Wechsler Adult Intelligence Scale-Revised Block Design broken configuration errors in nonpenetrating traumatic brain injury

Looking Ahead: Advancing Measurement and Analysis of the Block Design Test Using Technology and Artificial Intelligence

The block design test (BDT) has been used for over a century in research and clinical contexts as a measure of spatial cognition, both as a singular ability and as part of more comprehensive intelligence assessment. Traditionally, the BDT has been scored using methods that do not reflect the full potential of individual differences that could be measured by the test. Recent advancements in technology, including eye-tracking, embedded sensor systems, and artificial intelligence, have provided new opportunities to measure and analyze data from the BDT. In this methodological review, we outline the information that BDT can assess, review several recent advancements in measurement and analytic methods, discuss potential future uses of these methods, and advocate for further research using these methods.

A matter of quality: Kurt Goldstein's assessment of the abstract attitude after brain damage

Neurologist and psychiatrist Kurt Goldstein (1878-1965) made substantial contributions to neuropsychology in general and to the development of tests for the assessment of brain damage sequelae in particular. Unlike present-day neuropsychology's psychometric orientation, Goldstein kept a critical distance to a mere quantitative evaluation. Eighty years ago, he impressively demonstrated his own, qualitatively oriented diagnostic approach both in a remarkable monograph and in a didactic film, in collaboration with psychologist Martin Scheerer (1900-1961). By modifying a classical paradigm for the assessment of deficits in visuospatial construction, the Block Design Test, the two authors developed the Goldstein-Scheerer Cube Test. This version characterizes itself by offering the patient different types of cues in order to reveal the nature of the deficit at stake. The test remains an impressive illustration of Goldstein's most famous neuropsychological concept, viz. the human ability to abstract from a concrete situation: the abstract (or categorial) attitude.

Functional Neural Correlates of the WAIS-IV Block Design Test in Older Adult with Mild Cognitive Impairment and Alzheimer's Disease

The Wechsler Adult intelligence scale-Revised (WAIS-R) Block design test (BDT) is a neuropsychological test widely used to assess cognitive declines in aging population. Previous studies suggest parietal lobe is the key region to influence the performance on the BDT; yet, it has not been clearly identified. The aim of the current study, therefore, is to identify the functional neural correlates of the BDT in older adults with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia patients. The current study includes 213 cognitively impaired mid to old-aged community dwelling Korean. All participants underwent comprehensive clinical and neuropsychological assessments and 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) scans. Performance on the BDT was assessed using the WAIS-IV Korean version. Voxel-wise analyses were used to investigate the correlation between regional cerebral glucose metabolism and BDT performance. The same analyses were conducted on the subgroups categorized by clinical severity based on the Clinical Dementia Rating (CDR). Significant positive correlations between performance on the BDT and regional cerebral glucose metabolism were found bilaterally in the inferior parietal lobules, right thalamus and right middle frontal gyrus. Our results suggest that performance on the BDT in MCI and AD patients functionally relies on the brain regions known to be associated with motor and executive functions in addition to visuospatial function.

Measuring Change Over Time: A Systematic Review of Evaluative Measures of Cognitive Functioning in Traumatic Brain Injury

Objectives: The purpose of evaluative instruments is to measure the magnitude of change in a construct of interest over time. The measurement properties of these instruments, as they relate to the instrument's ability to fulfill its purpose, determine the degree of certainty with which the results yielded can be viewed. This work systematically reviews all instruments that have been used to evaluate cognitive functioning in persons with traumatic brain injury (TBI), and critically assesses their evaluative measurement properties: construct validity, test-retest reliability, and responsiveness. Data Sources: MEDLINE, Central, EMBASE, Scopus, PsycINFO were searched from inception to December 2016 to identify longitudinal studies focused on cognitive evaluation of persons with TBI, from which instruments used for measuring cognitive functioning were abstracted. MEDLINE, instrument manuals, and citations of articles identified in the primary search were then screened for studies on measurement properties of instruments utilized at least twice within the longitudinal studies. Study Selection: All English-language, peer-reviewed studies of longitudinal design that measured cognition in adults with a TBI diagnosis over any period of time, identified in the primary search, were used to identify instruments. A secondary search was carried out to identify all studies that assessed the evaluative measurement properties of the instruments abstracted in the primary search. Data Extraction: Data on psychometric properties, cognitive domains covered and clinical utility were extracted for all instruments. Results: In total, 38 longitudinal studies from the primary search, utilizing 15 instruments, met inclusion and quality criteria. Following review of studies identified in the secondary search, it was determined that none of the instruments utilized had been assessed for all the relevant measurement properties in the TBI population. The most frequently assessed property was construct validity. Conclusions: There is insufficient evidence for the validity and reliability of instruments measuring cognitive functioning, longitudinally, in persons with TBI. Several instruments with well-defined construct validity in TBI samples warrant further assessment for test-retest reliability and responsiveness. Registration Number: www.crd.york.ac.uk/PROSPERO/, identifier CRD42017055309.

Benton visual form discrimination test in healthy children: normative data and qualitative analysis

The attention evaluation may be considered a crucial phase in neuropsychological assessment. It must take into account the systemic nature of the attentional functions and must use different reliable tests in relation to the neurological and attentional problems to be addressed. The aim of the study was to offer the clinician an effective tool for attention assessment and provide the normative data and performance analysis on the Benton Visual Form Discrimination Test on an Italian sample (number 323) of healthy school children, from ages 5 to 11. Performance on Visual Form Discrimination Test (VFDT) significantly increased with growing age. Performances were significantly different when the test was divided into four sets. All groups, especially the younger ones, showed some difficulty in maintenance and sustained attention. The correct answers were significantly more numerous when they were placed at the top quadrants. This effect was more marked in the younger groups. Sex was never a significantly influencing performance. Our data seem to indicate that the higher attentional frontoparietal network becomes more functionally organized around 9-10 years. VFDT appears as a discriminative task. In clinical practice, our normative data can be used both on complex visual attention skill evaluation in children and on the ability to maintain visual attention in time.

The relationship between neuropsychological tests of visuospatial function and lobar cortical thickness

INTRODUCTION

Tests of visuospatial function are often administered in comprehensive neuropsychological evaluations. These tests are generally considered assays of parietal lobe function; however, the neural correlates of these tests, using modern imaging techniques, are not well understood. In the current study we investigated the relationship between three commonly used tests of visuospatial function and lobar cortical thickness in each hemisphere.

METHOD

Data from 374 patients who underwent a neuropsychological evaluation and MRI scans in an outpatient dementia clinic were included in the analysis. We examined the relationships between cortical thickness, as assessed with Freesurfer, and performance on three tests: Judgment of Line Orientation (JoLO), Block Design (BD) from the Fourth edition of the Wechsler Adult Intelligence Scale, and Brief Visuospatial Memory Test-Revised Copy Trial (BVMT-R-C) in patients who showed overall average performance on these tasks. Using a series of multiple regression models, we assessed which lobe's overall cortical thickness best predicted test performance.

RESULTS

Among the individual lobes, JoLO performance was best predicted by cortical thickness in the right temporal lobe. BD performance was best predicted by cortical thickness in the right parietal lobe, and BVMT-R-C performance was best predicted by cortical thickness in the left parietal lobe.

CONCLUSIONS

Performance on constructional tests of visuospatial function appears to correspond best with underlying cortical thickness of the parietal lobes, while performance on visuospatial judgment tests appears to correspond best to temporal lobe thickness. Future research using voxel-wise and connectivity techniques and including more diverse samples will help further understanding of the regions and networks involved in visuospatial tests.

Correlation of Visuospatial Ability and EEG Slowing in Patients with Parkinson's Disease

Background. Visuospatial dysfunction is among the first cognitive symptoms in Parkinson's disease (PD) and is often predictive for PD-dementia. Furthermore, cognitive status in PD-patients correlates with quantitative EEG. This cross-sectional study aimed to investigate the correlation between EEG slowing and visuospatial ability in nondemented PD-patients. Methods. Fifty-seven nondemented PD-patients (17 females/40 males) were evaluated with a comprehensive neuropsychological test battery and a high-resolution 256-channel EEG was recorded. A median split was performed for each cognitive test dividing the patients sample into either a normal or lower performance group. The electrodes were split into five areas: frontal, central, temporal, parietal, and occipital. A linear mixed effects model (LME) was used for correlational analyses and to control for confounding factors. Results. Subsequently, for the lower performance, LME analysis showed a significant positive correlation between ROCF score and parietal alpha/theta ratio (b = .59, p = .012) and occipital alpha/theta ratio (b = 0.50, p = .030). No correlations were found in the group of patients with normal visuospatial abilities. Conclusion. We conclude that a reduction of the parietal alpha/theta ratio is related to visuospatial impairments in PD-patients. These findings indicate that visuospatial impairment in PD-patients could be influenced by parietal dysfunction.

Mayo's Older Americans Normative Studies: Visual Form Discrimination and copy trial of the Rey–Osterrieth Complex Figure

Age-adjusted normative data are presented for persons age 70-89 years for the Visual Form Discrimination Test and Rey-Osterrieth Complex Figure (copy trial only). Adjustment for the effect of education on test performance is also provided. These data were collected as part of Mayo's Older Americans Normative Studies (MOANS). The normative information provided here should prove useful for characterizing performance on these measures as well as comparing the person's performance against his or her functioning on any other test with MOANS norms. Limitations and unique features of the MOANS normative data are also discussed.

Spatial-temporal characteristics of perceptual organization following acquired brain injury

OBJECTIVE

To assess characteristics of perceptual organization following brain injury.

RESEARCH DESIGN

A repeated measures between groups design.

METHODS

Perceptual thresholds were compared between 10 persons with brain injury and 10 demographically matched healthy control subjects. Ten young control subjects were also tested to evaluate effects of normal ageing on these processes. Participants viewed stimuli on a computer monitor in which regularities existed in either the spatial or temporal domain. Psychophysical measurements were made of perceptual thresholds, as well as time required to process stimuli.

RESULTS

Relative to age-matched control subjects, patients were impaired on all measures, with greatest deficits in conditions that contained a temporal component. Impairment did not occur with normal ageing.

CONCLUSIONS

These results reflect cognitive impairment resulting from reduced cortical integrative function as well as reduced information processing speed. Such deficits at this level of processing likely impact subsequent perceptual function, such as object recognition.

Neuropsychologic assessment of visual disorders

This article introduces the reader to a sample of visual tests used in the neuropsychologic assessment of patients who present with various visual deficits. As discussed, patients often present with visual abnormalities that cannot be assessed exclusively during the opthtalmologic examination, partly because these problems extend beyond the fundamental aspects of visual processing. Visual problems occur in the context of focal or diffuse brain damage. Neuropsychologic evaluation can provide valuable diagnostic information and information regarding functional strengths and weaknesses. Many visual tests have been developed for clinical use. Some of these tests have been validated with lesion analytic or neuroimaging studies, which highlight the areas of the brain presumed necessary for task performance. Knowledge regarding the neural substrates of test performance allows the clinician to identify the neuropathologic correlates of test failure, which, in turn, is relevant to differential diagnosis. A profile of functional strengths and weaknesses emerges contributing to the treatment of the patient with a visual disorder. In this article, the authors present a subset of visual tests used primarily in the clinical setting. Some of these tests measure lower-level visual deficits (e.g., Judgment of Line Orientation) and others measure higher-level visual/cognitive deficits (e.g., ROCF). Although no firm delineation of test subtypes exists, the authors divide the tests into general categories of visuoperceptual, visuospatial, visuoconstructive, and visual attention/memory. Ultimately, it is incumbent on a trained neuropsychologist to select appropriate visual tests based on the patient's described symptoms and the referral question.