Assessment of executive function in patients with mild traumatic brain injury

BACKGROUND: The nature of functional deficit after mild traumatic brain injury (TBI) defined by Glasgow Coma Score of 13-15 is not fully described. This study explored the sensitivity of several neuropsychological tests to identify sequelae of mild traumatic brain injury (TBI). METHODS: Eleven adult patients with mild TBI admitted to a Level 1 trauma center were studied. The battery of tests included the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Trails A and B, the Boston Naming Test, The Multilingual Aphasia Examination: Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Task. RESULTS: Control subjects performed significantly better than patients with mild TBI on Trails A and B, the Controlled Oral Word Association Test, and Paced Auditory Serial Addition Task (subtests 2-4). No significant differences in performances between patients and controls was found for the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Boston Naming Test, and Paced Auditory Serial Addition Task Subtest 1. CONCLUSION: The results suggest that tests of specific frontal lobe executive functions are valuable in diagnosing and monitoring recovery from mild TBI.     

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity

Neuropsychological assessment of older individuals with dementing illnesses has suffered from a lack of appropriately designed test instruments. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed for the dual purposes of identifying and characterizing abnormal cognitive decline in the older adult and as a neuropsychological screening battery for younger patients. The entire battery takes less than 30 minutes to administer, and yields scaled scores for five cognitive domains. The current study reports preliminary clinical validity results with the RBANS, comparing very mildly demented patients with a diagnosis of probable Alzheimer's disease (n = 20) to patients with Huntington's disease (n = 20) and normal controls (n = 40). Although the patient groups had essentially identical total scores on the RBANS, they exhibited opposite profiles, differing significantly on four of the five subsections. The AD patients performed most poorly on Language, and Delayed Memory subsections, while the HD patients obtained their lowest scaled scores on the Attention and the Visuospatial/Constructional subsections. These results are consistent with the neuropsychological profiles of these dementing disorders derived from lengthier standardized tests and experimental investigations. In addition, even those patients who performed above the suggested cut-off points on the MMSE and the Dementia Rating Scale scored significantly below their controls on the RBANS. These data suggest that the RBANS is effective at both detecting and characterizing dementia of different etiologies.     

The reliability of lactate measurements during exercise

The study of the epidemiology of dementia, specifically Alzheimer's disease, in developing countries requires specialized instruments and personnel. Cultural and sub-cultural differences among populations are highly relevant to the design of such instruments. Over and above the cultural issues, it is widely recognized that low education and illiteracy pose considerable challenges to reliable and valid cognitive screening. The overall objectives of the Indo-US Cross-National Dementia Epidemiology Study were: a) to determine the prevalence and incidence of, and risk factors for, Alzheimer's and other dementias in a defined Indian community; and b) to compare these results with those found in a defined American community. To achieve these epidemiological objectives, our first task was to develop, systematically and empirically, suitable cognitive and activities assessment screening instruments for use in India, which would 1) be culturally fair, psychometrically sound, and valid for a population with little or no education; 2) be optimally sensitive and specific for dementia; and 3) allow not only the identification but also the more detailed characterization of dementia, and of normal and abnormal cognitive aging. In this paper we address the practical issues involved in the development and administration of the modified cognitive screening battery in our rural Indian context.     

The functional status of arrhythmia patients in the late period after the radical correction of tetralogy of Fallot

OBJECTIVE: To assess the cognitive performance of elderly patients referred to the memory clinic. DESIGN: The patients were interviewed using the computerised mental state programme, GMS-AGECAT, and assessed on the Cognitive Assessment Scale (CAS) which includes the Elderly Cognitive Assessment Questionnaire (ECAQ) and the Cambridge Memory Test (CMT), modified for Chinese elderly. SUBJECTS: There were 72 Chinese elderly subjects aged 65 years and above, referred to the NUH Memory Clinic in the first year. RESULTS: Only 45 (62.5%) of the 72 subjects were diagnosed to have dementia using DSM III R criteria. There were 25 cases of Alzheimer's Disease and 20 multi-infarct dementia. In the non-demented group, 15 (20.8%) had depression or anxiety disorders and 12 (16.7%), had no mental disorders but had physical illness which could affect memory. There was a highly significant difference in the ECAQ, CMT and CAS scores of demented and non-demented elderly. There was also a significant difference in the cognitive performance of elderly with mild dementia and those with no mental disorder. CONCLUSION: The memory clinic is a useful facility for the diagnosis and management of dementia. The Cognitive Assessment Scale provides a valid and reliable battery of tests for dementia.     

External validation of the cognitive triad of the Personality Inventory for Children: Cautions on interpretation.

This research assessed the validity of the Personality Inventory for Children (PIC) using the Wechsler Intelligence Scale for Children—Revised (WISC—R) and the Wide Range Achievement Test (WRAT) as criterion instruments. The cognitive triad of the PIC was minimally correlated with all IQ measures, which does not support the use of the PIC for predicting intellectual ability. In general, significant correlations for the Reading and Spelling scales, but not for the Arithmetic scale, were found between the WRAT and the PIC cognitive triad. Differential validity for the Intellectual Screening and Achievement scales of the PIC was not substantiated, nor was a previously found relation between the WISC—R Freedom From Distractibility factor and the PIC Somatic Concern scale. The validity of the PIC for academic or intellectual screening is questionable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal examination of American National Adult Reading Test (AMNART) performance in dementia of the Alzheimer type (DAT): validation and correction based on degree of cognitive decline

The American National Adult Reading Test (AMNART) was constructed to provide a valid and stable estimate of premorbid verbal IQ (VIQ) in dementing individuals. However, recent studies have brought into question its validity in patients with dementia of the Alzheimer type (DAT). The present study was designed to longitudinally assess the validity of the AMNART in 40 DAT patients and 40 demographically matched normal control (NC) subjects. The results showed that VIQ estimates for patients with DAT were significantly lower than those of NC subjects and declined significantly over time with increasing dementia severity as measured by the Mini-Mental State Examination (MMSE) and the Dementia Rating Scale (DRS). An MMSE-based correction factor was derived for the DAT group which allows for the effective estimation of premorbid VIQ in these patients.     

Validation of measures of parents' preoperative anxiety and anesthesia knowledge

Parents' anxiety about their children's anesthesia may adversely affect the children's outcomes and compromise the quality of informed consent. Studies of these issues have been limited by the lack of validated measures of parental anxiety and knowledge surrounding anesthesia. In the present study, we evaluated psychometric properties of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Standard Anesthesia Learning Test (SALT) among 85 parents who participated in an evaluation of the effects of a videotape about pediatric anesthesia. The results supported the internal consistency, test-retest reliability, and concurrent validity of both instruments and documented the equivalence of two forms of the SALT. Factor analysis supported the previously demonstrated factor structure of the APAIS, further confirming its construct validity. We conclude that the APAIS and SALT are reliable and valid measures of parental anxiety and knowledge of pediatric anesthesia that can be used for clinical and research purposes. Implications: This study verified the reliability and validity of two questionnaires for measuring parents' knowledge and anxiety about pediatric anesthesia. These questionnaires can be used in further research on factors affecting parental anxiety and knowledge before their children's surgery.     

Relationship between cognitive status and behavioral symptoms in Alzheimer's disease and mixed dementia

OBJECTIVE: To investigate the relationship between cognitive and behavioral impairments in Alzheimer's disease (AD) and to examine whether the addition of cerebrovascular disease modifies that relationship. DESIGN: Correlational analysis. SETTING: An outpatient dementia clinic. PATIENTS: An autopsy-confirmed series of 28 patients with AD and 16 patients with mixed Alzheimer and vascular dementia (MIX). MEASUREMENTS: Neuropsychological and behavioral tests during life: Mini-Mental State (MMS), Blessed Dementia Scale (BDS), Haycox Dementia Behavior Scale (HDBS), and two non-cognitive functional scales derived from the BDS and HDBS. RESULTS: In the AD group, MMS scores correlated significantly with scores on the BDS, HDBS, and two non-cognitive functional scales. In the MIX group, however, no significant relationship was observed between MMS scores and scores on any of the behavioral measures. CONCLUSIONS: These observations suggest that in AD, cognitive and behavioral impairments progress simultaneously. However, with the addition of a vascular component to the dementing process, cognitive and behavioral impairments may progress more independently.     

Episodic and semantic memory in Alzheimer's disease and progressive supranuclear palsy: a comparative study

We compared 13 patients with dementia of the Alzheimer's type (DAT) and 9 progressive supranuclear palsy (PSP) patients, matched by age, sex, education, and the overall level of cognitive deterioration, measured by using the Dementia Rating Scale, and 12 normal controls. The results of this study confirm that the pattern of cognitive deterioration of PSP patients differs from that of DAT patients. While episodic memory is severely affected early in the course of DAT, it appears to be relatively spared in PSP. In contrast to previous suggestions, we found no evidence for differentially rapid forgetting in DAT, although we did confirm relatively preserved recognition memory in PSP. We had predicted that the performance of the DAT group on tests of semantic memory (the Boston Naming Test, the ADA Synonym Judgement Test, and the Pyramids and Palm Trees Test) would be worse than that of the PSP group. However, there was, in fact, no difference on any of these measures, except that the PSP patients showed a significantly greater deficit on the Synonym Judgement Test. We suggest that the underlying cause of the semantic memory impairment might, however, be different in the two pathologies.     

Long-term stability and intercorrelations of cognitive abilities in older persons.

This project studied the intercorrelations and long-term stabilities of standard Wechsler Adult Intelligence Scale—Revised (WAIS—R), Wechsler Memory Scale—Revised (WMS—R), and Auditory–Verbal Learning Test (AVLT) summary indexes. It also reports similar data on the recently published Mayo Cognitive Factor Scales (MCFS), which are derivative indexes for the combined administrations of these 3 tests. These analyses challenge 2 assumptions that most psychologists make when interpreting adult cognitive tests: (a) that for cognitively normal people, performance in one cognitive domain correlates well with and predicts functioning in other cognitive domains, and (b) that in the absence of pathology, cognition is stable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of feigned ADHD in college students.

Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale–Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test—II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal–Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do experienced diagnosticians agree about the diagnosis of dementia from survey data? The effects of informants' reports and interviewers' vignettes

Dementia in community settings is often diagnosed by computerized algorithms. This study examines the extent to which independent diagnosticians agreed among themselves in diagnosing dementia, severity and type when presented with data obtained during a population-based incidence study of cognitive decline and dementia. Secondly, it examines how judgements, based initially on respondents' self-reports and cognitive performance, were affected first by informants' reports and then by short case-vignettes written by trained lay interviewers. Thirdly, it compares diagnosticians' diagnosis of dementia with the algorithmic diagnosis (AGECAT). The items presented were selected from two screening interviews at wave 1 and wave 2 separated by an interval of 2 years and from wave 2 assessment and informant interviews, and included medical, psychiatric and ADL items and interviewers' own observations. The sample (N = 42) was derived from the first year of the wave 2 assessments, potential dementia cases entering consecutively while presumed normals were selected randomly. Informants were available in 30. Agreement on diagnosis and type of dementia improved with increasing information, particularly from informants, but remained poor regarding severity. The number of cases of dementia, defined operationally, increased from 10 to 12 and uncertain cases fell from eight to six, but no respondent initially diagnosed as a dementia case was rediagnosed as a non-case, or vice versa. Dementia type changed from agreement about Alzheimer's disease to agreement about vascular dementia in one case. Operational and algorithmic diagnoses showed good agreement. Causes of disagreement, the role of vignettes and the relevance of the results for population surveys are discussed.     

Cognitive impairment following frontal lobe damage and its relevance to human amnesia.

Whether frontal lobe pathology can account for some of the cognitive impairment oberved in amnesic patients with Korsakoff's syndrome was investigated. Various cognitive and memory tests were given to patients with circumscribed frontal lobe lesions, patients with Korsakoff's syndrome, non-Korsakoff amnesic patients, and control Ss. Patients with frontal lobe lesions were not amnesic. Nevertheless, they exhibited 2 deficits that were also exhibited by patients with Korsakoff's syndrome but not by other amnesic patients: (a) impairment on the Wisconsin Card Sorting Test and (b) impairment on the Initiation and Perseveration subscale of the Dementia Rating Scale. Thus, frontal lobe pathology can explain some of the cognitive deficits observed in patients with Korsakoff's syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mini-mental state examination in screening of cognitive dysfunction and dementia

The mini-mental state examination (MMSE) is one of the most widely used screening instruments for the detection of cognitive impairments, used primarily in connection with screening for dementia. The intent of this review is to describe the original purpose of the MMSE and how it is currently used in clinical practice and in research. Advantages and limitations of the MMSE in providing a valid diagnosis of cognitive impairments (dementia) are discussed including sensitivity and specificity, the issues of the relationship of the MMSE scores to sociodemographic variables and examinations of factor structures of the MMSE. It is concluded that the MMSE provides a valid diagnosis of cognitive impairments among people with moderate and severe dementia in general populations. However, MMSE is not recommended as a screening instrument for the detection of early stages of dementia. Studies are needed to extend the present knowledge about how or whether the MMSE can be used in the clinical diagnostic evaluation of dementia and how demented patients treated with medications should be monitored.     

The validity of new memory complaints in the elderly

OBJECTIVE: To determine the validity of new subjective memory complaints (MCs) from individuals who previously, when without dementia, denied having MCs. DESIGN: Prospective cohort. SETTING: Longitudinal, community-based study of aging and dementia. PATIENTS: One hundred thirty-three community-dwelling elderly individuals who were part of a registry for the study of conditions related to aging in North Manhattan, NY. Patients were selected if they were initially without dementia and had completed at least 2 successive annual clinical and neuropsychological evaluations and provided their own medical history. MAIN OUTCOME MEASURES: Performance on memory tests--the Buschke Selective Reminding Test and a visual memory task--and global performance on a neuropsychological test battery and clinical evaluation, by which questionable dementia or dementia was diagnosed according to a well-defined paradigm. RESULTS: Fifty-three subjects with MCs at the initial evaluation performed no worse on the memory test than the 80 subjects who denied MCs initially. There was a weak association between MCs and the diagnosis of questionable dementia at baseline (P = .04), but this was nonsignificant after adjusting for age and education. At 1-year follow-up, 21 of the 80 without baseline MCs now reported MCs. At the follow-up evaluation, these 21 subjects performed significantly worse on the memory tests, were 5 times more likely to have significant cognitive impairment, and had shown significantly greater decline over the preceding year on several of the cognitive measures than the 59 who continued to deny MCs. CONCLUSION: New MCs from individuals, who when without dementia recently denied MCs, may suggest the presence of significant impairment of memory or cognition.     

Regional distribution of neuritic plaques in the nondemented elderly and subjects with very mild Alzheimer disease

BACKGROUND: Identification of the neuropathological lesions that are most closely associated with the earliest symptoms of Alzheimer disease (AD) is crucial to the understanding of the disease process and the development of treatment strategies to affect its progress. Do the classical neuropathological lesions of AD precede, follow, or occur in synchrony with the earliest signs of cognitive deterioration? DESIGN AND OUTCOME MEASURES: We examined the extent of neuritic plaque (NP) formation in 5 neocortical regions and the hippocampus, entorhinal cortex, and amygdala in 66 elderly subjects with no dementia, questionable dementia, or mild dementia as assessed using the Clinical Dementia Rating Scale (CDR). SETTING AND PATIENTS: Postmortem study of nursing home residents. RESULTS: Even questionable dementia (CDR, 0.5) was associated with a significant (P = .04) increase in neocortical NP density. The density of NPs increased further with increasing dementia severity in all brain regions examined. However, subjects with questionable dementia or definite but mild dementia did not differ significantly from each other. Density of NPs was nearly maximal in subjects with moderate dementia (CDR = 2.0), suggesting that other neuropathological changes may be responsible for cognitive deficits beyond this level. Dementia severity correlated significantly with the density of NPs in all brain regions examined (r range, 0.47-0.56; P < .001), even when subjects with a CDR of 0 were excluded. CONCLUSIONS: These findings are consistent with the hypothesis that NPs are among the earliest neuropathological lesions in AD. Even very mild or questionable dementia is associated with increased density of neocortical NPs that do not distinguish between clinically questionable vs definite dementia.     

Neuropsychological comparison between dementia of Alzheimer type and multiple subcortical infarction by easily applicable test battery

We compared the neuropsychological findings between dementia of Alzheimer type (DAT) and multiple subcortical infarction (MSI) using easily applicable test battery. Patients with DAT (N = 27) fulfilled the criteria of NINCDS-ADRDA for probable DAT and belonged to the mild degree in the DSM-III-R criteria for dementia. Patients with MSI (N = 30) scored more than 7 points in Hachinski Ischemic Score and were physically independent (Rankin Disability Scale < or = 3). Patients with DAT showed significantly more impaired performance than MSI in Mini-Mental State Examination, copy and delayed recall of Rey-Osterrieth Complex Figure Test and trial 5 of Rey Auditory-Verbal Learning Test, while patients with MSI achieved fewer categories and made more perseverative errors on Wisconsin Card Sorting Test than patients with DAT. Among these tests, delayed recall of Rey-Osterrieth Complex Figure Test seemed to be the most sensitive to discriminate DAT from MSI. These findings were thought to be compatible with the pathological facts that the degenerative process progresses from temporo-parietal lobe in DAT and frontal-subcortical region in MSI.     

Toward more evidence-based guidelines for psychology.

Comments on the guidelines developed by the American Psychological Association (APA)'s Presidential Task Force on the Assessment of Age-Consistent Memory Decline and Dementia (see record 1998-11439-016). The present authors contend that the evidentiary basis for specific guidelines is limited especially with regard to discussion of collateral sources of information in the evaluation of dementia and cognitive decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of two screening tests (the Matrix Analogies Test—Short Form and the Kaufman Brief Intelligence Test) with the WISC-III.

This study examined the concurrent validity of two brief intelligence tests, the Matrix Analogies Test—Short Form (MAT; J. A. Naglieri, 1985) and the Kaufman Brief Intelligence Test (K-BIT; A. S. Kaufman & N. L. Kaufman, 1990), with the Wechsler Intelligence Scale for Children—Third Edition (WISC-III; D. Wechsler, 1991) using a sample of 50 referred students who were attending a large urban school district. The MAT/WISC-III and K-BIT/WISC-III correlations were high and did not differ significantly in magnitude (rs?=?.67 and .78, respectively). Both screening tests tended to give scores that were significantly higher than the WISC-III Full Scale IQ. Administration time was under 10 min for both screening tests. The MAT and K-BIT appeared to be equally useful as screening tests when the WISC-III was the criterion measure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)