Eye movement desensitization and reprocessing for post-stroke post-traumatic stress disorder: Case report using the three-phase approach.

Medically-induced post-traumatic stress disorder (PTSD) is substantially more prevalent than PTSD in the general population. In people with stroke, it can impact as many as 23% of patients, with negative effects on mental health as well as stroke-related disability. Medically-induced PTSD may have unique features compared to other forms of PTSD, and therefore there is a pressing need to evaluate existing treatments for PTSD in this context. The current study reports on the feasibility, safety, and efficacy of Eye Movement Desensitization and Reprocessing (EMDR) for PTSD subsequent to a pontine stroke. Using a quasi-experimental case design, a 44-year-old Caucasian woman received EMDR delivered via telehealth. Self-report measures were obtained at baseline, pre-EMDR, and post-EMDR, with brief neuropsychological testing pre/post-EMDR. After 3 sessions of EMDR, the patient no longer met criteria for PTSD, and showed clinically significant reductions in depressive and generalized anxiety symptoms. With proper safety provisions, it is feasible to deliver EMDR via telehealth to alleviate post-stroke PTSD. Reduced linguistic demands of EMDR may be particularly appealing for persons with neurological disorders as compared to other trauma therapies. Further work is also needed to understand the parameters of baseline neuropsychological function that could impact response to intervention.

Neuropsychological Impact of Trauma-Related Mental Illnesses: A Systematic Review of Clinically Meaningful Results.

A trauma history is present in approximately 90% of adults in the United States. Comparatively, lifetime post-traumatic stress disorder (PTSD) prevalence is only 8.3% (Kilpatrick et al. Journal of Traumatic Stress, 26, 537-547, 2013). A neuropsychological understanding of trauma is essential to effective trauma-informed assessments and treatments. Prior reviews have focused on PTSD, specific neuropsychological domains, and statistically rather than clinically significant results. The current systematic review investigated standardized test performance across neuropsychological domains in participants with trauma histories and any psychiatric diagnosis. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 2350 records, the search returned 21 eligible studies: 8 for combat trauma, 2 for childhood trauma, 2 for intimate partner violence and sexual assault, 2 for accidental trauma, 1 for refugee trauma, and 6 for unspecified trauma. Mean neuropsychological scores ranged from low to high average, with one mean verbal memory score in the borderline range. These findings diverge from reports of between-group differences or experimental task performance, which suggest greater levels of static cognitive impairment. Current results are limited by lack of distinction between trauma types in the literature, a dearth of cognitive domains examined, wide use of self-report trauma measures, and publication and outcome reporting biases. Clinical implications for assessment and rehabilitation are discussed in relation to clinical significance, state versus trait based changes, intra-individual variability, changes from pre- to post-trauma, and within-group variability in resilience. Future directions are recommended in consideration of cultural factors, prospective and follow-up designs, and psychiatric diagnosis.

Efficacy of Neurofeedback Interventions for Cognitive Rehabilitation Following Brain Injury: Systematic Review and Recommendations for Future Research.

OBJECTIVES: Interest in neurofeedback therapies (NFTs) has grown exponentially in recent years, encouraged both by escalating public interest and the financial support of health care funding agencies. Given NFTs' growing prevalence and anecdotally reported success in treating common effects of acquired brain injury (ABI), a systematic review of the efficacy of NFTs for the rehabilitation of ABI-related cognitive impairment is warranted. METHODS: Eligible studies included adult samples (18+ years) with ABI, the use of neurofeedback technology for therapeutic purposes (as opposed to assessment), the inclusion of a meaningful control group/condition, and clear cognitive-neuropsychological outcomes. Initial automated search identified n = 86 candidate articles, however, only n = 4 studies met the stated eligibility criteria. RESULTS: Results were inconsistent across studies and cognitive domains. Methodological and theoretical limitations precluded robust and coherent conclusions with respect to the cognitive rehabilitative properties of NFTs. We take the results of these systematic analyses as a reflection of the state of the literature at this time. These results offer a constructive platform to further discuss a number of methodological, theoretical, and ethical considerations relating to current and future NFT-ABI research and clinical intervention. CONCLUSIONS: Given the limited quantity and quality of the available research, there appears to be insufficient evidence to comment on the efficacy of NFTs within an ABI rehabilitation context at this time. It is imperative that future work increase the level of theoretical and methodological rigour if meaningful advancements are to be made understanding and evaluating NFT-ABI applications.

Cognitive, physical, and psychological benefits of yoga for acquired brain injuries: A systematic review of recent findings.

Yoga is a holistic practice that - when incorporated effectively into neurorehabilitation - has potential to meet the complex needs of persons with acquired brain injury (ABI). This systematic review, conducted in accordance with PRISMA guidelines, investigated cognitive, physical, and psychological outcomes following controlled trials of yoga for ABI. The search returned six eligible studies, four of which focused specifically on stroke rehabilitation. For persons with ABI broadly, within-group improvements were found after yoga for psychological and physical adjustment, quality of life, and respiratory functioning. For stroke specifically, physical and memory recovery was greater in the yoga group vs. exercise control, and within-group improvements were noted for motor functioning, self-efficacy, and quality of life outcomes. Lack of (1) between-group analyses despite the inclusion of control groups, and (2) a common yoga rehabilitation protocol including frequency, length, and duration of yoga must be addressed in future research to establish efficacy of these interventions. Considerations for psychophysiological outcome measures and cultural factors are presented in the context of future research and clinical directions.

Characteristics of Healthy Older Adults that Influence Self-rated Cognitive Function.

OBJECTIVES: We sought to clarify the nature of self-reported cognitive function among healthy older adults by considering the short-term, within-person association (coupling) of subjective cognitive function with objective cognitive performance. We expected this within-person coupling to differ between persons as a function of self-perceived global cognitive decline and depression, anxiety, or neuroticism. METHODS: This was an intensive measurement (short-term longitudinal) study of 29 older adult volunteers between the ages of 65 and 80 years without an existing diagnosis of dementia or mild cognitive impairment. Baseline assessment included neuropsychological testing and self-reported depression, anxiety, and neuroticism, as well as self- and informant-reported cognitive decline (relative to 10 years previously). Intensive within-person measurement occasions included subjective ratings of cognitive function paired with performance on a computerized working memory (n-back) task; each participant attended four or five assessments separated by intervals of at least one day. Statistical analysis was comprised of multilevel linear regression. RESULTS: Comparison of models suggested that both neuroticism and self-rated cognitive decline explained unique variance in the within-person, across-occasion coupling of subjective cognitive function with objective working memory performance. CONCLUSIONS: Self-ratings of cognition may accurately reflect day-to-day variations in objective cognitive performance among older adults, especially for individuals lower in neuroticism and higher in self-reported cognitive decline. Clinicians should consider these individual differences when determining the validity of complaints about perceived cognitive declines in the context of otherwise healthy aging. (JINS, 2018, 24, 57-66).

Respond, don't react: The influence of mindfulness training on performance monitoring in older adults.

A sizeable body of literature demonstrates positive effects of mindfulness training on brain, behavior, and psychological processes in both novice and expert practitioners as compared to non-meditators. However, only more recently has research begun to examine the specific mechanisms by which mindfulness exerts these effects. In the current study, we used event-related potentials (error-related negativity (ERN), error positivity (Pe)) to test the hypothesis that performance monitoring is one such mechanism. We conducted a randomized controlled trial in healthy older adults (n = 36), relevant because markers of performance monitoring are known to decline with normal aging. Compared to an active control condition, mindfulness participants showed an increase in the ERN, without an increase in the Pe. Participants in both groups reported a reduction in self-report of anxiety and self-judgment of one's own mental functioning, indicating the subjective impression of benefit from each intervention type. The current results are important insofar as they support the purported self-regulatory functions of mindfulness (i.e., learning to respond, not react), as well as demonstrating that such positive effects can be obtained in an older adult sample, both of which have important implications for intervention.

Non-Pharmacologic Interventions for Older Adults with Subjective Cognitive Decline: Systematic Review, Meta-Analysis, and Preliminary Recommendations.

In subjective cognitive decline (SCD), older adults present with concerns about self-perceived cognitive decline but are found to have clinically normal function. However, a significant proportion of those adults are subsequently found to develop mild cognitive impairment, Alzheimer's dementia or other neurocognitive disorder. In other cases, SCD may be associated with mood, personality, and physical health concerns. Regardless of etiology, adults with SCD may benefit from interventions that could enhance current function or slow incipient cognitive decline. The objective of this systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, is to examine the benefits of non-pharmacologic intervention (NPI) in persons with SCD. Inclusion criteria were studies of adults aged 55 + with SCD defined using published criteria, receiving NPI or any control condition, with cognitive, behavioural, or psychological outcomes in controlled trails. Published empirical studies were obtained through a standardized search of CINAHL Complete, Cochrane Central Register of Controlled Trials, MEDLINE with Full Text, PsycINFO, and PsycARTICLES, supplemented by a manual retrieval of relevant articles. Study quality and bias was determined using PEDro. Nine studies were included in the review and meta-analysis. A wide range of study quality was observed. Overall, a small effect size was found on cognitive outcomes, greater for cognitive versus other intervention types. The available evidence suggests that NPI may benefit current cognitive function in persons with SCD. Recommendations are provided to improve future trials of NPI in SCD.

Subjective Cognitive Decline in Preclinical Alzheimer's Disease.

Older adults with subjective cognitive decline (SCD) in the absence of objective neuropsychological dysfunction are increasingly viewed as at risk for non-normative cognitive decline and eventual progression to Alzheimer's disease (AD) dementia. The past decade has witnessed tremendous growth in research on SCD, which may reflect the recognition of SCD as the earliest symptomatic manifestation of AD. Yet methodological challenges associated with establishing common assessment and classification procedures hamper the construct. This article reviews essential features of SCD associated with preclinical AD and current measurement approaches, highlighting challenges in harmonizing study findings across settings. We consider the relation of SCD to important variables and outcomes (e.g., AD biomarkers, clinical progression). We also examine the role of self- and informant-reports in SCD and various psychological, medical, and demographic factors that influence the self-report of cognition. We conclude with a discussion of intervention strategies for SCD, ethical considerations, and future research priorities.

Implementation of subjective cognitive decline criteria in research studies.

INTRODUCTION: Subjective cognitive decline (SCD) manifesting before clinical impairment could serve as a target population for early intervention trials in Alzheimer's disease (AD). A working group, the Subjective Cognitive Decline Initiative (SCD-I), published SCD research criteria in the context of preclinical AD. To successfully apply them, a number of issues regarding assessment and implementation of SCD needed to be addressed. METHODS: Members of the SCD-I met to identify and agree on topics relevant to SCD criteria operationalization in research settings. Initial ideas and recommendations were discussed with other SCD-I working group members and modified accordingly. RESULTS: Topics included SCD inclusion and exclusion criteria, together with the informant's role in defining SCD presence and the impact of demographic factors. DISCUSSION: Recommendations for the operationalization of SCD in differing research settings, with the aim of harmonization of SCD measurement across studies are proposed, to enhance comparability and generalizability across studies.

A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome.

OBJECTIVE: To evaluate the effectiveness of the mindfulness-based stress reduction (MBSR) program tailored to individuals with mild traumatic brain injury (mTBI). DESIGN: A convenience sample recruited from clinical referrals over a 2-year period completed outcome measures pre- and posttreatment intervention. SETTING: Post-acute brain injury rehabilitation center within a suburban medical facility. PARTICIPANTS: Twenty-two individuals with mTBI and a time postinjury more than 7 months. Eleven participants were men and 11 were women, ranging in age from 18 to 62 years. INTERVENTION: A 10-week group (with weekly 2-hour sessions) modeled after the MBSR program of Kabat-Zinn, but with modifications designed to facilitate implementation in a population of individuals with brain injury. (The treatment involved enhancement of attentional skills, in addition to increased awareness of internal and external experiences associated with the perspective change of acceptance and nonjudgmental attitude regarding those experiences). MAIN OUTCOME MEASURES: Perceived Quality of Life Scale, Perceived Self-Efficacy Scale, and the Neurobehavioral Symptom Inventory. Secondary measures included neuropsychological tests, a self-report problem-solving inventory, and a self-report measure of mindfulness. RESULTS: Clinically meaningful improvements were noted on measures of quality of life (Cohen d = 0.43) and perceived self-efficacy (Cohen d = 0.50) with smaller but still significant effects on measures of central executive aspects of working memory and regulation of attention. CONCLUSION: The MBSR program can be adapted for participants with mTBI. Improved performance on measures associated with improved quality of life and self-efficacy may be related to treatment directed at improving awareness and acceptance, thereby minimizing the catastrophic assessment of symptoms associated with mTBI and chronic disability. Additional research on the comparative effectiveness of the MBSR program for people with mTBI is warranted.

Three potential neurovascular pathways driving the benefits of mindfulness meditation for older adults.

Mindfulness meditation has been shown to be beneficial for a range of different health conditions, impacts brain function and structure relatively quickly, and has shown promise with aging samples. Functional magnetic resonance imaging metrics provide insight into neurovascular health which plays a key role in both normal and pathological aging processes. Experimental mindfulness meditation studies that included functional magnetic resonance metrics as an outcome measure may point to potential neurovascular mechanisms of action relevant for aging adults that have not yet been previously examined. We first review the resting-state magnetic resonance studies conducted in exclusively older adult age samples. Findings from older adult-only samples are then used to frame the findings of task magnetic resonance imaging studies conducted in both clinical and healthy adult samples. Based on the resting-state studies in older adults and the task magnetic resonance studies in adult samples, we propose three potential mechanisms by which mindfulness meditation may offer a neurovascular therapeutic benefit for older adults: (1) a direct neurovascular mechanism via increased resting-state cerebral blood flow; (2) an indirect anti-neuroinflammatory mechanism via increased functional connectivity within the default mode network, and (3) a top-down control mechanism that likely reflects both a direct and an indirect neurovascular pathway.

Linking self-perceived cognitive functioning questionnaires using item response theory: The subjective cognitive decline initiative.

OBJECTIVE: Self-perceived cognitive functioning, considered highly relevant in the context of aging and dementia, is assessed in numerous ways-hindering the comparison of findings across studies and settings. Therefore, the present study aimed to link item-level self-report questionnaire data from international aging studies. METHOD: We harmonized secondary data from 24 studies and 40 different questionnaires with item response theory (IRT) techniques using a graded response model with a Bayesian estimator. We compared item information curves to identify items with high measurement precision at different levels of the self-perceived cognitive functioning latent trait. Data from 53,030 neuropsychologically intact older adults were included, from 13 English language and 11 non-English (or mixed) language studies. RESULTS: We successfully linked all questionnaires and demonstrated that a single-factor structure was reasonable for the latent trait. Items that made the greatest contribution to measurement precision (i.e., "top items") assessed general and specific memory problems and aspects of executive functioning, attention, language, calculation, and visuospatial skills. These top items originated from distinct questionnaires and varied in format, range, time frames, response options, and whether they captured ability and/or change. CONCLUSIONS: This was the first study to calibrate self-perceived cognitive functioning data of geographically diverse older adults. The resulting item scores are on the same metric, facilitating joint or pooled analyses across international studies. Results may lead to the development of new self-perceived cognitive functioning questionnaires guided by psychometric properties, content, and other important features of items in our item bank. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Systematic Review of Neuroimaging Studies Comparing Individuals with Subjective Cognitive Decline to Healthy Controls.

BACKGROUND: Individuals with subjective cognitive decline (SCD) are hypothesized to be the earliest along the cognitive continuum between healthy aging and Alzheimer's disease (AD), although more research is needed on this topic. Given that treatment approaches may be most effective pre-clinically, a primary objective of emerging research is to identify biological markers of SCD using neuroimaging methods. OBJECTIVE: The current review aimed to comprehensively present the neuroimaging studies on SCD to date. METHODS: PubMed and PsycINFO databases were searched for neuroimaging studies of individuals with SCD. Quality assessments were completed using the Appraisal tool for Cross-Sectional Studies. RESULTS: In total, 62 neuroimaging studies investigating differences between participants with SCD and healthy controls were identified. Specifically, the number of studies were as follows: 36 MRI, 6 PET, 8 MRI/PET, 4 EEG, 7 MEG, and 1 SPECT. Across neuroimaging modalities, 48 of the 62 included studies revealed significant differences in brain structure and/or function between groups. CONCLUSION: Neuroimaging methods can identify differences between healthy controls and individuals with SCD. However, inconsistent results were found within and between neuroimaging modalities. Discrepancies across studies may be best accounted for by methodological differences, notably variable criteria for SCD, and differences in participant characteristics and risk factors for AD. Clinic based recruitment and cross-sectional study design were common and may bias the literature. Future neuroimaging investigations of SCD should consistently incorporate the standardized research criteria for SCD (as recommended by the SCD-Initiative), include more details of their SCD sample and their symptoms, and examine groups longitudinally.

Identification of Earlier Biomarkers for Alzheimer's Disease: A Multimodal Neuroimaging Study of Individuals with Subjective Cognitive Decline.

BACKGROUND: Individuals with subjective cognitive decline (SCD) are thought to be the earliest along the cognitive continuum between healthy aging and Alzheimer's disease (AD). OBJECTIVE: The current study used a multi-modal neuroimaging approach to examine differences in brain structure and function between individuals with SCD and healthy controls (HC). METHODS: 3T high-resolution anatomical images and resting-state functional MRI scans were retrieved for 23 individuals with SCD and 23 HC from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. RESULTS: The SCD and HC groups were not significantly different in age or education level. Voxel-based morphometry results did not show significant differences in grey matter volume between the groups. Functional MRI results revealed significantly greater functional connectivity in the default mode network in regions including the bilateral precuneus cortex, bilateral thalamus, and right hippocampal regions in individuals with SCD relative to controls. Conversely, those with SCD showed decreased functional connectivity in the bilateral frontal pole, caudate, angular gyrus, and lingual gyrus, compared to HC. CONCLUSION: Findings revealed differences in brain function but not structure between individuals with SCD and HC. Overall, this study represents a crucial step in characterizing individuals with SCD, a group recognized to be at increased risk for AD. It is imperative to identify biomarkers of AD prior to significant decline on clinical assessment, so that disease-delaying interventions may be delivered at the earliest possible time point.

A multi-timescale, multi-method perspective on older adult neurocognitive adaptability.

Objective: Ethical and economic values compel us to improve the screening, monitoring, and enhancement of older adult neurocognitive adaptability. Diverse contemporary theoretical and empirical perspectives highlight the multi-timescale, multi-mechanistic nature of neurocognitive adaptability. Still lacking are frameworks and methodologies that demonstrate this convergence to allow for new paradigms that harness the clinical utility of neurocognitive adaptability.Method: We present a multi-method, multi-timescale analysis of neurocognitive adaptability in a group of healthy, community-dwelling older adults from the Victoria, British Columbia region. Each participant completed a 96-trial computerized cognitive flexibility task at 4 to 6 separate laboratory visits spanning about a month. This captured within-person changes at the within-occasion and across-occasion levels (timescales of seconds and days/weeks, respectively). We used standardized clinical assessments of cognitive reserve (i.e., estimated premorbid function) and conscientiousness (a personality dimension) as cross-sectional (time-invariant) predictors in multi-level linear regression to illustrate between-person differences in within-person cognitive performance trajectories.Results: Reserve predicted cognitive performance differences at the timescale of seconds (within occasions) but did not relate to differences at the timescale of days/weeks (across occasions); in contrast, conscientiousness predicted cognitive performance differences at both timescales. Distinct processes operating within the same task (stimulus-classification vs. set-shifting) improved with practice at discrepant rates.Conclusions: Neurocognitive adaptability is underlain by multiple biopsychosocial mechanisms. Certain widely-used clinical indices (e.g., of reserve or conscientiousness) may estimate distinct types of neurocognitive adaptability relevant to maintaining functional independence into old age. Our methodology and theoretical framework assume that neurocognitive adaptability unfolds at multiple hierarchical scales of time.

The characterisation of subjective cognitive decline.

A growing awareness about brain health and Alzheimer's disease in the general population is leading to an increasing number of cognitively unimpaired individuals, who are concerned that they have reduced cognitive function, to approach the medical system for help. The term subjective cognitive decline (SCD) was conceived in 2014 to describe this condition. Epidemiological data provide evidence that the risk for mild cognitive impairment and dementia is increased in individuals with SCD. However, the majority of individuals with SCD will not show progressive cognitive decline. An individually tailored diagnostic process might be reasonable to identify or exclude underlying medical conditions in an individual with SCD who actively seeks medical help. An increasing number of studies are investigating the link between SCD and the very early stages of Alzheimer's disease and other neurodegenerative diseases.

Tract-Based Spatial Statistics Reveal Lower White Matter Integrity Specific to Idiopathic Rapid Eye Movement Sleep Behavior Disorder as a Proxy for Prodromal Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is characterized by distinct motor symptoms which do not manifest until significant neurodegeneration has already occurred. Therefore, preventative treatments depend on PD being detected in a prodromal phase. To date, prodromal PD (pPD) has been conceptualized based on conditions such as REM Sleep Behavior Disorder (RBD), which has a high conversion rate to clinical PD (cPD). However, few studies have examined microstructural differences between healthy controls (HC), pPD, and cPD. OBJECTIVE: The current study examined white matter microstructure in different phases of PD progression. METHODS: Participants included 21 HC, 20 pPD (14 with RBD and 6 with hyposmia), and 17 cPD from the Parkinson's Progression Markers Initiative database. Tract-based spatial statistics were used to determine between group differences in fractional anisotropy (FA) and mean diffusivity (MD). RESULTS: Mean diffusivity was significantly increased in pPD relative to cPD in widespread, but mostly right lateralized regions. Post-hoc analyses indicated that this pattern was particular to individuals with RBD. There were no microstructural differences between HC and pPD or cPD. The pPD group had significantly higher RBD symptoms and the cPD group had significantly higher motor symptoms. CONCLUSIONS: Observed microstructural deterioration in individuals with RBD relative to cPD may indicate an altered pattern of neurodegeneration associated with RBD as a prodromal symptom of PD. Future studies should aim to further characterize possible differential patterns of progression from various non-motor symptoms (e.g., RBD, hyposmia) to cPD using longitudinal designs.

Neuropsychological and resting-state electroencephalographic markers of older adult neurocognitive adaptability.

OBJECTIVE: This study was undertaken to explore multimethod neurocognitive screening tools to aid in detection of older adults who may be at heightened risk of pathological cognitive decline (preclinical dementia). In so doing, this study advances the theoretical conceptualization of neurocognitive adaptability in the context of aging and dementia. METHOD: This article reports original data from the baseline measurement occasion of a longitudinal study of healthy, community-dwelling older adults from the Victoria, British Columbia region. Participants were diagnosed as normal, subtle decline, or mild cognitive impairment according to actuarial neuropsychological criteria (adjusted for age only or adjusted for age and premorbid IQ). Diagnostic classification was employed to illustrate group differences in a novel metric of multi-timescale neural adaptability derived from 4-min of resting-state electroencephalographic data collected from each participant (immediately following their neuropsychological evaluation). RESULTS: Prior findings were replicated; adjusting raw neuropsychological test scores for individual differences in estimated premorbid IQ appeared to increase the sensitivity of standardized clinical tasks to subtle cognitive impairment. Moreover, and consistent with prior neuroscientific research, timescale-specific (i.e. at ∼12-20 ms timescales) differences in resting-state neural adaptability appeared to characterize groups who differed in terms of neuropsycholgoical diagnostic classification. CONCLUSIONS: Recently proposed actuarial neuropsychological criteria for subtle cognitive decline identify older adults who show timescale-specific changes in resting brain function that may signal the onset of preclinical dementia. The subtle decline stage may represent a critical inflection point-partial loss of neurocognitive adaptability-on a pathological aging trajectory. These findings illustrate areas of potential future development in neurocognitive health care.

White matter and its relationship with cognition in subjective cognitive decline.

INTRODUCTION: Subjective cognitive decline (SCD) is the earliest stage on the continuum toward Alzheimer's disease. This study examined (1) differences in white matter integrity between individuals with SCD and healthy control subjects and (2) how white matter integrity related to memory and executive function. METHODS: Diffusion tensor imaging and neuropsychological assessment data were retrieved from the Alzheimer's Disease Neuroimaging Initiative database for 30 individuals with SCD and 44 control subjects. RESULTS: Results revealed significantly lower white matter integrity in individuals with SCD relative to control subjects in widespread regions, including the bilateral corticospinal tracts, superior and inferior longitudinal fasciculi, fronto-occipital fasciculi, corpus callosum, forceps major and minor, hippocampi, anterior thalamic radiations, and the cerebellum. There was a widespread relationship between diffusion tensor imaging metrics and executive function in SCD, but not healthy control subjects, and no relationship with memory for either group. DISCUSSION: Relatively lower white matter integrity in SCD may be a useful early biomarker for risk of future cognitive decline. Future research should better characterize the SCD group longitudinally and in individuals at risk for Alzheimer's disease.

Use of MMPI-2 to predict cognitive effort: a hierarchically optimal classification tree analysis.

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context.