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Suchy Y, Simpson A, Mora MG, DesRuisseaux LA, Brothers SL, Mullen CM. Test of Practical Judgment (TOP-J): Construct, Criterion, and Incremental Validity in a Community Sample of Older Adults. Arch Clin Neuropsychol 2024; 39:355-366. [PMID: 38097261 DOI: 10.1093/arclin/acad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/01/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE The Test of Practical Judgment (TOP-J) is a stand-alone judgment measure that is considered to tap into aspects of executive functioning (EF) and inform clinical predictions of daily functioning in older adults. Past validation research is variable and has some limitations. The present study sought to examine the reliability and construct, criterion, and incremental validities of scores on TOP-J 9-item version (TOP-J/9). METHOD Participants were 95 community-dwelling older adults aged 60 to 85. Participants completed TOP-J/9, measures of EF and global cognition, and three different modalities of instrumental activities of daily living (IADLs) (self-report, performance-based tasks conducted in the laboratory, and performance-based tasks completed at home over 3 weeks). RESULTS TOP-J/9 scores showed adequate internal consistency (α = 0.73) after correcting for the low number of items. TOP-J/9 was correlated with global cognition and EF, although EF did not survive correction for lower-order processes. Finally, although TOP-J/9 scores were associated with home-based IADL tasks (but not with self-report and laboratory-based IADLs), providing some evidence of criterion validity, they did not incrementally contribute to home-based IADL performance beyond other cognitive measures. However, when two items pertaining to social/ethical judgment were removed, this modified version of TOP-J did relate to EF beyond lower-order processes and contributed uniquely to prediction of home-based IADLs beyond other measures. CONCLUSION Results suggest that TOP-J/9 taps into global cognitive status (but not necessarily EF) and predicts "real-world" functioning (but not above and beyond other cognitive measures). TOP-J psychometrics may be improved by removing two social/ethical items.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Austin Simpson
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Christine M Mullen
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Suchy Y, Mullen CM, Brothers S, Niermeyer MA. Interpreting executive and lower-order error scores on the timed subtests of the Delis-Kaplan Executive Function System (D-KEFS) battery: Error analysis across the adult lifespan. J Clin Exp Neuropsychol 2020; 42:982-997. [PMID: 33267731 DOI: 10.1080/13803395.2020.1832203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Delis-Kaplan Executive Function System (D-KEFS) is a battery of tests designed to measure executive functions (EF). Additionally, the D-KEFS contains lower-order tasks, designed to control for speed of visual scanning, sequencing, and verbal and graphomotor output. The construct and criterion validities of D-KEFS scores that are time-based are well established. However, the constructs measured by the D-KEFS error scores are poorly understood, making clinical interpretations of such scores difficult. This study examined the construct validity of D-KEFS errors committed on EF tasks and tasks designed to measure lower-order processes (i.e., non-EF tasks), across the adult lifespan. METHOD Participants were 427 adults (18-93 years) who completed the timed subtests of the D-KEFS. Four hundred two participants also completed the Push-Turn-Taptap (PTT; a separate measure of EF) to allow cross-validation. RESULTS General linear regressions showed that D-KEFS errors committed on the EF tests were associated with EF timed performance (assessed using the D-KEFS time-based scores and the PTT), but only among older adults. Importantly, errors committed on the D-KEFS tasks of lower-order processes were also associated with D-KEFS time-based EF performance, and this relationship held across the adult lifespan. CONCLUSIONS These findings suggest that among older adults EF errors on the D-KEFS can be interpreted as indices of EF, but such interpretations are not automatically warranted for younger adults. Additionally, errors committed on non-EF tasks contained within the D-KEFS battery can be interpreted as reflecting EF weaknesses across the adult lifespan.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Christine M Mullen
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
| | - Stacey Brothers
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Madison A Niermeyer
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
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Suchy Y, Brothers S, Mullen CM, Niermeyer MA. Chronic versus recent expressive suppression burdens are differentially associated with cognitive performance among older adults. J Clin Exp Neuropsychol 2020; 42:834-848. [PMID: 32951515 DOI: 10.1080/13803395.2020.1817862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Expressive suppression (ES; suppression of affective behavior) has been shown to have a deleterious impact on subsequently administered tests of executive functions (EF), threatening validity, and reliability of EF assessment. Past research has shown that recent ES (i.e., across 24 hours prior to testing) and chronic ES (i.e., across 2 weeks prior to testing) have differential impact on test performance. The present study compared the association of chronic vs. recent ES with speed vs. accuracy of performance on tests of EF and tests of lower-order processes. METHOD Participants were 255 community-dwelling older adults aged 60 and older. Participants completed timed subtests of the Delis-Kaplan Executive Function System and the Burden of State Emotion Regulation Questionnaire. RESULTS Hierarchical linear regressions examined the contributions of chronic vs. recent ES to test performance. Recent ES was related to scores of both speed and accuracy on EF tests. The association between recent ES and EF errors held beyond covariates (i.e., chronic ES, demographics, depression, and general cognitive status). In contrast, the association between recent ES and EF speed was fully explained by EF error scores. Chronic ES was associated only with speed of performance and only on lower-order tasks, but this relationship did not survive correction for cognitive, psychiatric, and demographic factors. CONCLUSIONS Recent ES appears to be a risk factor for EF lapses. Chronic ES, while related to performance speed, seems to also relate to several other cognitive, psychiatric, and demographic factors, which themselves explain slower information processing.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah , Salt Lake City, UT, USA
| | - Stacey Brothers
- Department of Psychology, University of Utah , Salt Lake City, UT, USA
| | - Christine M Mullen
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, UT, USA
| | - Madison A Niermeyer
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, UT, USA
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Rolin SN, Mullen CM, Vaccariello E, Davis JJ. Examining the Cognitive Proficiency Index in rehabilitation patients. Appl Neuropsychol Adult 2019; 28:573-582. [PMID: 31530025 DOI: 10.1080/23279095.2019.1666269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Cognitive Proficiency Index (CPI) in relation to other WAIS-IV indices, overall test battery mean (OTBM), and impairment (IMP) in an outpatient rehabilitation setting. Participants (N = 329) were 35% female and 88% Caucasian with average age and education of 42.9 (SD = 13.5) and 13.6 (SD = 2.4) years, respectively. Participants were grouped by diagnosis and validity: traumatic brain injury (TBI; n = 176; 39% mild), cerebrovascular accident (CVA; n = 52), other neurologic and psychiatric conditions (OTH; n = 49), and questionable performance validity (QPV; n = 52). OTBM was calculated from non-WAIS-IV tests; IMP was dichotomously defined as four or more non-WAIS-IV scores below cutoff (≤35 T). Significant group differences were observed on CPI, WAIS-IV indices, OTBM, and IMP. CPI significantly contributed (β = .51) to a linear regression model predicting OTBM (R2 = .63) with education and GAI as covariates. A logistic regression model with IMP as the outcome and education, GAI, and CPI as predictors correctly classified 80% of cases with area under the curve of .86. A previously identified cutoff (CPI < 84) correctly classified 65-78% of clinical groups categorized by IMP. A novel cutoff (CPI ≤ 80) differentiated clinical participants with history of mild TBI from the QPV group with sensitivity of 44.2% and specificity of 89.7%. CPI showed incremental validity in predicting OTBM and IMP and warrants further study as a useful clinical addition to other WAIS-IV indices.
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Affiliation(s)
- Summer N Rolin
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christine M Mullen
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Jeremy J Davis
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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Abstract
OBJECTIVES Deficits in working memory (WM) are associated with age-related decline. We report findings from a clinical trial that examined the effectiveness of Cogmed, a computerized program that trains WM. We compare this program to a Sham condition in older adults with Mild Cognitive Impairment (MCI). METHODS Older adults (N = 68) living in the community were assessed. Participants reported memory impairment and met criteria for MCI, either by poor delayed memory or poor performance in other cognitive areas. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Delayed Memory Index) and the Clinical Dementia Rating scale (CDR) were utilized. All presented with normal Mini Mental State Exams (MMSE) and activities of daily living (ADLs). Participants were randomized to Cogmed or a Sham computer program. Twenty-five sessions were completed over five to seven weeks. Pre, post, and follow-up measures included a battery of cognitive measures (three WM tests), a subjective memory scale, and a functional measure. RESULTS Both intervention groups improved over time. Cogmed significantly outperformed Sham on Span Board and exceeded in subjective memory reports at follow-up as assessed by the Cognitive Failures Questionnaire (CFQ). The Cogmed group demonstrated better performance on the Functional Activities Questionnaire (FAQ), a measure of adjustment and far transfer, at follow-up. Both groups, especially Cogmed, enjoyed the intervention. CONCLUSIONS Results suggest that WM was enhanced in both groups of older adults with MCI. Cogmed was better on one core WM measure and had higher ratings of satisfaction. The Sham condition declined on adjustment.
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Affiliation(s)
- Lee Hyer
- a Georgia Neurosurgical Institute , Macon , Georgia , USA.,b Mercer University , School of Medicine , Macon , Georgia , USA.,c Medical Center of Central Georgia , Macon , Georgia , USA
| | - Ciera Scott
- a Georgia Neurosurgical Institute , Macon , Georgia , USA
| | | | - Christine M Mullen
- a Georgia Neurosurgical Institute , Macon , Georgia , USA.,b Mercer University , School of Medicine , Macon , Georgia , USA
| | - Anna Lee
- a Georgia Neurosurgical Institute , Macon , Georgia , USA.,b Mercer University , School of Medicine , Macon , Georgia , USA
| | - Aaron Johnson
- b Mercer University , School of Medicine , Macon , Georgia , USA.,c Medical Center of Central Georgia , Macon , Georgia , USA
| | - Laura C Mckenzie
- a Georgia Neurosurgical Institute , Macon , Georgia , USA.,b Mercer University , School of Medicine , Macon , Georgia , USA
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Hyer L, Scott C, Mullen CM, McKenzie LC, Robinson JS. Randomized double-blind placebo trial of duloxetine in perioperative spine patients. J Opioid Manag 2015; 11:147-55. [PMID: 25901480 DOI: 10.5055/jom.2015.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study describes a single-site investigation on the effects of a randomized double-blind placebo trial targeting duloxetine added to opioid use (duloxetine + opioid) against a comparator (placebo + opioid) in spine surgery patients, independent of major depression. DESIGN The double-blind comparator study assessed two groups on opioids: one using duloxetine and the other a placebo. Subjects were administered the respective medication 2 weeks prior to surgery and continued on this for more than 3 months. Subjects were assessed at three times: prior to surgery, 4 weeks postsurgery, and 12 weeks postsurgery. They completed a battery of tests assessing for pain, adjustment, and psychiatric problems. SETTING Neurosurgical outpatient and inpatient setting. PATIENTS Sixty-eight patients completed the study. They received one of three types of elective spine surgery. INTERVENTIONS Subjects were given duloxetine or placebo 2 weeks prior to surgery and continued with the regimen for more than 3 months. OUTCOMES The primary focus was pain and second on adjustment factors and psychiatric symptoms: depression and anxiety. The amount of opioid use presurgery and postsurgery was also evaluated. RESULTS There were differences among the groups on Brief Pain Inventory (BPI)-Average, the core pain marker, and BPI-Sleep. Within-subject analyses showed that duloxetine subjects improved significantly from baseline. For function, post-CIBIC and post-Functional Adjustment Questionnaire were significant, favoring duloxetine. Reduction of opioid use was not a factor; both groups' utilization declined. For affect, both groups were significantly improved over time. CONCLUSIONS Duloxetine seems to improve pain, assist with maintaining function, and reduce intensity of affect.
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Affiliation(s)
- Lee Hyer
- Georgia Neurosurgical Institute, Macon, Georgia; Clinical Medical Psychology, Mercer University School of Medicine, Macon, Georgia
| | - Ciera Scott
- Georgia Neurosurgical Institute, Macon, Georgia; Clinical Mental Health Counseling, Mercer University, Macon, Georgia
| | - Christine M Mullen
- Georgia Neurosurgical Institute, Macon, Georgia; Clinical Medical Psychology, Mercer University School of Medicine, Macon, Georgia
| | - Laura C McKenzie
- Georgia Neurosurgical Institute, Macon, Georgia; Clinical Medical Psychology, Mercer University School of Medicine, Macon, Georgia
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Mullen CM, Fouty HE. Comparison of the WRAT4 Reading Subtest and the WTAR for Estimating Premorbid Ability Level. Applied Neuropsychology: Adult 2013; 21:69-72. [DOI: 10.1080/09084282.2012.727111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Christine M. Mullen
- a Department of Psychology , University of Central Florida , Daytona Beach , Florida
| | - H. Edward Fouty
- a Department of Psychology , University of Central Florida , Daytona Beach , Florida
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Abstract
The Cognistat is a widely used screening instrument for the assessment of higher cerebral functioning. This study investigated the effects of gender and age on a specific item from the metric sequence of the Cognistat Judgment subtest. Participants consisted of 110 cognitively intact volunteers (45 males, 65 females). Results showed that females responded with 1-point answers, as defined by the manual, significantly more often than those who responded with a manual-defined 2-point response. Males responded with a 2-point answer with a significantly greater frequency than they responded with 1-point responses. The data indicate that a gender correction for females should be made to the Judgment subtest of the Cognistat.
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Affiliation(s)
- H Edward Fouty
- Department of Psychology, University of Central Florida, Daytona Beach, FL 32120-2811, USA.
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