The Memory Assessment Scale: A Population-based Cognitive Impairment Screening Instrument

This study re-examined the Memory Assessment Scale (MAS), a brief memory test developed in Hawai'i in 1987, to assess whether it remains a valid and reliable cognitive impairment screening tool in Hawai'i. Patients suspected of having neurocognitive dysfunction were divided into 2 groups (those with and without mild cognitive impairment) based on their results on a battery of neuropsychological tests. No differences in MAS scores were found between patients with and without mild cognitive impairment. Further research with the MAS comparing patients with mild cognitive disorder to healthy controls is indicated to further examine the efficacy of this population-based test.

Prevalence of invalid ImPACT baseline test results among high school athletes with invalidity and sandbagging indices

Objective: The comparison of baseline neuropsychological test results with post-concussion neuropsychological test results is a common practice to assess the aftermath of a sport-related concussion. The effectiveness of this approach is compromised when invalid baseline test performances occur. The present study was designed to assess the prevalence of invalid baseline test results of high school athletes, using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Method: A large sample of 8938 high school athletes' baseline test data were examined, including the four ImPACT Composite scores and three sets of embedded invalid indices: five ImPACT Invalidity Indicators, four ImPACT sandbagging red flags, and two ImPACT sandbagging subtest flags. Results: There were 8394 (93.91%) Valid scorers, who failed no Invalidity Indicators; 544 (6.09%) Invalid scorers, who failed at least one Invalidity Indicator, 2718 (30.41%) Red Flag scorers, who had at least one Red Flag score; and 4154 (46.47%) Subtest Flag scorers, who had at least one Subtest Flag score. Of the entire sample, 4485 (54.65%) failed at least one of the invalid indices. Conclusions: As in prior studies of high school athletes, the Invalidity Indicators identified a low portion (6.09%) of the athletes with invalid baseline test results, while other invalidity measures found 30.41% to 46.48% of the athletes producing questionable test results. The high rate of invalid test findings suggested in this research calls for greater efforts to improve the accuracy of baseline test results.

Population-based normative data and language effects of the Immediate Post-Concussion Assessmentand Cognitive Testing (ImPACT)

OBJECTIVE

When test results are interpreted based on the norms of the U.S. population, misdiagnoses of neurocognitive impairment could occur with subgroups of individuals whose demographic characteristics differ from the overall population. The present study compared locally-based normative test data of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of high school athletes in Hawaii, where diverse ethnicity and bilingualism are prominent, versus published test norms.

METHOD

8637 high school athletes in Hawaii underwent ImPACT baseline testing. Non-parametric group comparisons of age, sex, and language groups were performed. Classification ranges for the ImPACT Composite scores and Total Symptom of the Hawaii sample were presented in percentile ranks that corresponded to the published ImPACT normative tables.

RESULTS

Mann-Whitney U Test indicated significant differences in ImPACT Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time Composite scores between age groups and sexes, although the effect sizes were small. Kruskal-Wallis H Test indicated no differences among the language groups. Percentile ranks of the Hawaii scores were predominantly similar to the ImPACT norms, except for Visual Motor Speed in the Impaired and Borderline ranges.

CONCLUSION

The findings suggest that locally based normative data should be considered for sub-populations that may differ from the general population. Language factors, such as bilingualism, did not have significant effect on the ImPACT scores.

Sex comparisons in neuropsychological functioning and reported symptoms following a sports-related concussion among high school athletes

The aim of this study was to compare the neuropsychological functioning and symptoms of female and male high school athletes following a single concussion during the school year. The baseline test scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of 309 concussed athletes (169 females, 221 males) in varied sports were obtained. After a sport-related concussion, the athletes were re-administered the ImPACT, on the average, 7.25 days after the injury. MANCOVA compared the ImPACT baseline scores, post-concussion scores, and baseline-to-post-concussion changes of the female and male athletes, with p set at 0.01. The only significant sex comparison found females performing better on baseline visual motor speed (p < 0.001). Otherwise, no sex differences were found in baseline test scores, post-concussion scores, and baseline-to-post-concussion changes. The findings tentatively suggest that there are insignificant sex differences in the consequences of sport-related concussion after a week post-injury. Future studies on sex comparisons after a concussion are needed focusing on the acute and sub-acute phases of the recovery period.

Effects of a Single Concussion During the School Year on the Academic Performance and Neuropsychological Functioning of High School Athletes

There are very few studies examining the effects of sports-related concussion (SRC) on objective measures of school performance, such as grades or test scores. In this research, the grade point averages (GPAs) and scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of athletes who sustained an SRC during the school year were compared with those of athletes who did not have an SRC. Multivariate analysis of variance (MANOVA) revealed a significant linear decline in GPA of both groups across the school year, but indicated no difference in the GPA decline between the concussion and no concussion groups. The GPAs of the concussion and no concussion groups were not significantly different across the school year. Finally, no differences were found between the pre- and post-concussion ImPACT scores of the concussed athletes. This study found that an SRC during the school year did not affect the academic performance or neurocognitive test scores of high school athletes.

Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes?

The aim of this large-scale research was to determine the frequency of valid, invalid, and sandbagging results in ImPACT baseline testing of high school athletes. This retrospective study identified valid, invalid (identified by five embedded Invalidity Indicators), and sandbagging (identified by three "red flags") results in the ImPACT baseline test scores of 6,346 high school athletes. In addition, the ImPACT postconcussion scores of 266 athletes who sustained a concussion during the school year were evaluated to compare the baseline-to-postconcussion changes of valid versus a combined group of invalid and sandbagging scorers. There were 3,299 (51.99%) athletes who had valid baseline scores, 269 (4.24%) had invalid scores, and 3,009 (47.42%) had sandbagging scores. (There were 231 who obtained both invalidity and sandbagging scores.) The overall difference in baseline-to-postconcussion changes between the valid scorers and the combined group of invalid and sandbagging scorers was statistically significant. The high rate of athletes who had invalid and sandbagging scores raised concern that the underperformance of baseline testing occurs more commonly than is probably realized by those who utilize computerized neuropsychological testing with high school athletes. Accordingly, efforts are needed to improve test administration procedures so that maximal attention and effort can be maintained among the test takers. In the meantime, increased caution is called for in employing the baseline-to-postconcussion paradigm when return-to-play decisions are made.

Effects of repetitive subconcussive head trauma on the neuropsychological test performance of high school athletes: A comparison of high, moderate, and low contact sports

The aim of this study was to examine the neuropsychological test results of non-concussed high school athletes playing at three different levels of contact sports. Based on the concussion risk data of 12 different sports, a High Contact group (n=2819; wrestling/martial arts, cheerleading, track and field, football), a Moderate Contact group (n=2323; softball, basketball, soccer), and a Low Contact group (n=1580; baseball, volleyball, water polo, tennis, cross-country) were formed and compared in terms of their scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The results revealed that the High Contact group obtained small but statistically poorer performances in ImPACT Visual Memory, Visual Motor Speed, Impulse Control, and Total Symptom scores compared to the Moderate and Low Contact groups. The High Contact group also had poorer Reaction Time scores compared to the Low Contact group. No differences between the Moderate and Low Contact groups were noted. The findings, along with prior similar results, tentatively raise concerns that participant in high contact sports, exposed to repetitive subconcussive head trauma, may be at greater risk for lowered neuropsychological functioning and increased symptoms, compared to other high school athletes. In view of the preliminary nature of this investigation, more research into the effects of frequent head impacts in high school sports is strongly recommended.

Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position

Objective

This study was designed to determine concussion incidence, risk, and relative risk among middle and high school athletes participating in various sports.

Method

Data were retrospectively obtained from 10,334 athletes of 12 different sports in Hawaii. In addition to determining the overall concussion incidence, comparisons of incidence, risk, and relative risk were made according to age, sex, concussion history, sport, and football position.

Results

The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions.

Conclusions

Older youths, females, those with a history of concussion, and those participating in high contact sports were found to have higher risks of sustaining a concussion. The findings increase awareness of concussion patterns in young athletes and raise concerns regarding protective strategies and concussion management in youth sports.

Computerized neuropsychological test performance of youth football players at different positions: A comparison of high and low contact players

The aim of this study was to examine the effects of head impact frequency on the neuropsychological test results of football players who participate in different positions on the team. Based on the biomechanical measures of head impact frequency reported in high school football, a High Contact group (n = 480) consisting of offensive and defensive linemen was compared with a Low Contact group (n = 640) comprised of receivers and defensive backs. The results revealed that the High Contact group obtained poorer performances on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) on three Composite scores (Verbal Memory, Visual Motor Speed, Impulse Control) and the Total Symptom score compared to the Low Contact group. The present study is the first, to date, to report differences in the neuropsychological test performances of athletes who participate in high and low contact football positions. The findings raise tentative concerns that youth football players exposed to repetitive head trauma, including subconcussive impacts, may be at risk for lowered neuropsychological functioning and increased symptoms.

Are There Subconcussive Neuropsychological Effects in Youth Sports? An Exploratory Study of High- and Low-Contact Sports

This exploratory study was designed to examine the neuropsychological effects of sports-related head trauma-specifically, repetitive subconcussive impacts or head blows that do not result in a diagnosable concussion. The researchers compared the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test scores of 2 groups of nonconcussed youth athletes (n = 282), grouped according to the frequency of concussions in their respective sports, with the assumption that more subconcussive impacts occur in sports in which there are more reported concussions. The results indicated that high-contact-sport (football) athletes had significantly poorer performance in processing speed and reaction time compared with athletes in low-contact sports (wrestling, soccer, baseball, judo, and basketball). This study into the effects of repetitive subconcussive head trauma tentatively raises concern that participation in high-contact sports, even without evidence of a diagnosable concussion, could result in lowered neuropsychological functioning among high school athletes. Limitations of this exploratory research effort are discussed.

Two-year Test-Retest Reliability of ImPACT in High School Athletes

This research evaluated the 2-year test-retest reliability of the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) neuropsychological battery, and clarified the need for biennial updated baseline testing of high school athletes. This study compared the baseline test scores of 212 non-concussed athletes that were obtained in Grade 9 and again 2 years later when they were in Grade 11. Regression-based methods indicated that 4 of the 5 ImPACT scores were stable over 2 years, as they fell within the 80% and 95% confidence intervals (CIs). The results suggested that updating baseline testing for high school athletes after 2 years is not necessary. Further research into the consistency of computerized neuropsychological tests over 2 years with high school athletes is recommended.

Effects of Two Concussions on the Neuropsychological Functioning and Symptom Reporting of High School Athletes

To assess the effects of two sports-related concussions on neuropsychological functioning and symptom reporting, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was administered to 483 high school athletes. Three groups of athletes were determined based on the number of previous concussions: no concussion (n = 409), 1 concussion (n = 58), and 2 concussions (n = 16). The results showed that the three groups did not differ in terms of their ImPACT composite scores (Verbal Memory, Visual Memory, Reaction Time, and Processing Speed) and the Total Symptom Score. As there are only a few studies that have reported the sequelae of 2 concussions in high school athletes, it is premature to declare that a repeated concussion does not have persistent neurocognitive effects on high school athletes.

Neuropsychological test performance of Hawai'i high school athletes: updated Hawai'i immediate post-concussion assessment and cognitive testing data

The present study reviewed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline test scores of 247 high school athletes ages 13 to 18 from a private school in Hawai'i. The aim of the research was to update a prior exploratory investigation conducted in 2008 that compared the test scores of Hawai'i public high school athletes with the normative data provided by the ImPACT publishers. The results of this study provide assurance that the present ImPACT scores of the Hawai'i high school athletes are similar to the general ImPACT norms. The present study is a rare effort to compare the ImPACT scores of high school athletes from an ethnically diverse region with the ImPACT norms. The findings offer further support for the use of the ImPACT norms when evaluating high school athletes from Hawai'i. Future research in various regions of the United States and with other sociocultural backgrounds is encouraged.

Comparison of Four MMPI-2 Validity Scales in Identifying Invalid Neurocognitive Dysfunction in Traumatic Brain Injury Litigants

Four Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scales, the F Scale, Symptom Validity Scale (FBS), Henry-Heilbronner Index (HHI), and Response Bias Scale (RBS), were evaluated in 60 personal injury litigants who sustained a traumatic brain injury (TBI). Based on a modified Slick, Sherman, and Iverson ( 1999 ) diagnostic criteria for malingered neurocognitive dysfunction and utilizing test-effort measures embedded in standard neuropsychological testing, a group of 23 patients with probable invalid neurocognitive dysfunction (PI) and a comparable group of 37 patients with noninvalid neurocognitive dysfunction were identified and compared with respect to their MMPI-2 validity scale scores. Logistic regression analyses, receiver-operating characteristic curve and area under the curve analyses, as well as sensitivity, specificity, positive predictive value, and negative predictive value analyses all revealed that RBS performed better than F, FBS, and HHI in classifying PIs. The present results add to a number of recent studies that suggest that RBS is a useful predictor of symptom validity failure and probable neuropsychological malingering among litigating TBI patients. The study also encourages further research employing embedded test-effort measures in classifying invalid neurocognitive dysfunction per the Slick et al. diagnostic criteria.

Sex differences in the long-term neuropsychological outcome of mild traumatic brain injury

PRIMARY OBJECTIVE

To investigate possible sex differences in neuropsychological functioning among patients following mild traumatic brain injury (TBI).

METHODS AND PROCEDURES

Retrospective records analysis of the neuropsychological test results of 102 participants with head injury, including 62 males and 40 females.

MAIN OUTCOME AND RESULTS

A multivariate analysis of variance indicated that females and males performed similarly on neuropsychological tests, on average, approximately 2 years after minor head trauma. A sex-by-age interaction effect was found on the Category and Trail Making A Tests, with a pattern similar to those obtained in a previous research.

CONCLUSIONS

Although past research has found that females develop more TBI-related neuropsychological deficits than males in the immediate post-injury period, the present study found that, overall, sex differences in the performance of patients with mild TBI on a variety of neuropsychological tests were insignificant. More investigation into the sex-by-age interaction effect appears warranted.

Comparison of MMPI-2 validity scales among compensation-seeking Caucasian and Asian American medical patients

Validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) are widely used for the detection of exaggerated psychological complaints, although little is known about the results of these scales with racial or ethnic minority individuals. Five validity scales derived from the MMPI-2, including the F Scale, the Back Infrequency Scale, the Symptom Validity Scale, the Infrequency-Psychopathology Scale, and the Dissimulation Scale-MMPI-2, were evaluated in 157 medical patients-109 Caucasian Americans and 48 Asian Americans. All patients were involved in personal injury litigation or seeking compensation for alleged psychological conditions. Analyses of variance (ANOVAs) conducted on the five validity scales revealed no significant group effects for race. The results were consistent with the limited available data on the MMPI-2 validity scales with minority group samples. Further research with other racial minorities, including relevant extra-test criteria for malingering, is encouraged.

Neuropsychological test performance of Hawai'i high school athletes: Hawai'i ImPACT normative data

OBJECTIVE

Establishing normative data of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance of high school athletes in Hawai'i.

STUDY DESIGN

Pre-season ImPACT testing was performed on 751 participants in football, baseball, basketball, soccer, volleyball, softball, and track from 4 Oahu public high schools. The ImPACT composite scores included measures of Verbal Memory, Visual Memory Processing Speed, and Reaction Time. The descriptive statistical data collected were the group means, standard deviations, standard errors of measurement, distribution of scores and percentile ranks of (1) 262 boys ages 13 to 15; (2) 297 boys ages 16 to 18; and (3) 192 girls ages 13 to 18.

RESULTS

The means and standard deviations of the 4 ImPACT composite scores for the 751 student-athletes in Hawai'i were similar to the ImPACT scores obtained from a master database of ImPACT test results. Although differences between the Hawai'i and mainland data were nonsignificant, there appeared to be a trend revealing somewhat lower scores in the Hawai'i sample of athletes.

DISCUSSION

The similarity in ImPACT test performance of Hawai'i high school athletes as compared to the mainland normative data provides support for the applicability of this computerized neuropsychological battery in Hawai'i. However in view of a trend reflecting slightly lower ImPACT scores among Hawai'i participants, the use of the normative data produced by this study may be desirable in assessing Hawai'i high school athletes.

Depression, anxiety and neuropsychological test scores of candidates for coronary artery bypass graft surgery

The effect of depression and anxiety upon neuropsychological test scores of candidates for coronary artery bypass graft (CABG) surgery was examined. Sixty patients were administered the Beck Depression Inventory II and the State-Trait Anxiety Inventory, along with a battery of neuropsychological tests. Regression analyses were conducted in which the neuropsychological test scores were predicted using age, education, depression, anxiety, and combined depression-anxiety scores. While age and education were significant predictors of several neuropsychological test measures, no significant regression analysis results were obtained for the depression, anxiety and combined depression-anxiety scores. Similarities and discrepancies between this research and previous studies are discussed. It appears that low levels of preoperative depression and anxiety states do not affect neuropsychological functioning among CABG candidates.

MMPI-2 scores in the outcome prediction of gastric bypass surgery

BACKGROUND

A psychological assessment is critical for morbidly obese patients seeking Roux-en-Y gastric bypass (RYGBP) surgery. The Minnesota Multiphasic Personality Inventory (MMPI) has been widely used in past psychological studies of bariatric surgery patients, but, to date, there is no published research on the more recent version of the MMPI, the Minnesota Multiphasic Personality Inventory-2 (MMPI2), and its relation to RYGBP outcome. This investigation was designed to evaluate the predictive validity of the MMPI-2 with respect to outcome of RYGBP for morbid obesity.

METHODS

The research involved a retrospective analysis of MMPI-2 scores of 2 groups of patients 1 year following RYGBP: 1). those who lost >or= 50% of their excess weight and 2). those who lost <50% of their excess weight. Subjects were 52 morbidly obese patients (mean age 44 years, mean BMI 56 kg/m2). The measurement of psychological variables consisted of the MMPI-2 scores of 3 validity scales, 10 clinical scales, and 3 Content Scales, and BMI.

RESULTS

Those who lost <50% excess weight scored significantly higher than those who lost >50% excess weight on the F,Hysteria, Paranoia, and Health Concerns scales of the MMPI-2, and significantly lower on the Masculinity-femininity scale. Stepwise regression analysis found that a combination of the Health Concerns and Masculinity-femininity scales was the most accurate predictor model for 1-year post-surgery weight loss.

CONCLUSION

A standard personality measure, the MMPI-2, appears to be associated with weight loss outcome 1 year after RYGBP. Psychological traits such as anxiety and excessive health concerns are likely to influence bariatric surgical outcome.

MMPI-2 scores of patients with insomnia

Although the MMPI-2 has been employed since 1989, to date no study has been reported on its use with patients with insomnia. The MMPI-2 was administered to 104 insomnia patients. The T scores of all the MMPI-2 scales fell below the cut-off score of T = 65. Although the group profile was within the normal range, the percentages of patients who had MMPI-2 scores above T = 65 for each scale indicated that a substantial portion of the insomnia patients obtained elevated scores, particularly in the Hs, D, Hy, and Pt scales. Thus, the results suggest that many of the insomnia patients exhibit psychological distress and would benefit from brief psychological interventions, such as sleep hygiene education and relaxation training. In view of the large number of insomnia patients who obtained abnormal MMPI-2 scores, a psychological measure such as the MMPI-2 remains an important assessment tool in identifying insomnia patients who may need extensive psychotherapeutic intervention.

Benefits of off-pump bypass on neurologic and clinical morbidity: a prospective randomized trial

BACKGROUND

Neurologic and clinical morbidity after coronary artery bypass grafting (CABG) can be significant. By avoiding cardiopulmonary bypass, off-pump CABG (OPCAB) may reduce morbidity.

METHODS

Sixty patients (30 CABG and 30 OPCAB) were prospectively randomized. Neurocognitive testing was performed before the operation and 2 weeks and 1 year after the operation. Neurologic testing to detect stroke and (99m)Tc-HMPAO whole-brain single photon emission computed tomography scanning to assess cerebral perfusion were performed before the operation and 3 days afterward. Bilateral middle cerebral artery transcranial Doppler scanning was performed intraoperatively to detect cerebral microemboli. All examiners were blinded to treatment group. Clinical morbidity and costs were compared.

RESULTS

Coronary artery bypass grafting was associated with more cerebral microemboli (575 +/- 278.5 CABG versus 16.0 +/- 19.5 OPCAB (median +/- semiinterquartile range) and significantly reduced cerebral perfusion after the operation to the bilateral occipital, cerebellar, precunei, thalami, and left temporal lobes (p < or = 0.01). Cerebral perfusion with OPCAB was unchanged. Compared with base line, OPCAB patients performed better on the Rey Auditory Verbal Learning Test (total and recognition scores) at both 2 weeks and at 1 year (p < or = 0.05), whereas CABG performance was statistically unchanged for all cognitive measures. Patients who underwent CABG had more chest tube drainage (1389 +/- 1256 mL CABG versus 789 +/- 586 mL OPCAB, p = 0.02) and required more blood (3.9 +/- 5.8 U CABG versus 1.2 +/- 2.2 U OPCAB, p = 0.02), fresh frozen plasma (3.0 +/- 6.0 U CABG versus 0.5 +/- 2.2 U OPCAB, p = 0.03), and hours of postoperative use of dopamine (16.3 +/- 21.2 hours CABG versus 7.3 +/- 9.7 hours OPCAB, p = 0.04). These differences culminated in higher costs for CABG ($23,053 +/- $5,320 CABG versus $17,780 +/- $4,390 OPCAB, p < 0.0001). One stroke occurred with CABG, compared with none with OPCAB (p = NS). One OPCAB patient died because of a pulmonary embolus (p = NS).

CONCLUSIONS

Compared with CABG, OPCAB may reduce neurologic and clinical morbidity as well as cost.

Comparison of the Fake Bad Scale and other MMPI-2 validity scales with personal injury litigants

Five MMPI-2 validity scales were evaluated with 120 personal injury litigation patients (LP) and 208 clinical patients (CP) along with 43 normal participants (NP). The validity measures included the Fake Bad Scale (FBS), Infrequency scale (F), Back Infrequency scale (Fb), Infrequency-Psychopathology scale (F[p]), and the Dissimulation scale-2 (Ds2). Results showed that only the FBS significantly differentiated the LP and CP, whereas the LP and CP scored significantly higher than the NP on FBS, F, Fb, and Ds2. The content of the FBS, with several items from the Hypochondriasis (Hs) and Hysteria (Hy) Scales, appears to enhance the FBS' ability to detect the somatic overreporting often observed with personal injury claimants. The authors suggest that the FBS may be a useful index of symptom magnification when employed within a comprehensive assessment of malingering in personal injury plaintiffs.

Effects of headaches during neuropsychological testing of mild head injury patients

The Luria-Nebraska Neuropsychological Battery (LNNB) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 37 mild head injury patients, whose headache activity was rated at the time of testing. A one-way analysis of variance (ANOVA) compared each of the 11 LNNB scores of patients with severe headache, mild headache, and no headache. The results revealed no significant differences on varied neuropsychological tests between the three headache groups. Similar analyses of the 13 MMPI scores also indicated no significant differences between the three headache groups across various psychoemotional measures. The results are consistent with previous research and suggest that headaches do not affect the performance of mild head injury patients on varied neuropsychological tests requiring concentration and immediate memory, but because of the small number of patients in this study the findings should be considered tentative.

Short form of the WPPSI and WPPSI-R

A short form of the WPPSI, which consisted of the Block Design, Vocabulary, Arithmetic, and Comprehension subtests, was administered to 426 applicants to kindergarten at a private school. The following year a short form WPPSI-R, which consisted of the same subtests, was administered to 372 applicants to kindergarten at the same school. The FSIQs and subtest scores of the two short forms were nearly identical. The findings varied from the results of previous studies that found the complete WPPSI FSIQ to be 6 to 8 points higher than the WPPSI-R FSIQ. Limitations of the present study and of short form Wechsler IQs are discussed.

Relation between headaches and neuropsychological functioning among head injury patients

The Luria-Nebraska Neuropsychological Battery (LNNB) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 184 head injury patients with varying degrees of headache activity. A multiple regression analysis, controlling for neurological status, compared the 11 LNNB scores of patients with Daily Headaches, Frequent Headaches, Infrequent Headaches, and No Headaches and found that the Arithmetic Scale was the only significant predictor, with the Daily Headache patients performing more poorly than the Infrequent Headache patients. A similar analysis of the 13 MMPI scores indicated that the K, Hs, and Pt Scales were significant predictors. However, post hoc Tukey tests revealed that K and Pt scores did not vary significantly among the four headache groups and only showed that Daily Headaches and Frequent Headaches patients had significantly higher Hs scores than the No headaches group. Subsequent comparisons of patients with and without headaches at the time of testing revealed no differences between the two groups on the LNNB and MMPI, after controlling for age, duration of symptoms, and neurological status. Overall, the results suggested that the relation between headache symptoms and neuropsychological functioning was insignificant.

Predictive validity of two short-forms of the WPPSI: a 3-year follow-up study

An equally weighted WPPSI short-form (Comprehension, Arithmetic, Block Design, and Picture Completion) was administered to 64 prekindergarten children, while a verbally weighted WPPSI short-form (Comprehension, Arithmetic, Block Design, and Vocabulary) was administered to 63 prekindergarten children. All subjects subsequently were administered school achievement tests at the end of the first- and second-grade years. Low, but significant correlations between the FSIQ and achievement test scores were obtained; the Arithmetic and Block Design subtests were the best subtest predictors of school achievement in grades one and two. The predictive validities of the two WPPSI short-forms were found to be essentially equivalent.

Characteristics of treatment drop-outs among two samples of chronic headache patients

To examine the psychological characteristics of those who terminate treatment for headaches prematurely, this investigation employed 179 posttraumatic headache patients and 67 nontrauma headache patients who underwent electromyographic (EMG) biofeedback therapy. Dependent variables included the patient's age, socioeconomic status, duration of headache, forehead EMG levels, and MMPI. Multivariate analyses of variance revealed no significant differences between the drop-outs and non-drop-outs among the trauma headache patients, but three MMPI scales (Psychopathic-Deviate, Paranoia, and Mania) were significantly higher among the nontrauma headache patients who dropped out of treatment. These data imply that different characteristics underlie the drop-out behavior for different pain conditions and that efforts to uncover a single drop-out pattern may not be realistic.

Effects of a no-smoking policy upon medical center employees

Although the relationship between smoking and its harmful effects on health has been long known to the medical profession, relatively few medical institutions have taken serious measures to control smoking within their premises. This study focused on the effects of a smoking ban at a large private medical center, specifically its impact on smoking attitudes and behavior of the employees. A questionnaire was administered to more than 800 (over 50%) of the medical center employees before and after the implementation of a total ban on smoking on the worksite. The results revealed, after 1 year of the no-smoking policy, an increased acceptance of the smoking ban at work and a greater willingness to consider smoking cessation in the future. An important trend was noted in the decreased number of cigarettes smoked per day among the employees.

Current psychological treatments for stress-related skin disorders

Notable changes have been observed in the application of psychological therapies to medicine, including psychodermatology. This review article surveys current methods used by psychologists in the management of stress-related skin disorders, including hypnosis, relaxation training, biofeedback, operant conditioning, and cognitive-behavioral therapy. These techniques offer promise in the treatment of certain dermatologic conditions, but the limited amount of well-controlled and replicated studies of their use suggests that caution be taken in their application.

Sex differences in dichotic listening among Asian Americans

Dichotic-listening tests were conducted with 23 male and 23 female Asian-American college students. The mean correct responses for the men were right ear 54.7 and left ear 48.7, whereas the mean correct for the women were for the right ear 53.4 and the left ear 54.8. Among the men 60.9% did better with the right ear than with the left, while 43.5% of the women showed a right-ear superiority. The male-female differences, however, did not reach statistical significance. Clearly, larger samples are needed.

A comparison of the Halstead-Reitan Neuropsychological Battery and computerized tomography in the identification of brain disorder

An attempt was made to compare the diagnostic conclusions of the Halstead-Reitan battery with the diagnosis of the computerized tomography (CT) scanner), which has recently created profound changes in neuroradiological practice. Subjects were 45 patients whose neurological diagnosis was used as a criterion for CT, EEG, and three Halstead-Reitan diagnostic statements (Halstead Impairment Index, Rennick Average Impairment Rating, and clinical interpretation). Results indicated no false positive errors with the CT and the highest overall accuracy rate with a clinical interpretation of the Halstead-Reitan tests. The complementary roles of these varied neurodiagnostic methods, which provide different kinds of pertinent neurological information, are stressed.

MMPI results of male candidates for transsexual surgery

The MMPI was administered to a group of 27 male transsexual candidates for sex change surgery, and their test results were compared with those of 24 male kidney transplant surgical candidates and 26 males suspected of having a psychophysiological disorder. The data revealed a notable absence of psychopathology among the transsexuals as well as the kidney patients, while the psychophysiological patients showed the expected elevations in the Hypochondriasis, Depression, and Hysteria scales. The results were in keeping with previous research of male-to-female sex change candidates that reject the notion that transsexuals invariably suffer major emotional disturbance.

Clinical limitations of the Low Back Scale

Administered the Low Back (Lb) Scale, a special derivative of the MMPI, to 20 patients with functional low back pain and 20 patients with verifiable organic evidence for their low back complaints. The Social Desirability Scale also was administered in order to assess the test-taking attitudes of the patients. The two groups of patients were equated in terms of age and sex. The results revealed no significant differences between the functional and organic patients in scores on the Lb Scale and on the Social Desirability Scale. The findings, which were consistent with other recent studies of the Lb Scale, strongly suggested that the clinical usefulness of this scale is highly questionable.

The use of the low back and the dorsal scales in the identification of functional low back patients

Scores from the Low Back (Lb) and the Dorsal (DOR) scales of 20 patients with functional low back pain, 20 patients with functional gastrointestinal pain, and 20 psychoneurotic patients were compared. Among the various proposed cut-off scores, the Lb score of 11 yielded the highest rate (75%) of correct identification of Low Back patients and a hit rate similar to those reported in previous studies. However, it was noted that this 75% hit rate did not achieve statistical significance. Furthermore, the data indicated that neither the Lb nor the DOR scales could differentiate the Low Back patients from other psychosomatic and psychiatric patients and suggested that these two scales should be used with extreme caution by clinicians.