTIVE: This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHOD: A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics. RESULTS: Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96-0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68-0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses. CONCLUSIONS: The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed.

A systematic review and meta-analysis of the Test of Memory Malingering in adults: Two decades of deception detection.

Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention.Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models.Results: For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59-0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96-0.98) and moderately sensitive (0.46-0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59-0.70) while maintaining adequate specificity (0.91-0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia.Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.

Classification accuracy rates of four TOMM validity indices when examined independently and jointly.

Objective: This study investigated sensitivity and specificity rates of four Test of Memory Malingering (TOMM) indices (Trial 1, Trial 2, Retention, and Albany Consistency Index (ACI)) and examined how classification accuracy rates change when utilizing these indices in various combinations. Method: A sample of 202 neuropsychological outpatients was utilized. Patients were categorized as valid performers if they passed all criterion performance validity tests (PVTs) and were determined to be invalid performers if they failed two or more criterion PVTs. Classification accuracy statistics were obtained for individual TOMM indices as well as combinations of TOMM indices. Results: When using only Trial 1 as a validity indicator, the TOMM identified 57% of invalidly performing individuals. When all TOMM indices were examined, the ACI demonstrated the highest sensitivity value (63%) but it also demonstrated the lowest specificity value (91%). Allowing for failure of any of the four TOMM indices provided the best overall sensitivity value (67%) while maintaining adequate specificity (90%). Finally, it was determined that failure of three or more TOMM validity indices resulted in a specificity rate of 97% and failure of four of more TOMM validity indices resulted in a specificity rate of 98%. Conclusions: Classification accuracy of TOMM validity indices are discussed in relation to positive and negative predictive values. Results suggest that clinicians can examine all four TOMM validity indices concurrently, particularly in settings where high base rates of invalidity occur.

Research methods in performance validity testing studies: Criterion grouping approach impacts study outcomes.

OBJECTIVE: Performance validity test (PVT) research studies commonly utilize a known-groups design, but the criterion grouping approaches within the design vary greatly from one study to another. At the present time, it is unclear as to what degree different criterion grouping approaches might impact PVT classification accuracy statistics. METHOD: To analyze this, the authors used three different criterion grouping approaches to examine how classification accuracy statistics of a PVT (Word Choice Test; WCT) would differ. The three criterion grouping approaches included: (1) failure of 2+ PVTs versus failure of 0 PVTs, (2) failure of 2+ PVTs versus failure of 0-1 PVT, and (3) failure of a stand-alone PVT versus passing of a stand-alone PVT (Test of Memory Malingering). RESULTS: When setting specificity at ≥.90, WCT cutoff scores ranged from 41 to 44 and associated sensitivity values ranged from .64 to .88, depending on the criterion grouping approach that was utilized. CONCLUSIONS: When using a stand-alone PVT to define criterion group status, classification accuracy rates of the WCT were higher than expected, likely due to strong correlations between the reference PVT and the WCT. This held true even when considering evidence that this grouping approach results in higher rates of criterion group misclassification. Conversely, when using criterion grouping approaches that utilized failure of 2+ PVTs, accuracy rates were more consistent with expectations. These findings demonstrate that criterion grouping approaches can impact PVT classification accuracy rates and resultant cutoff scores. Strengths, weaknesses, and practical implications of each of the criterion grouping approaches are discussed.

Examination of optimal embedded PVTs within the BVMT-R in an outpatient clinical sample.

OBJECTIVE: This study investigated whether indices within the Brief Visuospatial Memory Test - Revised (BVMT-R) could function as embedded performance validity measures in an outpatient clinical sample. METHOD: A sample of 138 neuropsychological outpatients was utilized; approximately 45% had a known or suspected external incentive. Patients were determined to be valid performers if they passed all criterion performance validity tests (PVTs) and determined to be invalid performers if they failed two or more PVTs. BVMT-R indices met criteria for optimal embedded PVTs if they were not significantly correlated with genuine cognitive dysfunction and if they adequately differentiated the validly from invalidly performing patient groups. Classification accuracy statistics for the indices were then calculated. Supplementary analyses were also calculated for a separate dementia sample. RESULTS: Recognition Hits and Recognition Discrimination were identified as two optimal embedded PVTs for patients without dementia. Recognition Hits showed a sensitivity rate of 41% and a specificity rate of 95%. Recognition Discrimination showed a sensitivity rate of 54% and a specificity rate of 93%. CONCLUSION: Embedded BVMT-R PVTs are discussed in relation to previous research findings, which were obtained from veteran samples. Recognition Hits and Recognition Discrimination are now validated in a non-veteran clinical sample.

The Roth Project - Music and Memory: A Community Agency Initiated Individualized Music Intervention for People with Dementia.

INTRODUCTION: "The Roth Project - Music and Memory" is a music-based intervention program, implemented by the Alzheimer's Association of Central and Western Kansas, which provides a non-pharmacological means for addressing neuropsychiatric symptoms in individuals with dementia. METHODS: Participants were individuals with dementia who were enrolled in The Roth Project - Music and Memory. Post-intervention surveys were distributed to caregivers of participants which assessed caregiver satisfaction with the program as well as caregiver perception of the impact of individualized music on mood and behavioral symptoms. RESULTS: Of returned surveys (n = 79), 99% of caregivers indicated they were satisfied or very satisfied with the program and 94% of caregivers perceived participants to like or very much like listening to the music. While a substantial number of participants required assistance with iPod use (95%), the majority of participants were observed to listen to the music with stable or increased frequency over time. Personalized music was observed to improve mood in 78% of cases, with the most frequent benefits being improved overall happiness, decreased anxiety, increased positive emotional expression, and decreased depression. CONCLUSIONS: The Roth Project - Music and Memory was well received by caregivers and was perceived to benefit mood of individuals with dementia. These results provided ongoing support for individualized music-based interventions and demonstrated that such interventions, when implemented by community agencies, can be well received by those who use them.

Rates of Abnormally Low TOPF Word Reading Scores in Individuals Failing Versus Passing Performance Validity Testing.

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer's dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.