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Scott JC, Moore TM, Roalf DR, Satterthwaite TD, Wolf DH, Port AM, Butler ER, Ruparel K, Nievergelt CM, Risbrough VB, Baker DG, Gur RE, Gur RC. Development and application of novel performance validity metrics for computerized neurocognitive batteries. J Int Neuropsychol Soc 2023; 29:789-797. [PMID: 36503573 PMCID: PMC10258222 DOI: 10.1017/s1355617722000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Data from neurocognitive assessments may not be accurate in the context of factors impacting validity, such as disengagement, unmotivated responding, or intentional underperformance. Performance validity tests (PVTs) were developed to address these phenomena and assess underperformance on neurocognitive tests. However, PVTs can be burdensome, rely on cutoff scores that reduce information, do not examine potential variations in task engagement across a battery, and are typically not well-suited to acquisition of large cognitive datasets. Here we describe the development of novel performance validity measures that could address some of these limitations by leveraging psychometric concepts using data embedded within the Penn Computerized Neurocognitive Battery (PennCNB). METHODS We first developed these validity measures using simulations of invalid response patterns with parameters drawn from real data. Next, we examined their application in two large, independent samples: 1) children and adolescents from the Philadelphia Neurodevelopmental Cohort (n = 9498); and 2) adult servicemembers from the Marine Resiliency Study-II (n = 1444). RESULTS Our performance validity metrics detected patterns of invalid responding in simulated data, even at subtle levels. Furthermore, a combination of these metrics significantly predicted previously established validity rules for these tests in both developmental and adult datasets. Moreover, most clinical diagnostic groups did not show reduced validity estimates. CONCLUSIONS These results provide proof-of-concept evidence for multivariate, data-driven performance validity metrics. These metrics offer a novel method for determining the performance validity for individual neurocognitive tests that is scalable, applicable across different tests, less burdensome, and dimensional. However, more research is needed into their application.
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Affiliation(s)
- J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Tyler M. Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David R. Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison M. Port
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ellyn R. Butler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline M. Nievergelt
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Victoria B. Risbrough
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Dewleen G. Baker
- Center for Excellent in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California (UCSD), San Diego, CA, USA
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Moore TM, Di Sandro A, Scott JC, Lopez KC, Ruparel K, Njokweni LJ, Santra S, Conway DS, Port AM, D'Errico L, Rush S, Wolf DH, Calkins ME, Gur RE, Gur RC. Construction of a computerized adaptive test (CAT-CCNB) for efficient neurocognitive and clinical psychopathology assessment. J Neurosci Methods 2023; 386:109795. [PMID: 36657647 PMCID: PMC9892357 DOI: 10.1016/j.jneumeth.2023.109795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Traditional paper-and-pencil neurocognitive evaluations and semi-structured mental health interviews can take hours to administer and score. Computerized assessment has decreased that burden substantially, and contemporary psychometric tools such as item response theory and computerized adaptive testing (CAT) allow even further abbreviation. NEW METHOD The goal of this paper was to describe the application of CAT and related methods to the Penn Computerized Neurocognitive Battery (CNB) and a well-validated clinical assessment in order to increase efficiency in assessment and relevant domain coverage. To calibrate item banks for CAT, N = 5053 participants (63% female; mean age 45 years, range 18-80) were collected from across the United States via crowdsourcing, providing item parameters that were then linked to larger item banks and used in individual test construction. Tests not amenable to CAT were abbreviated using complementary short-form methods. RESULTS The final "CAT-CCNB" battery comprised 21 cognitive tests (compared to 14 in the original) and five adaptive clinical scales (compared to 16 in the original). COMPARISON WITH EXISTING METHODS This new battery, derived with contemporary psychometric approaches, provides further improvements over existing assessments that use collections of fixed-length tests developed for stand-alone administration. The CAT-CCNB provides an improved version of the CNB that shows promise as a maximally efficient tool for neuropsychiatric assessment. CONCLUSIONS We anticipate CAT-CCNB will help satisfy the clear need for broad yet efficient measurement of cognitive and clinical domains, facilitating implementation of large-scale, "big science" approaches to data collection, and potential widespread clinical implementation.
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Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA.
| | - Akira Di Sandro
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Cobb Scott
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, 19104, USA
| | - Katherine C Lopez
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Lucky J Njokweni
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Satrajit Santra
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David S Conway
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allison M Port
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lisa D'Errico
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sage Rush
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
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Kantor JR, Gur RC, Calkins ME, Moore TM, Port AM, Ruparel K, Scott JC, Troyan S, Gur RE, Roalf DR. Comparison of two cognitive screening measures in a longitudinal sample of youth at-risk for psychosis. Schizophr Res 2022; 246:216-224. [PMID: 35809354 PMCID: PMC10838490 DOI: 10.1016/j.schres.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Validated screening tools are needed to detect subtle cognitive impairment in individuals at-risk for developing psychosis. Here, the utility of the Mini-Mental Status Examination (MMSE) and Penn Computerized Neurocognitive Battery (CNB) were evaluated for detecting cognitive impairment in individuals with psychosis spectrum (PS) symptoms. METHODS Participants (n = 229; 54 % female) completed the MMSE and CNB at baseline and two-year follow-up. PS (n = 91) and typically developing (TD; n = 138) participants were enrolled at baseline based on the presence or absence of PS symptoms. After two years, 65 participants remained PS, 104 participants remained TD, 23 participants had Emergent (EP) subthreshold PS symptoms, and 37 participants were experiencing Other Psychopathology (OP). RESULTS Generally, those with PS had lower scores than TD on both the MMSE (p < 0.0001) and CNB (p < 0.0001). Additionally, OP participants performed lower on the MMSE than TD (p = 0.02). Receiver operating characteristic (ROC) analyses indicated similar area under the curve (AUCs) for the two instruments (0.67); the MMSE showed higher specificity (0.71 vs. 0.62), while the CNB showed higher sensitivity (0.66 vs 0.52). Use of the MMSE and CNB in combination provided the highest diagnostic classification. CONCLUSION The MMSE and CNB can be used to screen for cognitive impairment in PS. The MMSE is better at ruling out PS-related cognitive impairment while the CNB is better at ruling in PS-related cognitive impairment. Overall, our results indicate that both tests are useful in screening for cognitive impairment, particularly in combination, in a PS population.
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Affiliation(s)
- Jenna R Kantor
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Ruben C Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Monica E Calkins
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Tyler M Moore
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Allison M Port
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Kosha Ruparel
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - J Cobb Scott
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA 19104, USA
| | - Scott Troyan
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
| | - David R Roalf
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA.
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Scott JC, Moore TM, Stein DJ, Pretorius A, Zingela Z, Nagdee M, Ngqengelele L, Campbell M, Sibeko G, King MC, McClellan JM, Port AM, Jackson C, Ruparel K, Susser ES, Gur RC. Adaptation and validation of a computerized neurocognitive battery in the Xhosa of South Africa. Neuropsychology 2021; 35:581-594. [PMID: 34242045 DOI: 10.1037/neu0000742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Large-scale studies have revolutionized biomedical research, and neurocognitive tests can help elucidate the biological basis of neuropsychiatric diseases. However, studies have predominantly been conducted in Western settings. We describe the development and validation of a computerized battery (PennCNB) with the Xhosa population of South Africa. METHOD Individuals with schizophrenia (n = 525) and a normative comparison group (n = 744) were balanced on age, sex, education, and region. Participants provided blood samples, were assessed psychiatrically, and were administered a PennCNB translation to isiXhosa, including measures of executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed. Feasibility was examined with test completion rates and input from administrators, and psychometric structural validity and associations with clinical and demographic characteristics were examined. RESULTS Tests were well tolerated by participants, as >87% had one (or fewer) test missing. Results suggested a similar factor structure to prior PennCNB studies in Western contexts, and expected age and sex effects were apparent. Furthermore, a similar profile of schizophrenia was observed, with neurocognitive deficits most pronounced for executive functions, especially attention, as well as memory, social cognition, and motor speed relative to complex cognition and sensorimotor speed. CONCLUSIONS Results support the feasibility of implementing a culturally adapted computerized neurocognitive battery in sub-Saharan African settings and provide evidence supporting the concurrent validity of the translated instrument. Thus, the PennCNB is implementable on a large scale in non-Western contexts, shows expected factor structure, and can detect cognitive deficits associated with neuropsychiatric disorders. Obtaining valid measures of cognition by nonspecialized proctors is especially suitable in resource-limited settings, where traditional testing is prohibitive. Future work should establish normative standards, test-retest reliability, and sensitivity to treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- J Cobb Scott
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Tyler M Moore
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Adele Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Zukiswa Zingela
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Mohammed Nagdee
- Department of Psychiatry and Mental Health, University of Cape Town
| | | | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town
| | | | | | - Allison M Port
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Chad Jackson
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Kosha Ruparel
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Ezra S Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University
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Izgi B, Moore TM, Yalcinay-Inan M, Port AM, Kuscu K, Gur RC, Yapici Eser H. Test-retest reliability of the Turkish translation of the Penn Computerized Neurocognitive Battery. Appl Neuropsychol Adult 2021; 29:1258-1267. [PMID: 33492171 DOI: 10.1080/23279095.2020.1866572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Psychiatric disorders are associated with cognitive dysfunction (CD), and reliable screening and follow-up of CD is essential both for research and clinical practice globally; yet, most assessments are in Western languages. We aimed to evaluate the test-retest reliability of the Turkish version of the Penn Computerized Neurocognitive Battery (PennCNB) to guide confident interpretation of results. Fifty-eight healthy individuals completed the PennCNB Turkish version in two sessions. After quality control, reliability analysis was conducted using Intraclass Correlation Coefficients (ICC), corrected for practice effects. Most measures were not significantly different between the sessions and had acceptable ICC values, with several exceptions. Scores were improved considerably for some memory measures, including immediate Facial Memory and Spatial Memory, and for incorrect responses in abstraction and mental flexibility, with correspondingly acceptable ICCs. Test-retest assessment of the Turkish version of the PennCNB shows that it can be used as a reliable real-time measurement of cognitive function in snapshot cross-sectional or longitudinal determinations. Preliminary validity assessment in this normative sample showed expected positive correlations with education level and negative correlations with age. Thus, the Turkish version of the PennCNB can be considered a reliable neuropsychological testing tool in research and clinical practice. Practice effects should be considered, especially when applied in short intervals. Significantly better performances in the retest, beyond practice effect, likely reflect nonlinear improvements in some participants who "learned how to learn" the memory tests or had insight on solving the abstraction and mental flexibility test.
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Affiliation(s)
- Busra Izgi
- Graduate School of Health Sciences, Neuroscience Ph.D. program, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Tyler M Moore
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Allison M Port
- Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Kemal Kuscu
- School of Medicine, Department of Psychiatry, Koç University, Istanbul, Turkey
| | - Ruben C Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hale Yapici Eser
- Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey.,School of Medicine, Department of Psychiatry, Koç University, Istanbul, Turkey
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Moore TM, Butler ER, Scott JC, Port AM, Ruparel K, Njokweni LJ, Gur RE, Gur RC. When CAT is not an option: complementary methods of test abbreviation for neurocognitive batteries. Cogn Neuropsychiatry 2021; 26:35-54. [PMID: 33308027 PMCID: PMC7855518 DOI: 10.1080/13546805.2020.1859360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is an obvious need for efficient measurement of neuropsychiatric phenomena. A proven method-computerized adaptive testing (CAT)-is not feasible for all tests, necessitating alternatives for increasing test efficiency. METHODS We combined/compared two methods for abbreviating rapid tests using two tests unamenable to CAT (a Continuous Performance Test [CPT] and n-back test [NBACK]). N=9,498 (mean age 14.2 years; 52% female) were administered the tests, and abbreviation was accomplished using methods answering two questions: what happens to measurement error as items are removed, and what happens to correlations with validity criteria as items are removed. The first was investigated using quasi-CAT simulation, while the second was investigated using bootstrapped confidence intervals around full-form-short-form comparisons. RESULTS Results for the two methods overlapped, suggesting that the CPT could be abbreviated to 57% of original and NBACK could be abbreviated to 87% of original with the max-acceptable loss of precision and min-acceptable relationships with validity criteria. CONCLUSIONS This method combination shows promise for use in other test types, and the divergent results for the CPT/NBACK demonstrate the methods' abilities to detect when a test should not be shortened. The methods should be used in combination because they emphasize complementary measurement qualities: precision/validity..
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Affiliation(s)
- Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA,Correspondence concerning this article should be addressed to Tyler M. Moore, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, 3700 Hamilton Walk, Office B502, Philadelphia, PA 19104.
| | - Ellyn R. Butler
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - J. Cobb Scott
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA,VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA
| | - Allison M. Port
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lucky J. Njokweni
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raquel E. Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C. Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA,VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA
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Scott JC, Van Pelt AE, Port AM, Njokweni L, Gur RC, Moore TM, Phoi O, Tshume O, Matshaba M, Ruparel K, Chapman J, Lowenthal ED. Development of a computerised neurocognitive battery for children and adolescents with HIV in Botswana: study design and protocol for the Ntemoga study. BMJ Open 2020; 10:e041099. [PMID: 32847928 PMCID: PMC7451956 DOI: 10.1136/bmjopen-2020-041099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Neurodevelopmental delays and cognitive impairments are common in youth living with HIV. Unfortunately, in resource-limited settings, where HIV infection impacts millions of children, cognitive and neurodevelopmental disorders commonly go undetected because of a lack of appropriate assessment instruments and local expertise. Here, we present a protocol to culturally adapt and validate the Penn Computerized Neurocognitive Battery (PennCNB) and examine its validity for detecting both advanced and subtle neurodevelopmental problems among school-aged children affected by HIV in resource-limited settings. METHODS AND ANALYSIS This is a prospective, observational cohort study. The venue for this study is Gaborone, Botswana, a resource-limited setting with high rates of perinatal exposure to HIV and limited neurocognitive assessment tools and expertise. We aim to validate the PennCNB in this setting by culturally adapting and then administering the adapted version of the battery to 200 HIV-infected, 200 HIV-exposed uninfected and 240 HIV-unexposed uninfected children. A series of analyses will be conducted to examine the reliability and construct validity of the PennCNB in these populations. ETHICS AND DISSEMINATION This project received ethical approval from local and university Institutional Review Boards and involved extensive input from local stakeholders. If successful, the proposed tools will provide practical screening and streamlined, comprehensive assessments that could be implemented in resource-limited settings to identify children with cognitive deficits within programmes focused on the care and treatment of children affected by HIV. The utility of such assessments could also extend beyond children affected by HIV, increasing general access to paediatric cognitive assessments in resource-limited settings.
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Affiliation(s)
- J Cobb Scott
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Amelia E Van Pelt
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allison M Port
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lucky Njokweni
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Onkemetse Phoi
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
- Baylor College of Medicine, Gaborone, Botswana
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Lee G, Moore TM, Basner M, Nasrini J, Roalf DR, Ruparel K, Port AM, Dinges DF, Gur RC. Age, Sex, and Repeated Measures Effects on NASA's "Cognition" Test Battery in STEM Educated Adults. Aerosp Med Hum Perform 2020; 91:18-25. [PMID: 31852569 DOI: 10.3357/amhp.5485.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Cognition is a neurocognitive test battery created at the University of Pennsylvania and adapted by the National Aeronautics and Space Administration (NASA). It comprises 10 neurocognitive tests that examine multiple domains, and has been validated in a normative sample of STEM-educated adults and compared to NASA's WinSCAT battery.METHODS: The purpose of this study was to follow the original sample to assess Cognition and WinSCAT's test-retest reliability and age, sex, and test-retest interval effects on performance.RESULTS: Performance on both Cognition and WinSCAT decreased with age but improved with repeated administration due to practice effects, and men had higher scores than women on tasks that required vigilant attention, spatial reasoning, and risk-taking behaviors. Assessment of test-retest reliability showed intraclass coefficients for efficiency ranging from 0.417 to 0.810, reflecting the broad nature of constructs assessed by Cognition.DISCUSSION: Results largely matched predictions, with some counter-intuitive results for test-retest reliability interval.Lee G, Moore TM, Basner M, Nasrini J, Roalf DR, Ruparel K, Port AM, Dinges DF, Gur RC. Age, sex, and repeated measures effects on NASA's "Cognition" Test Battery in STEM educated adults. Aerosp Med Hum Perform. 2020; 91(1):18-25.
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Yudien MA, Moore TM, Port AM, Ruparel K, Gur RE, Gur RC. Development and public release of the Penn Reading Assessment Computerized Adaptive Test (PRA-CAT) for premorbid IQ. Psychol Assess 2019; 31:1168-1173. [PMID: 31192630 PMCID: PMC6706308 DOI: 10.1037/pas0000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An important component of neuropsychological testing is assessment of premorbid intelligence to estimate a patient's ability independent of neurological impairment. A common test of premorbid IQ-namely, the Reading section of the Wide Range Achievement Test (WRAT)-has been shown to have high measurement error in the high ability range, is unnecessarily long (55 items), and is proprietary. We describe the development of an alternative, nonproprietary, computerized adaptive test for premorbid IQ, the Penn Reading Assessment (PRA-CAT). PRA-CAT items were calibrated using a 1-parameter item response theory model in a large community sample (N = 9,498), Ages 8 to 21, and the resulting parameters were used to simulate computerized adaptive testing sessions. Simulations demonstrated that the PRA-CAT achieves low measurement error (0.25; equivalent to Cronbach's alpha = .94) and acceptable measurement error (0.40; Cronbach's alpha = .84) after only 18 and 6 items, respectively (on average). Correlation of WRAT and PRA-CAT scores with numerous clinical, cognitive, demographic, and neuroimaging criteria suggests that validity of PRA-CAT score interpretation is comparable (and sometimes superior) with the WRAT. The fully functioning PRA-CAT for public use (including item parameter estimates reported here) has been built using the open-source program Concerto, and can be installed by anyone on a local computer or on the "cloud." Given the length and proprietary nature of the WRAT, the PRA-CAT shows promise as a potential alternative (and with minimal or no cost). Further validation in the context of neurological injury is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Mikhal A. Yudien
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Swarthmore College, Swarthmore, PA 19081, USA
| | - Tyler M. Moore
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allison M. Port
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kosha Ruparel
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E. Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C. Gur
- Brain Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Liu HS, Hartung EA, Jawad AF, Ware JB, Laney N, Port AM, Gur RC, Hooper SR, Radcliffe J, Furth SL, Detre JA. Regional Cerebral Blood Flow in Children and Young Adults with Chronic Kidney Disease. Radiology 2018; 288:849-858. [PMID: 29893643 DOI: 10.1148/radiol.2018171339] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose To investigate the pathophysiologic effects of chronic kidney disease (CKD) on brain function in children with CKD by correlating cerebral blood flow (CBF) with clinical and behavioral indexes. Materials and Methods In this prospective study, 73 pediatric patients with CKD (mean age, 15.80 years ± 3.63; range, 9-25 years) and 57 control subjects (mean age, 15.65 years ± 3.76; range, 9-25 years) were recruited. CBF measurements were acquired with an MRI arterial spin labeling scheme. Neurocognitive measurements were performed with traditional and computerized neurocognitive batteries. Clinical data were also collected. Group-level global and regional CBF differences between patients with CKD and control subjects were assessed. Regression analyses were conducted to evaluate the associations among regional CBF, clinical variables, and cognitive performance. Results Patients with CKD showed higher global CBF compared with control subjects that was attributable to reduced hematocrit level (mean, 60.2 mL/100 g/min ± 9.0 vs 56.5 mL/100 g/min ± 8.0, respectively). White matter CBF showed correlation with blood pressure (r = 0.244, P = .039), a finding suggestive of altered cerebrovascular autoregulation. Regional CBF differences between patients and control subjects included regions in the "default mode" network. In patients with CKD, positive extrema in the precuneus showed a strong correlation with executive function (ρ = 0.608, P = .001). Conclusion Systemic effects of estimated glomerular filtration rate, hematocrit level, and blood pressure on CBF and alterations in regional CBF may reflect impaired brain function underlying neurocognitive symptoms in CKD. These findings further characterize the nature of alterations in brain physiologic features in children, adolescents, and young adults with CKD.
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Affiliation(s)
- Hua-Shan Liu
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Erum A Hartung
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Abbas F Jawad
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Jeffrey B Ware
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Nina Laney
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Allison M Port
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Ruben C Gur
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Stephen R Hooper
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Jerilynn Radcliffe
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - Susan L Furth
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
| | - John A Detre
- From the School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center of Translational Imaging, College of Medicine, Taipei Medical University, Taipei, Taiwan (H.S.L.); Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (E.A.H.); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (A.F.J.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (J.B.W.); Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (N.L.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (A.M.P.); Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa (R.C.G.); Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC (S.R.H.); Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.R.); Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania; Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.L.F.); and Departments of Neurology and Radiology, Perelman School of Medicine at the University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104 (J.A.D.)
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Moore TM, Risbrough VB, Baker DG, Larson GE, Glenn DE, Nievergelt CM, Maihofer A, Port AM, Jackson CT, Ruparel K, Gur RC. Effects of military service and deployment on clinical symptomatology: The role of trauma exposure and social support. J Psychiatr Res 2017; 95:121-128. [PMID: 28843074 PMCID: PMC5653464 DOI: 10.1016/j.jpsychires.2017.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/14/2017] [Accepted: 08/17/2017] [Indexed: 01/01/2023]
Abstract
The Marine Resiliency Study-II examined changes in symptomatology across a deployment cycle to Afghanistan. U.S. Servicemembers (N = 1041) received clinical testing at two time points either bracketing a deployment (855) or not (186). Factor analyses were used to generate summary and change scores from Time 1 to Time 2. A between-subject design was used to examine changes across the deployment cycle with deployment (low-trauma, high-trauma, and non-deployed) and social support (low vs. high) as the grouping variables. Insomnia increased post-deployment regardless of deployment trauma (std. effect for high-trauma and low-trauma = 0.39 and 0.26, respectively). Only the high-trauma group showed increased PTSD symptoms and non-perspective-taking (std. effect = 0.40 and 0.30, respectively), while low-trauma showed decreased anxiety symptoms after deployment (std. effect = -0.17). These associations also depend on social support, with std. effects ranging from -0.22 to 0.51. When the groups were compared, the high-trauma deployed group showed significantly worse PTSD and non-perspective-taking than all other groups. Similar to studies in other military divisions, increased clinical symptoms were associated with high deployment stress in active duty Servicemembers, and social support shows promise as a moderator of said association.
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Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, CA, USA; Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA
| | - Gerald E Larson
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA
| | - Daniel E Glenn
- Department of Psychiatry, University of California San Diego, CA, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, CA, USA; Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA
| | - Adam Maihofer
- Department of Psychiatry, University of California San Diego, CA, USA; Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA
| | - Allison M Port
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chad T Jackson
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, USA
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Moore TM, Basner M, Nasrini J, Hermosillo E, Kabadi S, Roalf DR, McGuire S, Ecker AJ, Ruparel K, Port AM, Jackson CT, Dinges DF, Gur RC. Validation of the Cognition Test Battery for Spaceflight in a Sample of Highly Educated Adults. Aerosp Med Hum Perform 2017; 88:937-946. [PMID: 28923143 DOI: 10.3357/amhp.4801.2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuropsychological changes that may occur due to the environmental and psychological stressors of prolonged spaceflight motivated the development of the Cognition Test Battery. The battery was designed to assess multiple domains of neurocognitive functions linked to specific brain systems. Tests included in Cognition have been validated, but not in high-performing samples comparable to astronauts, which is an essential step toward ensuring their usefulness in long-duration space missions. METHODS We administered Cognition (on laptop and iPad) and the WinSCAT, counterbalanced for order and version, in a sample of 96 subjects (50% women; ages 25-56 yr) with at least a Master's degree in science, technology, engineering, or mathematics (STEM). We assessed the associations of age, sex, and administration device with neurocognitive performance, and compared the scores on the Cognition battery with those of WinSCAT. Confirmatory factor analysis compared the structure of the iPad and laptop administration methods using Wald tests. RESULTS Age was associated with longer response times (mean β = 0.12) and less accurate (mean β = -0.12) performance, women had longer response times on psychomotor (β = 0.62), emotion recognition (β = 0.30), and visuo-spatial (β = 0.48) tasks, men outperformed women on matrix reasoning (β = -0.34), and performance on an iPad was generally faster (mean β = -0.55). The WinSCAT appeared heavily loaded with tasks requiring executive control, whereas Cognition assessed a larger variety of neurocognitive domains. DISCUSSION Overall results supported the interpretation of Cognition scores as measuring their intended constructs in high performing astronaut analog samples.Moore TM, Basner M, Nasrini J, Hermosillo E, Kabadi S, Roalf DR, McGuire S, Ecker AJ, Ruparel K, Port AM, Jackson CT, Dinges DF, Gur RC. Validation of the Cognition Test Battery for spaceflight in a sample of highly educated adults. Aerosp Med Hum Perform. 2017; 88(10):937-946.
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Moore TM, Reise SP, Roalf DR, Satterthwaite TD, Davatzikos C, Bilker WB, Port AM, Jackson CT, Ruparel K, Savitt AP, Baron RB, Gur RE, Gur RC. Development of an itemwise efficiency scoring method: Concurrent, convergent, discriminant, and neuroimaging-based predictive validity assessed in a large community sample. Psychol Assess 2016; 28:1529-1542. [PMID: 26866796 DOI: 10.1037/pas0000284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Traditional "paper-and-pencil" testing is imprecise in measuring speed and hence limited in assessing performance efficiency, but computerized testing permits precision in measuring itemwise response time. We present a method of scoring performance efficiency (combining information from accuracy and speed) at the item level. Using a community sample of 9,498 youths age 8-21, we calculated item-level efficiency scores on 4 neurocognitive tests, and compared the concurrent, convergent, discriminant, and predictive validity of these scores with simple averaging of standardized speed and accuracy-summed scores. Concurrent validity was measured by the scores' abilities to distinguish men from women and their correlations with age; convergent and discriminant validity were measured by correlations with other scores inside and outside of their neurocognitive domains; predictive validity was measured by correlations with brain volume in regions associated with the specific neurocognitive abilities. Results provide support for the ability of itemwise efficiency scoring to detect signals as strong as those detected by standard efficiency scoring methods. We find no evidence of superior validity of the itemwise scores over traditional scores, but point out several advantages of the former. The itemwise efficiency scoring method shows promise as an alternative to standard efficiency scoring methods, with overall moderate support from tests of 4 different types of validity. This method allows the use of existing item analysis methods and provides the convenient ability to adjust the overall emphasis of accuracy versus speed in the efficiency score, thus adjusting the scoring to the real-world demands the test is aiming to fulfill. (PsycINFO Database Record
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Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, University of Pennsylvania
| | | | - David R Roalf
- Department of Psychiatry, University of Pennsylvania
| | | | | | - Warren B Bilker
- Department of Biostatistics and Epidemiology, University of Pennsylvania
| | | | | | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania
| | - Adam P Savitt
- Department of Psychiatry, University of Pennsylvania
| | | | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania
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Basner M, Savitt A, Moore TM, Port AM, McGuire S, Ecker AJ, Nasrini J, Mollicone DJ, Mott CM, McCann T, Dinges DF, Gur RC. Development and Validation of the Cognition Test Battery for Spaceflight. Aerosp Med Hum Perform 2015; 86:942-52. [PMID: 26564759 DOI: 10.3357/amhp.4343.2015] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sustained high-level cognitive performance is of paramount importance for the success of space missions, which involve environmental, physiological, and psychological stressors that may affect brain functions. Despite subjective symptom reports of cognitive fluctuations in spaceflight, the nature of neurobehavioral functioning in space has not been clarified. METHODS We developed a computerized cognitive test battery (Cognition) that has sensitivity to multiple cognitive domains and was specifically designed for the high-performing astronaut population. Cognition consists of 15 unique forms of 10 neuropsychological tests that cover a range of cognitive domains, including emotion processing, spatial orientation, and risk decision making. Cognition is based on tests known to engage specific brain regions as evidenced by functional neuroimaging. Here we describe the first normative and acute total sleep deprivation data on the Cognition test battery as well as several efforts underway to establish the validity, sensitivity, feasibility, and acceptability of Cognition. RESULTS Practice effects and test-retest variability differed substantially between the 10 Cognition tests, illustrating the importance of normative data that both reflect practice effects and differences in stimulus set difficulty in the population of interest. After one night without sleep, medium to large effect sizes were observed for 3 of the 10 tests addressing vigilant attention (Cohen's d = 1.00), cognitive throughput (d = 0.68), and abstract reasoning (d = 0.65). CONCLUSIONS In addition to providing neuroimaging-based novel information on the effects of spaceflight on a range of cognitive functions, Cognition will facilitate comparing the effects of ground-based analogues to spaceflight, increase consistency across projects, and thus enable meta-analyses.
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Affiliation(s)
- Mathias Basner
- Division of Sleep and Chronobiology, Department of Psychiatry, and the Behavior Laboratory, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Hartung EA, Kim JY, Laney N, Hooper SR, Radcliffe J, Port AM, Gur RC, Furth SL. Evaluation of Neurocognition in Youth with CKD Using a Novel Computerized Neurocognitive Battery. Clin J Am Soc Nephrol 2015; 11:39-46. [PMID: 26500247 DOI: 10.2215/cjn.02110215] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neurocognitive problems in CKD are well documented; time-efficient methods are needed to assess neurocognition in this population. We performed the first study of the efficient 1-hour Penn Computerized Neurocognitive Battery (CNB) in children and young adults with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We administered the Penn CNB cross-sectionally to individuals aged 8-25 years with stage 2-5 CKD (n=92, enrolled from three academic nephrology practices from 2011 to 2014) and matched healthy controls (n=69). We analyzed results from 12 tests in four domains: executive control, episodic memory, complex cognition, and social cognition. All tests measure accuracy and speed; we converted raw scores to age-specific z-scores on the basis of Philadelphia Neurodevelopmental Cohort (n=1790) norms. We analyzed each test in a linear regression with accuracy and speed z-scores as dependent variables and with (1) CKD versus control or (2) eGFR as explanatory variables, adjusted for race, sex, and maternal education. RESULTS Patients with CKD (mean±SD eGFR, 48±25 ml/min per 1.73 m(2); mean age, 16.3±3.9 years) and controls (mean eGFR, 98±20 ml/min per 1.73 m(2); mean age, 16.0±4.0 years) were similar demographically. CKD participants had lower accuracy than controls in tests of complex cognition, with moderate to large effect sizes: -0.53 (95% confidence interval [95% CI], -0.87 to -0.19) for verbal reasoning, -0.52 (95% CI, -0.83 to -0.22) for nonverbal reasoning, and -0.64 (95% CI, -0.99 to -0.29) for spatial processing. For attention, patients with CKD had lower accuracy (effect size, -0.35 [95% CI, -0.67 to -0.03]) but faster response times (effect size, 0.44 [95% CI, 0.04 to 0.83]) than controls, perhaps reflecting greater impulsivity. Lower eGFR was associated with lower accuracy for complex cognition, facial and visual memory, and emotion identification tests. CONCLUSIONS CKD is associated with lower accuracy in tests of complex cognition, attention, memory, and emotion identification, which related to eGFR. These findings are consistent with traditional neurocognitive testing in previous studies.
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Affiliation(s)
| | - Ji Young Kim
- Biostatistics Core, Clinical and Translational Research Center, and
| | | | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and
| | - Jerilynn Radcliffe
- Department of Pediatrics and Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison M Port
- Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan L Furth
- Division of Nephrology, Department of Pediatrics and Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Hartung EA, Laney N, Kim JY, Ruebner RL, Detre JA, Liu HS, Davatzikos C, Erus G, Doshi JJ, Schultz RT, Herrington JD, Jawad AF, Moodalbail DG, Gur RC, Port AM, Radcliffe J, Hooper SR, Furth SL. Design and methods of the NiCK study: neurocognitive assessment and magnetic resonance imaging analysis of children and young adults with chronic kidney disease. BMC Nephrol 2015; 16:66. [PMID: 25924831 PMCID: PMC4419485 DOI: 10.1186/s12882-015-0061-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/22/2015] [Indexed: 12/04/2022] Open
Abstract
Background Chronic kidney disease is strongly linked to neurocognitive deficits in adults and children, but the pathophysiologic processes leading to these deficits remain poorly understood. The NiCK study (Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease) seeks to address critical gaps in our understanding of the biological basis for neurologic abnormalities in chronic kidney disease. In this report, we describe the objectives, design, and methods of the NiCK study. Design/methods The NiCK Study is a cross-sectional cohort study in which neurocognitive and neuroimaging phenotyping is performed in children and young adults, aged 8 to 25 years, with chronic kidney disease compared to healthy controls. Assessments include (1) comprehensive neurocognitive testing (using traditional and computerized methods); (2) detailed clinical phenotyping; and (3) multimodal magnetic resonance imaging (MRI) to assess brain structure (using T1-weighted MRI, T2-weighted MRI, and diffusion tensor imaging), functional connectivity (using functional MRI), and blood flow (using arterial spin labeled MRI). Primary analyses will examine group differences in neurocognitive testing and neuroimaging between subjects with chronic kidney disease and healthy controls. Mechanisms responsible for neurocognitive dysfunction resulting from kidney disease will be explored by examining associations between neurocognitive testing and regional changes in brain structure, functional connectivity, or blood flow. In addition, the neurologic impact of kidney disease comorbidities such as anemia and hypertension will be explored. We highlight aspects of our analytical approach that illustrate the challenges and opportunities posed by data of this scope. Discussion The NiCK study provides a unique opportunity to address key questions about the biological basis of neurocognitive deficits in chronic kidney disease. Understanding these mechanisms could have great public health impact by guiding screening strategies, delivery of health information, and targeted treatment strategies for chronic kidney disease and its related comorbidities.
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Affiliation(s)
- Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Nina Laney
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA.
| | - Ji Young Kim
- Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Rebecca L Ruebner
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - John A Detre
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Hua-Shan Liu
- Graduate Institute of Clinical Medicine and Imaging Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Jimit J Doshi
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Robert T Schultz
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Abbas F Jawad
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Divya G Moodalbail
- Division of Pediatric Nephrology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Allison M Port
- Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jerilynn Radcliffe
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Moore TM, Scott JC, Reise SP, Port AM, Jackson CT, Ruparel K, Savitt AP, Gur RE, Gur RC. Development of an abbreviated form of the Penn Line Orientation Test using large samples and computerized adaptive test simulation. Psychol Assess 2015; 27:955-64. [PMID: 25822834 DOI: 10.1037/pas0000102] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Visuospatial processing is a commonly assessed neurocognitive domain with deficits linked to dysfunction in right posterior regions of the brain. With the growth of large-scale clinical research studies, there is an increased need for efficient and scalable assessments of neurocognition, including visuospatial processing. The purpose of the current study was to use a novel method that combines item response theory (IRT) and computerized adaptive testing (CAT) approaches to create an abbreviated form of the computerized Penn Line Orientation Test (PLOT). The 24-item PLOT was administered to 8,498 youths (aged 8-21 years) as part of the Philadelphia Neurodevelopmental Cohort study and, by Web-based data collection, in an independent sample of 4,593 adults from Great Britain as part of a TV documentary. IRT-based CAT simulations were used to select the best PLOT items for an abbreviated form by performing separate simulations in each group and choosing only items that were selected as useful (i.e., high item discrimination and in the appropriate difficulty range) in at least 1 of the simulations. Fifteen items were chosen for the final, short form of the PLOT, indicating substantial agreement among the models in how they evaluated each item's usefulness. Moreover, this abbreviated version performed comparably to the full version in tests of sensitivity to age and sex effects. This abbreviated version of the PLOT cuts administration time by 50% without detectable loss of information, which points to its feasibility for large-scale clinical and genomic studies.
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Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Steven P Reise
- Department of Psychology, University of California-Los Angeles
| | - Allison M Port
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Chad T Jackson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Adam P Savitt
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Port AM, Stothard J. Thromboprophylaxis and death after total hip replacement. J Bone Joint Surg Br 1997; 79:879-80. [PMID: 9331061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
We compared two conservative methods of treating Weber B1 (Lauge-Hansen supination-eversion 2) isolated fractures of the lateral malleolus in 65 patients. Treatment by immediate weight-bearing and mobilisation resulted in earlier rehabilitation than immobilisation for four weeks in a plaster cast. There was no significant difference in the amount of pain experienced or in the requirement for analgesics and early mobilisation was not associated with any complications. We therefore advocate early mobilisation for these stable ankle fractures.
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Affiliation(s)
- A M Port
- Sunderland District General Hospital, England
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Port AM, McVie JL, Naylor G, Kreibich DN. Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus. J Bone Joint Surg Br 1996; 78:568-72. [PMID: 8682822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared two conservative methods of treating Weber B1 (Lauge-Hansen supination-eversion 2) isolated fractures of the lateral malleolus in 65 patients. Treatment by immediate weight-bearing and mobilisation resulted in earlier rehabilitation than immobilisation for four weeks in a plaster cast. There was no significant difference in the amount of pain experienced or in the requirement for analgesics and early mobilisation was not associated with any complications. We therefore advocate early mobilisation for these stable ankle fractures.
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Affiliation(s)
- A M Port
- Sunderland District General Hospital, England
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