Age Effects on Subtest and Composite Scores of the Wechsler Abbreviated Scale of Intelligence-Second Edition

We evaluated age effects in the Wechsler Abbreviated Scale of Intelligence-Second Edition (WASI-II) standardization sample. This extends work completed using previous editions of the Wechsler Adult Intelligence Scales. Of the four subtests, Vocabulary (VC) and Similarities (SI) were most resistant to aging. VC showed minimal variation regardless of age; SI peaked at 30 to 54 years followed by a decline. Block Design (BD) and Matrix Reasoning (MR) showed substantial drops from the younger to older groups. BD peaked at 17 to 44 years and then declined; MR peaked at 20 to 29 years and then consistently deteriorated. The WASI-II Verbal Comprehension Index peak at 30 to 44 years was followed by a maximum drop at 85 to 90 years. The Perceptual Reasoning Index peaked at 20 to 29 years, with a marked decline by 65 to 69 years. The Full Scale IQ was average until age 65 years followed by a decline. Minor changes in points of peak performance and subsequent decline were seen as a function of Full Scale IQ level. Results were consistent with crystallized and fluid intelligence theory.

Effects of different anesthetic regimens on postoperative cognitive function of elderly patients undergoing thoracic surgery: a double-blinded randomized controlled trial

OBJECTIVE

Postoperative cognitive dysfunction (POCD) is a serious surgical complication. We assessed the different POCD incidences between anesthesia using sevoflurane and sevoflurane combined with dexmedetomidine, with propofol-based sedation in elderly patients who underwent a thoracic surgical procedure.

METHODS

A total of 90 patients aged 65 to 80 years old who underwent a thoracic surgical procedure at our hospital and 15 nonsurgical participants as controls, were enrolled in this study. Patients were divided in a randomized 1:1:1 ratio into 3 groups. All participants were randomized into a trial with three anesthesia groups (P, PS, PSD) or a control group (C) of healthy matches. All trial groups received distinct anesthetic combinations during surgery, while controls mirrored patient criteria.Group P (propofol and remifentanil were maintained during the surgery), Group PS (propofol, remifentanil, and sevoflurane were maintained during the surgery), and Group PSD (propofol, remifentanil, sevoflurane, and dexmedetomidine were maintained during the surgery).All participants were rated using a series of cognitive assessment scales before and three days after surgery. All participants were interviewed over the telephone, 7 days, 30 days, and 90 days postoperatively.

RESULTS

POCD incidences in the PSD (combined anesthetization with propofol, sevoflurane, and dexmedetomidine) group was significantly lower than that in the PS (combined anesthetization with propofol and sevoflurane) group, 1 day post-surgery (10.0% vs. 40.0%, P = 0.008), and the results were consistent at 3 days post-surgery. When the patients were assessed 7 days, 30 days, and 90 days postoperatively, there was no significant difference in POCD incidence among the three groups. Multivariate logistic regression analysis of POCD one day after surgery showed that education level was negatively correlated with incidence of POCD (P = 0.018) and single lung ventilation time was positively correlated with incidence of POCD (P = 0.001).

CONCLUSION

For elderly patients who underwent a thoracic surgical procedure, dexmedetomidine sedation shows an obvious advantage on improving short-term POCD incidence, which is caused by sevoflurane.

Do Wechsler intelligence scales predict academic achievement in children with ADHD or autism? A systematic review and meta-analysis

Intelligence tests predict academic achievement in typically developed children, however if this is the case also in children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) is not clear. This systematic review and meta-analysis examined if Wechsler intelligence scales predict academic achievement and/or grades in children, ages 6-16 years, with ADHD and/or ASD. We searched the databases PubMed, PsycINFO and Education Research Complete for studies published between 2000 and 2023. We used the Newcastle-Ottawa Scale to assess risk of bias. Narrative synthesis and meta-analysis were performed. Twelve studies (ADHD n = 1,834, ASD n = 176) were included in the review, and six samples (ADHD n = 1,112) of those were included in the meta-analyses. The results of the meta-analyses showed moderate overall weighted correlations between IQ and word reading, written language, and mathematics respectively. Similarly, the overall weighted correlations between processing speed and the aforementioned domains of academic achievement were moderate. Meta-analysis with additional Wechsler scales composite scores could not be conducted. In the narrative synthesis, Full Scale IQ was associated with academic achievement in both ADHD and ASD, and grades in ADHD. The limited number of ASD participants and the heterogeneity of the samples need to be considered when interpreting results. Generally, the results indicate that Wechsler scales are valuable in predicting academic achievement in children with ADHD or ASD. Motivation and other factors related with academic achievement need to be further explored in these groups.

Recent Advances in Neuropsychological Test Interpretation for Clinical Practice

Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.

Associations between the resting EEG aperiodic slope and broad domains of cognitive ability

Recent studies suggest that the EEG aperiodic exponent (often represented as a slope in log-log space) is sensitive to individual differences in momentary cognitive skills such as selective attention and information processing speed. However, findings are mixed, and most of the studies have focused on just a narrow range of cognitive domains. This study used an archival dataset to help clarify associations between resting aperiodic features and broad domains of cognitive ability, which vary in their demands on momentary processing. Undergraduates (N = 166) of age 18-52 years completed a resting EEG session as well as a standardized, individually administered assessment of cognitive ability that included measures of processing speed, working memory, and higher-order visuospatial and verbal skills. A subsample (n = 110) also completed a computerized reaction time task with three difficulty levels. Data reduction analyses revealed strong correlations between the aperiodic offset and slope across electrodes, and a single component accounted for ~60% of variance in slopes across the scalp, in both eyes-closed and eyes-open conditions. Structural equation models did not support relations between the slope and specific domains tapping momentary processes. However, secondary analyses indicated that the eyes-open slope was related to higher overall performance, as represented by a single general ability factor. A latent reaction time variable was significantly inversely related to both eyes-closed and eyes-open resting exponents, such that faster reaction times were associated with steeper slopes. These findings support and help clarify the relation of the resting EEG exponent to individual differences in cognitive skills.

Evaluating initial usability of a hand augmentation device across a large and diverse sample

The advancement of motor augmentation and the broader domain of human-machine interaction rely on a seamless integration with users' physical and cognitive capabilities. These considerations may markedly fluctuate among individuals on the basis of their age, form, and abilities. There is a need to develop a standard for considering these diversity needs and preferences to guide technological development, and large-scale testing can provide us with evidence for such considerations. Public engagement events provide an important opportunity to build a bidirectional discourse with potential users for the codevelopment of inclusive and accessible technologies. We exhibited the Third Thumb, a hand augmentation device, at a public engagement event and tested participants from the general public, who are often not involved in such early technological development of wearable robotic technology. We focused on wearability (fit and control), ability to successfully operate the device, and ability levels across diversity factors relevant for physical technologies (gender, handedness, and age). Our inclusive design was successful in 99.3% of our diverse sample of 596 individuals tested (age range from 3 to 96 years). Ninety-eight percent of participants were further able to successfully manipulate objects using the extra thumb during the first minute of use, with no significant influences of gender, handedness, or affinity for hobbies involving the hands. Performance was generally poorer among younger children (aged ≤11 years). Although older and younger adults performed the task comparably, we identified age costs with the older adults. Our findings offer tangible demonstration of the initial usability of the Third Thumb for a broad demographic.

Multivariate base rates of potentially problematic scores on the NIH Toolbox Emotion Battery

OBJECTIVE

To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB).

METHOD

Participants (N = 753; ages 18-85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e., Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores.

RESULTS

The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e., 18-49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity.

CONCLUSIONS

Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized.

Cognitive Profile in Autism and ADHD: A Meta-Analysis of Performance on the WAIS-IV and WISC-V

OBJECTIVE

Previous research has suggested that neurodevelopmental conditions may be associated with distinctive cognitive profiles on the Wechsler intelligence tests (of which the most recent editions are the WAIS-IV and WISC-V). However, the extent to which a cognitive profile can be reliably identified for individuals meeting criteria for autism or ADHD remains unclear. The present review investigated this issue.

METHOD

A search was conducted in PsycInfo, Embase, and Medline in October 2022 for papers reporting the performance of children or adults diagnosed with autism or ADHD on the WAIS-IV or the WISC-V. Test scores were aggregated using meta-analysis.

RESULTS

Scores were analyzed from over 1,800 neurodivergent people reported across 18 data sources. Autistic children and adults performed in the typical range for verbal and nonverbal reasoning, but scored ~1 SD below the mean for processing speed and had slightly reduced scores on working memory. This provides evidence for a "spiky" cognitive profile in autism. Performance of children and adults with ADHD was mostly at age-expected levels, with slightly reduced scores for working memory.

CONCLUSION

Although the pattern of performance on the Wechsler tests is not sufficiently sensitive or specific to use for diagnostic purposes, autism appears to be associated with a cognitive profile of relative strengths in verbal and nonverbal reasoning and a weakness in processing speed. Attention deficit hyperactivity disorder appears less associated with a particular cognitive profile. Autistic individuals may especially benefit from a cognitive assessment to identify and support with their strengths and difficulties.

Cognitive Processing Speed and Loneliness in Stroke Survivors: Insights from a Large-Scale Cohort Study

OBJECTIVE

Loneliness, when prolonged, is associated with many deleterious effects and has been shown to be highly prevalent in those with a history of stroke, yet the cognitive mechanisms underpinning this phenomenon remain unclear. Therefore, the current study aims to investigate the extent to which cognitive factors, with specific focus on processing speed, are associated with loneliness in those with a history of stroke.

METHOD

Utilizing data from the British Cohort Study, a nationally representative dataset, we conducted secondary data analysis. A total of 7,752 participants completed relevant questions related to health, social interactions, demographics, loneliness, and cognitive assessments. Among them, 47 had experienced a stroke ("stroke," n = 47), 5,545 reported other health conditions ("ill," n = 5,545), and 2,857 were deemed healthy ("healthy," n = 2,857).

RESULTS

Consistent with previous research, our findings confirmed a positive correlation between stroke history and heightened loneliness. However, inferential analysis revealed that processing speed, alongside other cognitive factors, had a minimal impact on loneliness, with correlations too small to draw definitive conclusions.

CONCLUSION

This study suggests that cognitive processing speed alone is not a robust predictor of loneliness in stroke survivors. Consequently, when developing interventions to combat loneliness in this population, it is crucial to consider a broader spectrum of factors, such as social engagement, emotional wellbeing, and interpersonal relationships. This underscores the imperative need for comprehensive assessments to better comprehend the multifaceted nature of loneliness and inform more effective intervention strategies.

Interpreting reliable change on the Spanish-language NIH toolbox cognition battery

This study applied a reliable change methodology to the test-retest data from the Spanish-language NIH Toolbox Cognition Battery (NIHTB-CB) normative sample. Participants included Spanish-speaking adults (n = 48; 54.2% women, 100% Latinx) evaluated twice within one to two weeks on the Spanish-language NIHTB-CB, consisting of two crystallized and five fluid cognitive tests. Test-retest means, standard deviations, and intraclass correlations were used to calculate upper and lower bounds of 70, 80, and 90% confidence intervals (CIs) around change scores, with these bounds used as cutoffs for inferring reliable change. Cutoffs were calculated for raw scores, age-adjusted standard scores (SS; M = 100, SD = 15), and demographic-adjusted T-scores (T; M = 50, SD = 10), adjusting for age, gender, and education. Test-retest change scores on the Spanish-language NIHTB-CB exceeding the following cutoffs indicate reliable change based on an 80% CI (i.e., values exceeding these cutoffs indicate greater decline or greater improvement than 90% of the sample): Dimensional Change Card Sort (SS ≥ 15/T ≥ 11), Flanker (SS ≥ 13/T ≥ 10), List Sorting (SS ≥ 13/T ≥ 9), Picture Sequence Memory (SS ≥ 14/T ≥ 9), Pattern Comparison (SS ≥ 14/T ≥ 10), Picture Vocabulary (SS ≥ 8/T ≥ 6), Oral Reading (SS ≥ 7/T ≥ 5), Fluid Cognition Composite (SS ≥ 12/T ≥ 9), Crystallized Cognition Composite (SS ≥ 6/T ≥ 5), and Total Cognition Composite (SS ≥ 8/T ≥ 7). These cutoffs are one of few resources to interpret cognitive change at retest among Spanish-speaking patients and participants.

Using supplemental memory measures to refine interpretation of the repeatable battery for the assessment of neuropsychological status

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is frequently used as a cognitive screening measure or as part of a comprehensive neuropsychological battery. Augmenting the current memory subtests of the RBANS to reflect clinically meaningful distinctions in memory performance may improve its clinical utility, allowing users to generate additional hypotheses and refine clinical interpretations. We pilot four supplementary memory measures to use with the RBANS, adapted from paradigms commonly used by other neuropsychological tests. We also provide several new theoretically derived memory indices to supplement the standard Delayed Memory Index. The new subtests correlated significantly with the standard memory measures, and the new indices demonstrated good reliability and diagnostic accuracy. This study provides preliminary support for supplementing the RBANS to allow for more nuanced interpretations of memory performance.

Attorney demands for protected psychological test information: Is access necessary for cross examination or does it lead to misinformation? An interorganizational* position paper

Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.

Ability of the Wisconsin Card-Sorting Test-64 as an embedded measure to identify noncredible neurocognitive performance in mild traumatic brain injury litigants

OBJECTIVE

To investigate the ability of selective measures on the Wisconsin Card Sorting Test-64 (WCST-64) to predict noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (mTBI) litigants.

METHOD

Participants included 114 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT).

RESULTS

Participants failing PVTs performed worse across all WCST-64 dependent variables of interest compared to participants who passed PVTs. Receiver operating curve analysis revealed that only categories completed was a significant predictors of PVT status. Multivariate logistic regression did not add to classification accuracy.

CONCLUSION

Consideration of noncredible executive functioning may be warranted in mild traumatic brain injury (mTBI) litigants who complete ≤ 1 category on the WCST-64.

Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies

Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.

Forensic neuropsychological assessment

With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.

Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists

Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists' practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.

Generalizability of the Swedish WISC-V to the Finland-Swedish minority - the FinSwed study

International guidelines highlight the importance of using appropriate and culturally fair test materials when conducting clinical psychological assessments. In the present study, the generalizability of the Swedish WISC-V with Scandinavian normative data was explored in 6-16-year-old Swedish-speaking children in Finland (N = 134), as no local test versions or norms are available for this minority. First, metric measurement invariance was established, i.e., the constructs measured were equivalent between the standardization data and the present sample. Second, the performance of this minority group on the Swedish WISC-V was compared to the Scandinavian normative mean. The findings showed that the Finland-Swedish children performed overall higher than the normative mean on the Swedish WISC-V, with an FSIQ of 103. The performance was significantly higher also in the indexes VSI, FRI, and WMI as well as in several subtests. However, in the subtest Vocabulary, the Finland-Swedish children achieved significantly lower scores than the Scandinavian mean. Further analyses showed significant associations between cognitive performance and age as well as parental education. For the VCI and the FSIQ, performance increased significantly with age, despite the use of age-standardized scaled scores. The general high performance was suggested to relate to the overall high educational level of the Finland-Swedes as well as to other cultural and test-related factors. The results have implications for clinicians conducting assessments with this minority, but also highlight the importance of establishing test fairness by validating tests when used in different cultural groups.

A survey of the perceptions and practices of faculty in clinical neuropsychology doctoral training programs: is heterogeneity the norm?

Objective: Doctoral education is a cornerstone in the training of clinical neuropsychologists. However, we know little about perceptions, practices, and needs of the faculty who oversee doctoral training in clinical neuropsychology (CN). Method: Seventy-one faculty from 45 doctoral programs providing CN training completed at least part of a survey assessing characteristics of their programs, current training practices and views, and challenges to CN doctoral training. Results: Over half of CN faculty reported having zero or only one CN colleague. CN faculty reported that the goals of CN doctoral training are research training, clinical training, and acquisition of knowledge and skills reflected in the Houston Conference Guidelines (HCG). CN faculty reported that doctoral trainees obtain more clinical hours than faculty would like and endorsed alternative clinical metrics, including competency-based ratings. CN faculty are divided about the benefits of a required two-year postdoctoral CN fellowship. Conclusions: The HCG states that specialization in CN begins at the doctoral level. CN faculty in doctoral programs are fully immersed in the early development and education of future CN researchers and practitioners. Tensions between clinical and research training in CN at the doctoral level-and student overemphasis on accruing clinical hours-might place CN at risk for failing to make research innovations necessary for our field to evolve and thrive. More CN doctoral faculty are needed to serve as mentors to students, especially for students from backgrounds that have been historically excluded and marginalized. A greater voice from CN doctoral faculty in CN governance is needed.

Cross-validating the Clinical Assessment of Attention Deficit-Adult symptom validity scales for assessment of attention deficit/hyperactivity disorder in adults

INTRODUCTION

The Clinical Assessment of Attention Deficit-Adult is among the few questionnaires that offer validity indicators (i.e., Negative Impression [NI], Infrequency [IF], and Positive Impression [PI]) for classifying underreporting and overreporting of attention-deficit/hyperactivity disorder (ADHD) symptoms. This is the first study to cross-validate the NI, IF, and PI scales in a sample of adults with suspected or known ADHD.

METHOD

Univariate and multivariate analyses were conducted to examine the independent and combined value of the NI, IF, and PI scores in predicting invalid symptom reporting and neurocognitive performance in a sample of 543 adults undergoing ADHD evaluation.

RESULTS

The NI scale demonstrated better classification accuracy than the IF scale in discriminating patients with and without valid scores on measures of overreporting. Only NI scores significantly predicted validity status when used in combination with IF scores. Optimal cut-scores for the NI (≤51; 30% sensitivity / 90% specificity) and IF (≥4; 18% sensitivity / 90% specificity) scales were consistent with those reported in the original manual; however, these indicators poorly discriminated patients with invalid and valid neurocognitive performance. The PI scale demonstrated acceptable classification accuracy in discriminating patients with invalid and valid scores on measures of underreporting, albeit with an optimal cut-score (≥27; 36% sensitivity / 90% specificity) lower than that described in the manual.

CONCLUSION

Findings provide preliminary evidence of construct validity for these scales as embedded validity indicators of symptom overreporting and underreporting. However, these scales should not be used to guide clinical judgment regarding the validity of neurocognitive test performance.

Cognitive Intra-individual Variability in the Laboratory Is Associated With Greater Executive Dysfunction in the Daily Lives of Older Adults With HIV

BACKGROUND

Executive dysfunction, which is common among persons with HIV (PWH), can have an adverse impact on health behaviors and quality of life. Intra-individual variability (IIV) is a measure of within-person variability across cognitive tests that is higher in PWH and is thought to reflect cognitive dyscontrol.

OBJECTIVE

To assess whether cognitive IIV in the laboratory is associated with self-reported executive dysfunction in daily life among older PWH.

METHOD

Participants included 71 PWH aged ≥50 years who completed six subtests from the Cogstate battery and two subscales from the Frontal Systems Behavior Scale (FrSBe; self-report version). Cognitive IIV was calculated from the Cogstate as the coefficient of variation derived from age-adjusted normative T scores.

RESULTS

Cognitive IIV as measured by the Cogstate showed a significant, positive, medium-sized association with current FrSBe ratings of executive dysfunction but not disinhibition.

CONCLUSION

Higher cognitive IIV in the laboratory as measured by the Cogstate may be related to the expression of HIV-associated symptoms of executive dysfunction in daily life for older PWH.

A systematic review of the utility of continuous performance tests among adults with ADHD

OBJECTIVE

The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population.

METHODS

This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies.

RESULTS

Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores.

CONCLUSION

Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment.

Development and Validation of a Vocabulary Measure in the Mobile Toolbox

OBJECTIVE

We describe the development of a new computer adaptive vocabulary test, Mobile Toolbox (MTB) Word Meaning, and validity evidence from 3 studies.

METHOD

Word Meaning was designed to be a multiple-choice synonym test optimized for self-administration on a personal smartphone. The items were first calibrated online in a sample of 7,525 participants to create the computer-adaptive test algorithm for the Word Meaning measure within the MTB app. In Study 1, 92 participants self-administered Word Meaning on study-provided smartphones in the lab and were administered external measures by trained examiners. In Study 2, 1,021 participants completed the external measures in the lab and Word Meaning was self-administered remotely on their personal smartphones. In Study 3, 141 participants self-administered Word Meaning remotely twice with a 2-week delay on personal iPhones.

RESULTS

The final bank included 1363 items. Internal consistency was adequate to good across samples (ρxx = 0.78 to 0.81, p < .001). Test-retest reliability was good (ICC = 0.65, p < .001), and the mean theta score was not significantly different upon the second administration. Correlations were moderate to large with measures of similar constructs (ρ = 0.67-0.75, p < .001) and non-significant with measures of dissimilar constructs. Scores demonstrated small to moderate correlations with age (ρ = 0.35 to 0.45, p < .001) and education (ρ = 0.26, p < .001).

CONCLUSION

The MTB Word Meaning measure demonstrated evidence of reliability and validity in three samples. Further validation studies in clinical samples are necessary.

Test-Retest Reliability and Reliable Change on the NIH Toolbox Cognition Battery

OBJECTIVE

Researchers and practitioners can detect cognitive improvement or decline within a single examinee by applying a reliable change methodology. This study examined reliable change through test-retest data from the English-language National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) normative sample.

METHOD

Participants included adults (n = 138; age: M ± SD = 54.8 ± 20.0, range: 18-85; 51.4% men; 68.1% White) who completed test-retest assessments about a week apart on five fluid cognition tests, providing raw scores, age-adjusted standard scores (SS), and demographic-adjusted T-scores (T).

RESULTS

The Fluid Cognition Composite (SS: ICC = 0.87; T-score: ICC = 0.84) and the five fluid cognition tests had good test-retest reliability (SS: ICC range = 0.66-0.85; T-score: ICC range = 0.64-0.86). The lower and upper bounds of 70%, 80%, and 90% confidence intervals (CIs) were calculated around change scores, which serve as cutoffs for determining reliable change. Using T-scores, 90% CI, and adjustment for practice effects, 32.3% declined on one or more tests, 9.7% declined on two or more tests, 36.6% improved on one or more tests, and 5.4% improved on two or more tests.

CONCLUSIONS

It was common for participants to show reliable change on at least one test score, but not two or more test scores. Per an 80% CI, test-retest difference scores beyond these cutoffs would indicate reliable change: Dimensional Change Card Sort (SS ≥ 14/T ≥ 10), Flanker (SS ≥ 12/T ≥ 8), List Sorting (SS ≥ 14/T ≥ 10), Picture Sequence Memory (SS ≥ 19/T ≥ 13), Pattern Comparison (SS ≥ 11/T ≥ 8), and Fluid Cognition Composite (SS ≥ 10/T ≥ 7). The reliable change cutoffs could be applied in research or practice to detect within-person change in fluid cognition at the individual level.

Test-retest reliability and reliable change index of the Philips IntelliSpace Cognition digital test battery

OBJECTIVE

This article provides the test-retest reliability and Reliable Change Indices (RCIs) of the Philips IntelliSpace Cognition (ISC) platform, which contains digitized versions of well-established neuropsychological tests.

METHOD

147 participants (ages 19 to 88) completed a digital cognitive test battery on the ISC platform or paper-pencil versions of the same test battery during two separate visits. Intraclass correlation coefficients (ICC) were calculated separately for the ISC and analog test versions to compare reliabilities between administration modalities. RCIs were calculated for the digital tests using the practice-adjusted RCI and standardized regression-based (SRB) method.

RESULTS

Test-retest reliabilities for the ISC tests ranged from moderate to excellent and were comparable to the test-retest reliabilities for the paper-pencil tests. Baseline test performance, retest interval, age, and education predicted test performance at visit 2 with baseline test performance being the strongest predictor for all outcome measures. For most outcome measures, both methods for the calculation of RCIs show agreement on whether or not a reliable change was observed.

CONCLUSIONS

RCIs for the digital tests enable clinicians to determine whether a measured change between assessments is due to real improvement or decline. Together, this contributes to the growing evidence for the clinical utility of the ISC platform.

A voxel- and source-based morphometry analysis of grey matter volume differences in very-late-onset schizophrenia-like psychosis

BACKGROUND

Very-late-onset schizophrenia-like psychosis (VLOSLP) is associated with significant burden. Its clinical importance is increasing as the global population of older adults rises, yet owing to limited research in this population, the neurobiological underpinnings of VLOSP remain insufficiently clarified. Here we address this knowledge gap using novel morphometry techniques to investigate grey matter volume (GMV) differences between VLOSLP and healthy older adults, and their correlations with neuropsychological scores.

METHODS

In this cross-sectional study, we investigated whole-brain GMV differences between 35 individuals with VLOSLP (mean age 76.7, 26 female) and 36 healthy controls (mean age 75.7, 27 female) using whole-brain voxel-based morphometry (VBM) and supplementary source-based morphometry (SBM) on high resolution 3D T1-weighted MRI images. Additionally, we investigated relationships between GMV differences and cognitive function assessed with an extensive neuropsychological battery.

RESULTS

VBM showed lower GMV in the thalamus, left inferior frontal gyrus and left insula in patients with VLOSLP compared to healthy controls. SBM revealed lower thalamo-temporal GMV in patients with VLOSLP. Processing speed, selective attention, mental flexibility, working memory, verbal memory, semantic fluency and confrontation naming were impaired in patients with VLOSLP. Correlations between thalamic volumes and memory function were significant within the group of individuals with VLOSLP, whereas no significant associations remained in the healthy controls.

CONCLUSIONS

Lower GMV in the thalamus and fronto-temporal regions may be part of the underlying neurobiology of VLOSLP, with lower thalamic GMV contributing to memory impairment in the disorder.

Computerized adaptive test strategies for the matrix reasoning subtest of the Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV)

OBJECTIVE

Most neuropsychological tests were developed without the benefit of modern psychometric theory. We used item response theory (IRT) methods to determine whether a widely used test - the 26-item Matrix Reasoning subtest of the WAIS-IV - might be used more efficiently if it were administered using computerized adaptive testing (CAT).

METHOD

Data on the Matrix Reasoning subtest from 2197 participants enrolled in the National Neuropsychology Network (NNN) were analyzed using a two-parameter logistic (2PL) IRT model. Simulated CAT results were generated to examine optimal short forms using fixed-length CATs of 3, 6, and 12 items and scores were compared to the original full subtest score. CAT models further explored how many items were needed to achieve a selected precision of measurement (standard error ≤ .40).

RESULTS

The fixed-length CATs of 3, 6, and 12 items correlated well with full-length test results (with r = .90, .97 and .99, respectively). To achieve a standard error of .40 (approximate reliability = .84) only 3-7 items had to be administered for a large percentage of individuals.

CONCLUSIONS

This proof-of-concept investigation suggests that the widely used Matrix Reasoning subtest of the WAIS-IV might be shortened by more than 70% in most examinees while maintaining acceptable measurement precision. If similar savings could be realized in other tests, the accessibility of neuropsychological assessment might be markedly enhanced, and more efficient time use could lead to broader subdomain assessment.

NeuroAIreh@b: an artificial intelligence-based methodology for personalized and adaptive neurorehabilitation

Cognitive impairments are a prevalent consequence of acquired brain injury, dementia, and age-related cognitive decline, hampering individuals' daily functioning and independence, with significant societal and economic implications. While neurorehabilitation represents a promising avenue for addressing these deficits, traditional rehabilitation approaches face notable limitations. First, they lack adaptability, offering one-size-fits-all solutions that may not effectively meet each patient's unique needs. Furthermore, the resource-intensive nature of these interventions, often confined to clinical settings, poses barriers to widespread, cost-effective, and sustained implementation, resulting in suboptimal outcomes in terms of intervention adaptability, intensity, and duration. In response to these challenges, this paper introduces NeuroAIreh@b, an innovative cognitive profiling and training methodology that uses an AI-driven framework to optimize neurorehabilitation prescription. NeuroAIreh@b effectively bridges the gap between neuropsychological assessment and computational modeling, thereby affording highly personalized and adaptive neurorehabilitation sessions. This approach also leverages virtual reality-based simulations of daily living activities to enhance ecological validity and efficacy. The feasibility of NeuroAIreh@b has already been demonstrated through a clinical study with stroke patients employing a tablet-based intervention. The NeuroAIreh@b methodology holds the potential for efficacy studies in large randomized controlled trials in the future.

Kids name the darndest things: confrontation naming in pediatric neuropsychology

Few confrontation naming tests are designed for pediatric populations. The Children's Visual Naming Test (cVNT; Hamberger et al., 2018) was developed to fill this gap. No independent studies using cVNT with clinical populations have been published to date. We aimed to characterize cVNT performance in a clinical sample and analyze the relationship between cVNT and other neuropsychological tests/constructs. Retrospective data was collected from 126 consecutively referred youth, aged 6-15 years (M = 11.28, SD = 2.80), who underwent clinical neuropsychological evaluation through an academic medical center. Naming under 2 seconds (cVNT-L2) and the summary scores (cVNT-SUM) were lower compared to the normative sample (cVNT-L2: Mz =-1.30, SD = 2.17; cVNT-SUM: Mz =-1.26, SD = 2.15). cVNT was related to core verbal abilities, processing speed, and response inhibition. cVNT-L2 and cVNT-SUM, but not naming under 20 seconds, were related to overall intellectual functioning, verbal fluency, and working memory, and were associated with overall attention, processing speed, executive functions, and verbal fluency. The cVNT provides assessment of confrontation naming without downward extension in pediatric neuropsychological assessment. Importantly, cVNT offers variables of higher fidelity to the neural process of naming than previous measures. cVNT may be associated with commonly assessed neuropsychological functions, providing a rapidly effective tool for screening batteries or improving efficiency.

The Short Executive Function Scale

This study involved a psychometric evaluation of the Short Executive Function Scale (SEFS), a new 15-item self-report questionnaire measuring five constructs: Planning, Inhibition, Working Memory, Shifting, and Emotional Control. Participants included 717 U.S. undergraduate students (M = 18.9 years old, SD = 1.9; 78.8% cisgender female, 81.7% White) who completed the SEFS. A subset of 156 participants (M = 18.8 years old, SD = 0.9; 79.5% cisgender female, 83.3% White) completed the SEFS again at 2- to 3-month retest along with the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) and the Patient Health Questionnaire (PHQ-8). The five-factor model fit well (CFI = 0.941, RMSEA = 0.079) and each scale had acceptable internal consistency (ω range: .68-.81) and test-retest reliability (ICC range: .75-.89). Apart from Shifting, all SEFS scales had significantly larger convergent validity coefficients with their respective BRIEF-A scales (r range: -.25 to -.70) than discriminant validity coefficients with the PHQ-8 (r range: -.06 to -.28). These findings provide preliminary psychometric support for the SEFS.

The California Cognitive Assessment Battery (CCAB)

Introduction

We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers.

Methods

The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently.

Results

Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification.

Discussion

The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.

The Auditory Consonant Trigram (ACT) Test: A norm updating study for university students

The Auditory Consonant Trigram (ACT) Test is accepted as a pure measurement of verbal working memory, but its norm study and psychometric properties have not been sufficiently researched. This study aims to update the norm data of the ACT, validity and reliability studies of which have been previously conducted on an adult Turkish sample, on a broader young sample and in a way that would end some methodological limitations. For this purpose, the data is collected from 304 voluntary healthy young adults (aged 18-26, 152 females-152 males). According to the results, a difference is found among all delay intervals. While the test scores decrease in females as delay interval increases, there is no difference in males between the delay intervals of 9 and 18 sec. While there is no difference between the genders for very short delay intervals (0-3 sec), males show a more successful performance than females as the delay interval increases (9-18 sec). Males are also more successful than females in terms of total test scores of the ACT. In this respect, it is concluded that the ACT measurement of working memory with a total score reliability coefficient of 0.75 is reliable.

Baseline Differences in Driving Frequency as a Predictor of Cognitive Decline and Alzheimer's Disease

OBJECTIVE

To extend prior research by examining daily driving frequency as a predictor of cognitive decline and later diagnosis of Alzheimer's disease.

METHODS

1,426 older adults completed batteries of questionnaires and neuropsychological tests at baseline and yearly follow-ups (M = 6.8, SD = 4.9). Linear mixed effects models were estimated to examine whether daily driving frequency at baseline was predictive of cognitive decline while accounting for IADLs, mobility, depression, and demographics. Cox regression was used to examine driving frequency as a predictor of Alzheimer's disease diagnosis.

RESULTS

Less daily driving frequency was associated with greater decline in all cognitive domains over time except for working memory. Although driving frequency was associated with these changes in cognition, it did not uniquely predict the development of Alzheimer's disease when accounting for other factors (eg, other IADLs).

CONCLUSIONS

Our findings extend prior research linking driving cessation to greater levels of cognitive decline. Future work might benefit from examining the utility of driving habits (especially changes in driving) as measures of everyday functioning in older adult evaluations.

Detection of noncredible cognitive performance with Wechsler Memory Scale-IV measures in mild traumatic brain injury litigants

OBJECTIVE

To investigate the operating characteristics of selective measures on the Wechsler Memory Scale-IV (WMS-IV) to predict noncredible neurocognitive dysfunction in a sample of mild traumatic brain injury (mTBI) litigants.

METHOD

Participants included 110 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity testing (PVT).

RESULTS

Participants failing two stand-alone PVTs exhibited significantly lower scores across all WMS-IV dependent variables of interest compared to participants who passed both PVTs. Participants who failed one PVT were excluded. Bivariate logistic regression revealed that all six dependent variables were significant predictors of PVT status. The best prediction model consisted of three WMS-IV variables including Logical Memory Delayed Recall (LM2), Logical Memory Recognition (LMR), and Visual Reproduction Recognition (VRR). This model demonstrated an accuracy of 90.2%, 0.89 sensitivity, 0.92 specificity, and a Receiver Operating Curve (ROC) of 0.957.

CONCLUSION

The current empirically-derived cutscores and logit equation for the WMS-IV may be an additional consideration in analyzing database validity and noncredible performance in mTBI personal injury litigants ages 18-69.

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities-focused research

Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.

BRIEF-A: Factor structure and measurement invariance across self-report and informant forms

OBJECTIVE

This study analyzes the psychometric properties of the two forms (self-report and informant) of the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) in a sample of healthy Portuguese adults.

METHOD

The participants were 608 adults, 304 of whom answered the self-report form (ages 18-59; 137 male and 167 female) and 304 who answered the informant form (ages 18-70; 110 male and 194 female).

RESULTS

The internal consistency for the indexes and the Global Executive Composite was very good (≥.90), whereas for the scales they were either acceptable (between .70 and .80) or good (≥.80), except for the Inhibit scale in both forms. Confirmatory factor analysis was used to test seven competing factor models for each of the forms. The original two-factor model (Behavioral Regulation and Metacognition Indexes) showed a slightly better model fit than the three-factor model (Behavioral Regulation, Emotional Regulation, and Metacognition Indexes) in both forms. The multiple-group analysis of the two-correlated-factor model across forms was supported (configural, metric, and partial scalar invariance).

CONCLUSIONS

Overall, the BRIEF-A showed adequate psychometric properties, suggesting that it is a useful instrument to assess everyday executive functioning in healthy Portuguese adults.

Cross-Validating the Executive Errors Scale of the Repeatable Battery for the Assessment of Neuropsychological Status

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed to briefly measure a broad range of cognitive abilities, but it initially lacked a scale to evaluate executive functioning. Robert Spencer and colleagues recently created an Executive Errors scale (RBANS-EE) that quantified executive functioning (EF) errors committed during four RBANS subtests: List Learning, Semantic Fluency, Coding, and List Recall. In the present paper we cross-validated the RBANS-EE with a sample of 234 U.S. military veterans (M AGE = 67.2, SD = 11.5 years; M EDUCATION = 13.3, SD = 2.4 years) who completed the RBANS and various EF criterion measures as part of neuropsychological assessments they underwent during their clinical care. We found the RBANS-EE to be significantly correlated with most of the criterion EF measures. The RBANS-EE scale demonstrated modest ability to classify EF impairment at mild and severe levels; and, similarly, the RBANS-EE was modestly capable of accurately classifying those veteran respondents who were determined to have or to not have a neurocognitive disorder. Overall, the RBANS-EE can be quickly calculated, adds no administration time to an RBANS assessment, and yields useful scores to screen for EF dysfunction without replacing standalone EF tests.

Machine learning item selection for short scale construction: A proof-of-concept using the SIMS

ObjectiveThis proof-of-concept paper provides evidence to support machine learning (ML) as a valid alternative to traditional psychometric techniques in the development of short forms of longer parent psychological tests. ML comprises a variety of feature selection techniques that can be efficiently applied to identify the set of items that best replicates the characteristics of the original test. MethodsIn the present study, we integrated a dataset of 329 participants from published and unpublished datasets used in previous research on the Structured Inventory of Malingered Symptomatology (SIMS) to develop a short version of the scale. The SIMS is a multi-axial self-report questionnaire and a highly efficient psychometric measure of symptom validity, which is frequently applied in forensic settings. Results State-of-the-art ML item selection techniques achieved a 72% reduction in length while capturing 92% of the variance of the original SIMS. The new SIMS short form now consists of 21 items. ConclusionsThe results suggest that the proposed ML-based item selection technique represents a promising alternative to standard psychometric correlation-based methods (i.e. item selection, item response theory), especially when selection techniques (e.g. wrapper) are employed that evaluate global, rather than local, item value.

A quantitative review of competing learning slope metrics: effects of age, sex, and clinical diagnosis

INTRODUCTION

In learning and memory tests that involve multiple presentations of the same material, learning slope refers to the degree to which examinees improve performances over successive learning trials. We aimed to quantitatively review the traditional raw learning slope (RLS), and the newly created learning ratio (LR) to understand the effects of demographic variables and clinical diagnoses on learning slope (e.g., limited improvement over multiple trials), and to develop demographically sensitive norms.

METHOD

A systematic literature search was conducted to evaluate the potential for these aims to be examined across the most popular contemporary multi-trial learning tests. Two databases were searched. Following this, hierarchical linear modeling was used to examine how demographic variables predict learning slope indices. These results were in turn used to contrast the performance of clinical groups with the predicted performance of demographically similar healthy controls. Finally, preliminary normative estimates for learning slope indices were presented.

RESULTS

A total of 82 studies met criteria for inclusion in this study. However, the Rey Auditory Verbal Learning Test (RAVLT) was the only test to have sufficient trial-level learning and demographic data. Fifty-eight samples from 19 studies were quantitatively examined. Hierarchical linear models provided evidence of sex differences and a curvilinear decline in learning slope with age, with strongest and most consistent effects for LR relative to RLS. Regression-based norms for demographically corrected RLS and LR scores for the RAVLT are presented. The effect of clinical diagnoses was consistently stronger for LR, and Alzheimer's disease had the strongest effect, followed by invalid performances, severe traumatic brain injury, and seizures/epilepsy.

CONCLUSION

Overall, LR enjoys both conceptual and demonstrated psychometric advantages over RLS. Replication of these findings can be completed by reanalyzing existing datasets. Further work may focus on the utility of using LR in diagnosis and prediction of clinical prognosis.

Semantic clustering on common list-learning tasks: a systematic review of the state of the literature and recommendations for future directions

INTRODUCTION

On some list-learning tasks, such as the California Verbal Learning Test (CVLT) or Hopkins Verbal Learning Test (HVLT), examinees have the opportunity to group words based on semantically related categories (i.e., semantic clustering). Semantic clustering (SC) is often considered the most efficient organizational strategy and adopting SC is presumed to improve learning and memory. In addition, SC is conceptualized as reflecting higher-order executive functioning skills. Although SC measures have intuitive appeal, to date, there are no comprehensive reviews of the SC literature base that summarize its psychometric utility. In this systematic review, we synthesize the literature to judge the validity of SC scores.

METHOD

We conducted a systematic literature search for empirical articles reporting SC from the CVLT and HVLT. We qualitatively described the relationship of SC with other list-learning and cognitive test scores and clinical diagnoses, contrasting SC with serial clustering and total learning scores when possible.

RESULTS

SC was inversely correlated with serial clustering. Higher SC was strongly associated with better learning and memory performances. When compared with cognitive tests, SC tended to have the strongest relationships with other memory measures and modest relationships with tests of executive functioning. SC had negligible to small relationships with most other cognitive domains. Traditional memory scores yielded stronger relationships to cognitive test performances than did SC. SC across clinical groups varied widely, but clinical groups tended to use SC less often than healthy comparison groups.

CONCLUSION

Our comprehensive review of the literature revealed that SC is strongly related to measures of learning and memory on the CVLT and HVLT and is correlated with a wide range of cognitive functions. SC has been understudied in relevant populations and additional research is needed to test the degree to which it adds incremental validity beyond traditional measures of learning and memory.

Measuring memory: A survey of neuropsychological practice amongst New Zealand psychologists

This study sought to explore patterns of memory assessment in neuropsychological practice within New Zealand (NZ), to compare it to that previously described in Europe, North America and Australia, and to consider the implications for neuropsychology training in NZ. 80 NZ-registered psychologists completed an online survey asking them how frequently they utilized 50 commonly used tests of memory. Participants were also asked about their main areas of specialty, work context and demographic information. Whilst participants appeared, broadly, to utilize a similar set of 'core' tests to their colleagues in Europe, Australia and North America, there were a number of tests and test domains that were rarely utilized by NZ psychologists, in contrast to overseas samples. Furthermore, several of the tests in common usage have been shown to have significant validity issues for use with an NZ population. Overall, this study suggests that most NZ psychologists employ a similar approach to memory assessment, typically relying upon a small number of well-known tests. This appears to contrast with a greater variability of practice shown in studies of European, North American and Australian psychologists and raises several interesting questions for the future development of neuropsychology in NZ.

A rationale and framework for addressing physician cognitive impairment

Medical error is costly, in terms of the health and wellbeing of the patient, their family, and the financial burden placed on the medical system. Reducing medical error is paramount to minimizing harm and improving outcomes. One potential source of medical error is physician cognitive impairment. Determining how to effectively assess and mange physician cognitive impairment is an important, albeit difficult problem to address. There have been calls and attempts to implement age-based cognitive screening, but this approach is not optimal. Instead, we propose that neuropsychological assessment is the gold standard for fitness-for-duty evaluations and that there is a need for the development of physician-based, normative data to improve these evaluations. Here, we outline the framework of our research protocol in a large, academic medical center, in partnership with hospital leadership and legal counsel, which can be modeled by other medical centers. With high rates of physician burnout and an aging physician population, the United States is facing a looming public health crisis that requires proactive management.

Age-based stereotype threat and neuropsychological performance in older adults

The current study investigated the effects of age-based stereotype threat on neuropsychological assessment outcomes in an older adult population. Community volunteers (n = 49) age 65 and older were screened for cognitive impairment, depression, and anticholinergic medication use. Screened individuals were randomly stratified into either an ABST or a Control group. All participants were administered a broad range of neuropsychological measures of cognition as well as a self-rating measure assessing subjective concern about cognitive ability. A main effect of ABST on subjective concern about cognitive ability was supported. Specifically, individuals in the ABST group were significantly more likely to attribute their memory errors to the onset of dementia (F(1,41) = 5.334, p = .026). However, results showed no significant difference between groups on objective neuropsychological performance measures. The current study discusses the importance of considering ABST effects in the context of neuropsychological assessment in older adult populations.

Selected Wechsler Memory Scale norms and aging: Implications for assessment

The Wechsler Memory Scale-I was published in 1945, although it had been used clinically since 1940. Since the original publication, there have been three major revisions. The Wechsler Memory Scale-Revised was published in 1987, the Wechsler Memory Scale-III in 1997, and the Wechsler Memory Scale-IV in 2009. It is significant to note that all official versions of the memory scale have remained in clinical and research use well into the second decade of the 20th century. Each version of the scale was designed to assess memory and attention dysfunction in various clinical populations by comparing the discrepancy between intelligence and memory test performance using age-corrected standard scores. It has long been known that intellectual and memory performance declines with age. Most psychologists, however, are likely unaware of the extent of the decline with age or how this decline is manifested in the various versions of the Wechsler Memory Scale. The purpose of this paper is to investigate what selected norms accompanying each official version of the Wechsler Memory Scale reveal about aging and memory performance and discuss the possible clinical implications of such.

Reliability and validity of the electronic version of the Hopkins verbal learning test-revised in middle-aged and elderly Chinese people

Background

The aging population is increasing, making it essential to have a standardized, convenient, and valid electronic memory test that can be accessed online for older people and caregivers. The electronic version of the Hopkins Verbal Learning Test-Revised (HVLT-R) as a test with these advantages and its reliability and validity has not yet been tested. Thus, this study examined the reliability and validity of the electronic version of the HVLT-R in middle-aged and elderly Chinese people to provide a scientific basis for its future dissemination and use.

Methods

We included 1,925 healthy participants aged over 40, among whom 38 were retested after 3-6 months. In addition, 65 participants completed both the pad and paper-and-pencil versions of the HVLT-R (PAP-HVLT-R). We also recruited 42 Alzheimer's disease (AD) patients, and 45 amnestic mild cognitive impairment (aMCI) patients. All participants completed the Pad-HVLT-R, the Hong Kong Brief Cognitive Test (HKBC), the Brief Visual Memory Test-Revised (BVMT-R), and the Logical Memory Test (LM).

Results

(1) Reliability: the Cronbach's α value was 0.94, the split-half reliability was 0.96. The test-retest correlation coefficients were moderate, ranging from 0.38 to 0.65 for direct variables and 0.16 to 0.52 for derived variables; (2) Concurrent validity: the Pad-HVLT-R showed a moderate correlation with the HKBC and BVMT-R, with correlation coefficients between total recall of 0.41 and 0.54, and between long-delayed recall of 0.42 and 0.59, respectively. It also showed a high correlation with the LM, with correlation coefficients of 0.72 for total recall and 0.62 for long-delayed recall; (3) Convergent validity: the Pad-HVLT-R was moderately correlated with the PAP version, with correlation coefficients ranging from 0.29 to 0.53 for direct variables and 0.15 to 0.43 for derived variables; (4) Discriminant capacity: the Pad-HVLT-R was effective in differentiating AD patients, as demonstrated by the ROC analysis with AUC values of 0.834 and 0.934 for total recall and long-delayed recall, respectively.

Conclusion

(1) The electronic version of HVLT-R has good reliability and validity in middle-aged and elderly Chinese people; (2) The electronic version of HVLT-R can be used as an effective tool to distinguish AD patients from healthy people.

Mayo-PACC: A parsimonious preclinical Alzheimer's disease cognitive composite comprised of public-domain measures to facilitate clinical translation

INTRODUCTION

We aimed to define a Mayo Preclinical Alzheimer's disease Cognitive Composite (Mayo-PACC) that prioritizes parsimony and use of public domain measures to facilitate clinical translation.

METHODS

Cognitively unimpaired participants aged 65 to 85 at baseline with amyloid PET imaging were included, yielding 428 amyloid negative (A-) and 186 amyloid positive (A+) individuals with 7 years mean follow-up. Sensitivity to amyloid-related cognitive decline was examined using slope estimates derived from linear mixed models (difference in annualized change across A+ and A- groups). We compared differences in rates of change between Mayo-PACC and other composites (A+ > A- indicating more significant decline in A+).

RESULTS

All composites showed sensitivity to amyloid-related longitudinal cognitive decline (A+ > A- annualized change p < 0.05). Comparisons revealed that Mayo-PACC (AVLT sum of trials 1-5+6+delay, Trails B, animal fluency) showed comparable longitudinal sensitivity to other composites.

DISCUSSION

Mayo-PACC performs similarly to other composites and can be directly translated to the clinic.

Age effects on Wechsler Memory Scale-Fourth Edition (WMS-IV) indexes and subtests

This study examined age effects in the standardization samples of the Wechsler Memory Scale-Fourth Edition (WMS-IV) and compared these, where appropriate, to the norms of the Wechsler Memory Scale-Third Edition (WMS-III). On the Adult (16-69 years) and Older Adult (65-90 years) batteries of the WMS-IV, the most pronounced declines were on the Visual Memory Indexes starting in the 35-44 years cohort. The Auditory Memory Indexes showed the least deterioration, which did not commence until the 85-90 years age range. Subtest scores for the Adult Battery indicated that Logical Memory I was unchanged from 16 to 69 years. Likewise, only one scaled score point decline was evidenced on Logical Memory II. Conversely, WMS-III Logical Memory I performance showed a one scaled score point decline in the 18-19 years age band and progressed to moderate (i.e., 4 scaled score points) and large (i.e., ≥6 scaled score points) reductions by the 65-69 and ≥80 years cohorts. Logical Memory II showed even greater age-related deterioration. Age decline data at each age cohort are provided for all subtests and indexes from the Adult and Older Adult batteries as well as for the WMS-III subtests in common with the WMS-IV.

The Rey Auditory Verbal Learning Test: Cross-validation of Mayo Normative Studies (MNS) demographically corrected norms with confidence interval estimates

OBJECTIVE

The Mayo Normative Studies (MNS) represents a robust dataset that provides demographically corrected norms for the Rey Auditory Verbal Learning Test. We report MNS application to an independent cohort to evaluate whether MNS norms accurately adjust for age, sex, and education differences in subjects from a different geographic region of the country. As secondary goals, we examined item-level patterns, recognition benefit compared to delayed free recall, and derived Auditory Verbal Learning Test (AVLT) confidence intervals (CIs) to facilitate clinical performance characterization.

METHOD

Participants from the Emory Healthy Brain Study (463 women, 200 men) who were administered the AVLT were analyzed to demonstrate expected demographic group differences. AVLT scores were transformed using MNS normative correction to characterize the success of MNS demographic adjustment.

RESULTS

Expected demographic effects were observed across all primary raw AVLT scores. Depending on sample size, MNS normative adjustment either eliminated or minimized all observed statistically significant AVLT differences. Estimated CIs yielded broad CI ranges exceeding the standard deviation of each measure. The recognition performance benefit across age ranged from 2.7 words (SD = 2.3) in the 50-54-year-old group to 4.7 words (SD = 2.7) in the 70-75-year-old group.

CONCLUSIONS

These findings demonstrate generalizability of MNS normative correction to an independent sample from a different geographic region, with demographic adjusted performance differences close to overall performance levels near the expected value of T = 50. A large recognition performance benefit is commonly observed in the normal aging process and by itself does not necessarily suggest a pathological retrieval deficit.

Calling on clinicians to get social and emotional

OBJECTIVE

Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning.

METHOD

In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests.

RESULTS

In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments.

CONCLUSION

We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.

Multivariate models provide an effective psychometric solution to the variability in classification accuracy of D-KEFS Stroop performance validity cutoffs

ObjectiveThe study was designed to expand on the results of previous investigations on the D-KEFS Stroop as a performance validity test (PVT), which produced diverging conclusions. Method The classification accuracy of previously proposed validity cutoffs on the D-KEFS Stroop was computed against four different criterion PVTs in two independent samples: patients with uncomplicated mild TBI (n = 68) and disability benefit applicants (n = 49). Results Age-corrected scaled scores (ACSSs) ≤6 on individual subtests often fell short of specificity standards. Making the cutoffs more conservative improved specificity, but at a significant cost to sensitivity. In contrast, multivariate models (≥3 failures at ACSS ≤6 or ≥2 failures at ACSS ≤5 on the four subtests) produced good combinations of sensitivity (.39-.79) and specificity (.85-1.00), correctly classifying 74.6-90.6% of the sample. A novel validity scale, the D-KEFS Stroop Index correctly classified between 78.7% and 93.3% of the sample. Conclusions A multivariate approach to performance validity assessment provides a methodological safeguard against sample- and instrument-specific fluctuations in classification accuracy, strikes a reasonable balance between sensitivity and specificity, and mitigates the invalid before impaired paradox.

Logical memory, visual reproduction, and verbal paired associates are effective embedded validity indicators in patients with traumatic brain injury

OBJECTIVE

This study was design to evaluate the potential of the recognition trials for the Logical Memory (LM), Visual Reproduction (VR), and Verbal Paired Associates (VPA) subtests of the Wechsler Memory Scales-Fourth Edition (WMS-IV) to serve as embedded performance validity tests (PVTs).

METHOD

The classification accuracy of the three WMS-IV subtests was computed against three different criterion PVTs in a sample of 103 adults with traumatic brain injury (TBI).

RESULTS

The optimal cutoffs (LM ≤ 20, VR ≤ 3, VPA ≤ 36) produced good combinations of sensitivity (.33-.87) and specificity (.92-.98). An age-corrected scaled score of ≤5 on either of the free recall trials on the VPA was specific (.91-.92) and relatively sensitive (.48-.57) to psychometrically defined invalid performance. A VR I ≤ 5 or VR II ≤ 4 had comparable specificity, but lower sensitivity (.25-.42). There was no difference in failure rate as a function of TBI severity.

CONCLUSIONS

In addition to LM, VR, and VPA can also function as embedded PVTs. Failing validity cutoffs on these subtests signals an increased risk of non-credible presentation and is robust to genuine neurocognitive impairment. However, they should not be used in isolation to determine the validity of an overall neurocognitive profile.