The Need for a Specialized Neurocognitive Screen and Consistent Cognitive Impairment Criteria in Spinal Cord Injury: Analysis of the Suitability of the Neuropsychiatry Unit Cognitive Assessment Tool

The assessment of mild cognitive impairment (MCI) following spinal cord injury (SCI) is vital. However, there are no neurocognitive screens which have been developed specifically to meet the unique requirements for SCI, nor are there consistent MCI criteria applied to determine the rates of MCI. The aim of this study was to determine the suitability of a neurocognitive screen for assessing MCI in adults with SCI. A total of 127 participants were recruited. Socio-demographic and injury related variables were assessed. All participants completed the screen. Descriptive statistics are provided for total/domain screen scores and all items, and the screen’s ability to distinguish MCI was examined. Congeneric confirmatory factor analyses (CFA) were employed to investigate structural validity. The screen total score was sensitive to differences in neurocognitive capacity, as well as for time since the injury occurred (p < 0.01). The MCI rate ranged between 17−36%. CFA revealed attention and visuoconstruction domains had an adequate model fit and executive function had poor fit, while CFA models for memory and language did not fit the data (did not converge), hence could not be determined. While the screen differentiated between those with MCI and those without, and MCI as a function of time since injury, limitations of its suitability for assessing MCI after SCI exist, demonstrating the need for a specialized neurocognitive screen for adults with SCI.

Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke

BACKGROUND

There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning.

OBJECTIVE

To understand the relationship between locomotor learning and retention and cognition after stroke.

METHODS

Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables.

RESULTS

Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning (R² = 0.17, P = .008; overall model R² = 0.31, P = .002) and retention (ΔR² = 0.17, P = .023; overall model R² = 0.44, P = .002).

CONCLUSIONS

Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.

A Demonstration of Mokken Scale Analysis Methods Applied to Cognitive Test Validation Using the Egyptian WAIS-IV

The fourth edition of the Wechsler Adult Intelligence Scale (WAIS-IV) has been used extensively for assessing adult intelligence. This study uses Mokken scale analysis to investigate the psychometric proprieties of WAIS-IV subtests adapted for the Egyptian population in a sample of 250 adults between 18 and 25 years of age. The monotone homogeneity model and the double monotonicity model were consistent with the subtest data. The items of all subtests except Matrix Reasoning, Information, Similarities, and Vocabulary formed a unidimensional scale. The WAIS-IV subtests have discriminatory and invariantly ordered items, although some items violated the invariant item ordering and scalability criteria. Therefore, the WAIS-IV subtests—with the exception of some items—are hierarchical scales that allow items to be ordered according to difficulty and subjects to be ordered using the sum score. In conclusion, the current study provides evidence of the dimensionality and hierarchy of the WAIS-IV subtests in the framework of Mokken scaling, although care should be taken when interpreting or including certain items.

Hierarchical Structure of the Wechsler Adult Intelligence Scale–Fourth Edition with an Egyptian Sample

The Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV) is one of the most well-known tests in the field of adult intelligence assessment. This study explores the validity of the Egyptian adaptation for the subscales of the WAIS-IV. Confirmatory factor analysis (CFA) indicated that the first-order, second-order, and bifactor models of both the five-factor Cattel–Horn–Carroll (CHC) and the four-factor structures fitted with the WAIS-IV. When the Arithmetic subscale was pathed to Perceptual Reasoning and Working Memory, the modified four first-order factor showed a better fit than any other model. Estimates of internal consistency revealed that Cronbach’s alpha was very high (.91) for the WAIS-IV scale and for four-factor structures (ranging from .81 to .95), while [Formula: see text] was low (0.61) for the WAIS-IV scale and for four-factor structures, ranging from 0.20 to 0.68. Overall, these findings provided adding evidence about the dimensionality of WAIS-IV with a new sample.

Confirmatory Factor Analysis of the Dutch Version of the Wechsler Memory Scale-Fourth Edition (WMS-IV-NL)

The latent factor structure of the Dutch version of the Wechsler Memory Scale-Fourth Edition (WMS-IV-NL) was examined with a series of confirmatory factor analyses. As part of the Dutch standardization, 1,188 healthy participants completed the WMS-IV-NL. Four models were tested for the Adult Battery (16-69 years; N = 699), and two models were tested for the Older Adult Battery (65-90 years; N = 489). Results corroborated the presence of three WMS-IV-NL factors in the Adult Battery consisting of Auditory Memory, Visual Memory, and Visual Working Memory. A two-factor model (consisting of Auditory Memory and Visual Memory) provided the best fit for the data of the Older Adult Battery. These findings provide evidence for the structural validity of the WMS-IV-NL, and further support the psychometric integrity of the WMS-IV.