Olfactory and Neuropsychological Functioning in Olfactory Reference Syndrome.

BACKGROUND: Olfactory reference syndrome (ORS) is an underrecognized, understudied, and often severe psychiatric disorder characterized by a prominent and distressing or impairing preoccupation with a false belief of emitting an offensive body odor. As this condition has only recently been recognized in the International Classification of Diseases (the 11th Edition), no empirical evidence exists about the underlying features and etiology of the disorder. OBJECTIVE: To examine the neuropsychological and olfactory functioning of individuals with ORS and address whether there is central nervous system or sensory dysfunction associated with the condition. METHODS: In this preliminary investigation, 9 consecutive participants with ORS completed a structured clinical interview and neuropsychological and olfaction evaluations. RESULTS: A proportion of individuals with ORS displayed deficits in aspects of cognitive functioning (i.e., processing speed, executive functioning, recognition memory bias for ORS-related words), olfaction functioning (i.e., odor detection and discrimination), and emotional processing. CONCLUSIONS: Based on these preliminary findings of cognitive, olfaction, and emotional processing deficits in individuals with ORS, further neuropsychological and olfaction studies are needed that better characterize this understudied patient group and address this study's limitations.

Self-reported depressive syndromes in mild cognitive impairment and mild Alzheimer's disease.

BACKGROUND: There is suggestion that self-reported depressive syndromes can independently manifest in the general population as cognitive/affective or somatic/vegetative. The Beck Depression Inventory, 2nd edition (BDI-II), a self-report measure of depressive symptoms, has been shown to support this two-factor structure. However, this finding has not been examined in an older adult sample with cognitive impairment. In order to determine whether older adults with cognitive impairments exhibit similarly independent cognitive/affective and somatic/vegetative depressive syndromes, we explored the factor structure of the BDI-II in this population. METHODS: Participants were 228 older adults (mean age = 74, SD = 7.9) diagnosed with mild cognitive impairment (MCI; n = 137) or early Alzheimer's disease (n = 85), who completed the BDI-II as part of an outpatient neuropsychological evaluation. Exploratory principal component factor analysis with direct Oblimin rotation was conducted, and a two-factor solution was specified based on our theoretical conceptualization of the cognitive/affective and somatic/vegetative items from the scale. RESULTS: The first factor represented cognitive/affective symptoms of depression (e.g. self-dislike, pessimism, worthlessness), and accounted for 36% of the variance. Adding the second factor, reflecting somatic/vegetative items (e.g. sleep and appetite changes, loss of energy), accounted for an additional 6.8% of the variance. CONCLUSION: Results supported the presence of two distinct depressive syndromes, cognitive/affective and somatic/vegetative symptoms. Thus, cognitively impaired older adults report mood symptoms relatively similarly to younger and midlife adults. This supports the validity of self-reported mood in this group, and the results may have implications for psychiatric treatment in this population.

Neuropsychologists' beliefs about alcohol and dementia.

Alcohol-related dementia (ARD) is a controversial concept, and the prevailing view of neuropsychologists regarding this disorder is unknown. The purpose of this study was to gain an understanding of neuropsychologists' beliefs and practices regarding ARD. A total of 140 board-certified neuropsychologists completed an anonymous online survey about alcohol and dementia. Almost all respondents (93%) reported alcohol has direct neurotoxic effects, but most were unsure whether moderate alcohol use can be neuroprotective. The presence and course of cognitive deficits as well as functional impairments were rated as the most important factors to consider when making this diagnosis, and declines in memory, executive functions, and processing speed were most frequently observed cognitive changes. Neuropsychologists were mixed in their opinions about cognitive prognosis, with half the sample endorsing stability of cognitive deficits and about one-third of the group indicating gradual improvement. Although laboratory workup was not a major diagnostic consideration, 68% of respondents recommended treatment with vitamins and nutritional supplements. Findings are consistent with the research literature and suggest that while neuropsychologists generally believe alcohol can have direct neurotoxic effects, they vary in their beliefs about diagnosis, treatment, and prognosis. Future research should focus on providing diagnostic and treatment guidelines for ARD.

Cognitive abilities and functional capacity in older adults: results from the modified Scales of Independent Behavior-Revised.

The relationship between cognitive and functional abilities was examined in a sample of community-dwelling older adults. Self and informant (e.g., spouse) reports of participants' functional status were obtained on the modified Scales of Independent Behavior-Revised (mSIB-R). Participants also completed measures of processing speed, episodic memory, executive functioning, and verbal ability. Results showed that the mSIB-R correlated positively with cognitive variables. Hierarchical regression analyses suggested that each mSIB-R factor is predicted by somewhat different cognitive variables, after adjusting for demographic, health, and motor variables. This report-based measure was as accurate as a performance-based measure in classifying cognitive groups. Informant social/cognitive engagement and self physical/environment engagement factors showed the most promise in this regard. The findings reveal links between cognitive and functional abilities in a sample with varying degrees of cognitive impairment.

How'd they do it? Malingering strategies on symptom validity tests.

Twenty-five undergraduate students were instructed to feign believable impairment following a brain injury from a car accident and 27 students were told to perform like they had recovered from such an injury. Three forced-choice tests, the Test of Memory Malingering (TOMM), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT) were given. Test-taking strategies were evaluated by means of a questionnaire given at the end of the test session. The results revealed that all the tasks differentiated between groups. Using conventional cut-scores, the WMT proved most efficient while the VSVT captured the most participants in the definitive below-chance category. Individuals instructed to feign injury were more likely to prepare prior to the experiment, with feigning of memory loss as the most frequently reported strategy. Regardless, preparation effort did not translate into believable performance on the tests.