Chemotherapeutic drug-specific alteration of microvascular blood flow in murine breast cancer as measured by diffuse correlation spectroscopy.

The non-invasive, in vivo measurement of microvascular blood flow has the potential to enhance breast cancer therapy monitoring. Here, longitudinal blood flow of 4T1 murine breast cancer (N=125) under chemotherapy was quantified with diffuse correlation spectroscopy based on layer models. Six different treatment regimens involving doxorubicin, cyclophosphamide, and paclitaxel at clinically relevant doses were investigated. Treatments with cyclophosphamide increased blood flow as early as 3 days after administration, whereas paclitaxel induced a transient blood flow decrease at 1 day after administration. Early blood flow changes correlated strongly with the treatment outcome and distinguished treated from untreated mice individually for effective treatments.

Base rate comparison of suboptimal scores on the RBANS effort scale and effort index in Parkinson's disease.

OBJECTIVE: The effort index (EI) and the effort scale are commonly used embedded effort indicators on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). This investigation examined the rates of suboptimal scores on the EI and effort scale in a Parkinson's disease (PD) sample. METHOD: One hundred and sixty-three participants who have been diagnosed with PD by a board-certified neurologist were included in the study. The base rate of suboptimal scores on the EI and effort scale was calculated for the entire group. RESULTS: On average, participants were 66.8 years of age (SD = 9.5) and had a mean education of 13.5 years (SD = 2.79). The mean Mini-Mental State Examination score was 27.0 (SD = 3.1). Overall, 8% of participants scored below the cut-off for optimal performance on the EI while 62.6% performed in the suboptimal range for the effort scale. CONCLUSION: The utility of the EI and the effort scale in PD populations warrants further examination. Additionally, results demonstrate the need for validation of embedded RBANS effort measures in various disease populations.

Simulating high frequency water quality monitoring data using a catchment runoff attenuation flux tool (CRAFT).

High resolution water quality data has recently become widely available from numerous catchment based monitoring schemes. However, the models that can reproduce time series of concentrations or fluxes have not kept pace with the advances in monitoring data. Model performance at predicting phosphorus (P) and sediment concentrations has frequently been poor with models not fit for purpose except for predicting annual losses. Here, the data from the Eden Demonstration Test Catchments (DTC) project have been used to calibrate the Catchment Runoff Attenuation Flux Tool (CRAFT), a new, parsimonious model developed with the aim of modelling both the generation and attenuation of nutrients and sediments in small to medium sized catchments. The CRAFT has the ability to run on an hourly timestep and can calculate the mass of sediments and nutrients transported by three flow pathways representing rapid surface runoff, fast subsurface drainage and slow groundwater flow (baseflow). The attenuation feature of the model is introduced here; this enables surface runoff and contaminants transported via this pathway to be delayed in reaching the catchment outlet. It was used to investigate some hypotheses of nutrient and sediment transport in the Newby Beck Catchment (NBC) Model performance was assessed using a suite of metrics including visual best fit and the Nash-Sutcliffe efficiency. It was found that this approach for water quality models may be the best assessment method as opposed to using a single metric. Furthermore, it was found that, when the aim of the simulations was to reproduce the time series of total P (TP) or total reactive P (TRP) to get the best visual fit, that attenuation was required. The model will be used in the future to explore the impacts on water quality of different mitigation options in the catchment; these will include attenuation of surface runoff.

Criterion Validity of the WAIS-IV Cognitive Proficiency Index (CPI).

OBJECTIVE: The current study sought to validate the Cognitive Proficiency Index (CPI) against similar, well-established measures of attention and processing speed. Additionally, the sensitivity of the CPI and Attention Index of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and their ability to differentiate among clinical groups were compared. METHOD: The first objective was accomplished by calculating correlation coefficients between the CPI and similar attention and processing speed measures. The second objective was accomplished using a clinical group of 25 individuals with Mini-Mental State Exam (MMSE) scores of less than or equal to 23 matched to a non-clinical group of 43 participants with MMSE scores of 30, all derived from the original sample. RESULTS: The CPI correlated in expected ways with other measures of attention and processing speed (magnitude of r = .19-.77). ANCOVA, receiver operating characteristic, and discriminant function analyses suggested that the CPI is superior to the RBANS Attention Index in differentiating between clinical and non-clinical groups. CONCLUSIONS: These findings provide support for convergent validity and criterion-related concurrent validity for the CPI.

Improving the diagnostic accuracy of the RBANS in mild cognitive impairment with construct-consistent measures.

Research on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has suggested that it has somewhat limited sensitivity in the differentiation of patients with mild cognitive impairment (MCI) from patients with dementia and elderly patients with no neurologic or psychiatric diagnoses. This study sought to increase the diagnostic utility of the RBANS in differentiating between patients with Alzheimer's disease (AD), MCI, and no diagnosis (ND) with the addition of construct comparable neuropsychological test measures. Diagnostic utility was assessed by comparing patients diagnosed with MCI to patients diagnosed with AD as well as to the ND group. The following cognitive domains were investigated: short-term memory, retention and long-term memory, language, attention, visuoconstruction, and overall cognitive functioning. Stepwise logistic regressions found that in the comparisons between MCI and ND, the Step 2 addition of construct comparable neuropsychological measures provided a significant diagnostic increase in the short-term memory and overall cognitive functioning models. In the comparisons between MCI and AD, the Step 2 additions provided a significant diagnostic increase in the short-term memory, visuoconstruction, and overall cognitive functioning models. Results suggested that the inclusion of construct similar neuropsychological tests significantly increases the diagnostic accuracy of the RBANS when attempting to identify more subtle cognitive deficits inherent in MCI.

A pseudoisochromatic test of color vision for human infants.

Despite the development of experimental methods capable of measuring early human color vision, we still lack a procedure comparable to those used to diagnose the well-identified congenital and acquired color vision anomalies in older children, adults, and clinical patients. In this study, we modified a pseudoisochromatic test to make it more suitable for young infants. Using a forced choice preferential looking procedure, 216 3-to-23-mo-old babies were tested with pseudoisochromatic targets that fell on either a red/green or a blue/yellow dichromatic confusion axis. For comparison, 220 color-normal adults and 22 color-deficient adults were also tested. Results showed that all babies and adults passed the blue/yellow target but many of the younger infants failed the red/green target, likely due to the interaction of the lingering immaturities within the visual system and the small CIE vector distance within the red/green plate. However, older (17-23 mo) infants, color- normal adults and color-defective adults all performed according to expectation. Interestingly, performance on the red/green plate was better among female infants, well exceeding the expected rate of genetic dimorphism between genders. Overall, with some further modification, the test serves as a promising tool for the detection of early color vision anomalies in early human life.

Longitudinal stability of RBANS profiles in a geriatric community-dwelling sample.

This investigation is an extension of a previous study that identified four neurocognitive RBANS groups via cluster analysis in a geriatric community-dwelling sample of 699 individuals who were at least 65 years of age. Groups were examined longitudinally over a 2-year interval to establish if they exhibited marked score changes over three assessment periods. Dropout rates, onset of medical pathology, and self-reported functioning were tracked at each evaluation. Results confirmed that cluster scores were generally stable over time although the Low Immediate Memory group's Immediate Memory index score regressed upward toward the mean by the third assessment. Of interest, individuals in the Below Average group had substantial dropout between the first and third assessments. Results are interpreted through a clinical framework to explore how RBANS cluster profiles may have predictive value in general neurocognitive functioning over the observed time period and be potentially influenced by general health factors.

RBANS cluster profiles in a geriatric community-dwelling sample.

Neuropsychological heterogeneity is prevalent in geriatric individuals and is due to a number of factors including the onset of neuropathology, increased risk of emotional complications, and normal cognitive changes associated with aging. In order to better characterize normal neurocognitive variability in this population, cluster analysis was used on a sample of 699 community-dwelling geriatric patients who completed The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Three-, four-, five-, and six-cluster solutions were examined and based on a number of criteria, the four-cluster solution was selected for further analysis. Clusters were defined primarily by measures of immediate memory, delayed memory, and processing speed, and differed on self-reported measures of functioning. These findings provide insights on normal neuropsychological variation in community-dwelling geriatric individuals.

Efficacy of the ANAM General Neuropsychological Screening Battery (ANAM GNS) for detecting neurocognitive impairment in a mixed clinical sample.

The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized neuropsychological assessment battery that has demonstrated utility in a variety of clinical populations including multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, acquired brain injury, migraine headaches, and Alzheimer's disease. This study utilized selected tests from the ANAM General Neuropsychological Screening Battery (ANAM GNS), a newly defined subset of tests from the broader ANAM library designed for general clinical assessment of cognition. ANAM GNS is an expansion of the ANAM Core battery which has been utilized in a military setting. The efficacy of the ANAM GNS was explored in a mixed clinical sample relative to well-established, traditional neuropsychological measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). It was hypothesized that scores from the ANAM GNS would accurately predict participants as either impaired (n = 30) or normal (n = 113). Participants were grouped a priori based on RBANS Total Index scores with impairment defined as scores ≤ 15th percentile. Logistic regression analysis was conducted to evaluate the classification accuracy of the ANAM GNS. The predictor variables were the Throughput scores from seven selected ANAM GNS subtests. The full model significantly predicted impairment status, sensitivity was 81% and specificity was 89.1%. Overall classification rate was 87.9% and the Odds Ratio for the overall model was 34.65. Positive predictive value was 56.7% and negative predictive value was 96.4%. This study represents the first clinical data on the ANAM GNS, and documents that it has good concurrent and predictive validity with a well-established neuropsychological measure.

Comparison of Patti Pics and Lea Symbols optotypes in children and adults.

PURPOSE: Although a great variety of pediatric tests of visual acuity exist, few have been compared directly within the same patients or have been evaluated directly against an adult gold standard. METHODS: Right eyes from 80 3- to 5-year-old preschoolers were tested at 3 m with the two current pediatric optotype tests-the Patti Pics and the Lea Symbols (Mass VAT versions)-that best adhere to the international standard for early eye and vision screening. For comparison, right eyes from 52 adults were tested under the same conditions with both pediatric tests and with a gold standard Mass VAT Sloan letter test. RESULTS: Compared with the Patti Pics, both children and adults showed relatively better and finer levels of visual acuity with Lea Symbols (0.07-0.11 logMAR better). Compared with Sloan letters, adults' acuity was also 0.09 logMAR better with the Lea Symbols but was virtually identical and also showed good statistical agreement with Patti Pics acuity. CONCLUSIONS: Although both pediatric tests show excellent testability, our data suggest that acuity values obtained with the Patti Pics optotypes are more consistent with those obtained with a gold standard visual acuity test used for older children and adults.

Children with fetal alcohol spectrum disorder show an amblyopia-like pattern of vision deficit.

AIM: The aim of the study was to assess and characterize visual functioning in children with fetal alcohol spectrum disorder (FASD) using a broader and more inclusive range of measures than has been reported previously. METHOD: Standard tests of visual functioning were used to assess 21 children (11 females, 10 males) with FASD and 21 sex- and age-matched comparison children without FASD. The age of the children ranged from 6 years 9 months to 11 years 11 months (mean 9y 6mo). Children were tested individually under standardized conditions for visual acuity, stereoacuity, contrast sensitivity, ocular alignment/motility, color vision, and refractive error. RESULTS: Compared with non-affected children, children with FASD showed deficits in visual acuity, contrast sensitivity, and stereoacuity. Ocular alignment/motility, refractive error, and color vision measures were normal. Among children with FASD, 62% met the criteria for referral to an eye specialist, compared with 20% of children without FASD. INTERPRETATION: Children with FASD showed an amblyopia-like pattern of vision deficit in the absence of the optical and oculomotor disruptions of early experience that usually precede this condition. Evidence from animal models suggests that the deficits in spatial vision may be due to alterations in the functional architecture of the neocortex that occurs following prenatal alcohol exposure.

Brief report: the temporal stability of the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index in geriatric samples.

The Effort Index (EI) of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed to identify inadequate effort. Although researchers have examined its validity, the reliability of the EI has not been evaluated. The current study examined the temporal stability of the EI across 1 year in two independent samples of older adults. One sample consisted of 445 cognitively intact older adults (mean age = 72.89; 59% having 12-15 years of education) and the second sample consisted of 51 individuals diagnosed with amnestic Mild Cognitive Impairment (mean age = 82.41; 41% having 12-15 years of education). For both samples, the EI was found to have low stability (Spearman's ρ = .32-.36). When participants were divided into those whose EI stayed stable or improved versus those whose EI worsened (i.e., declining effort) on retesting, it was observed that individuals with lower baseline RBANS Total scores tended to worsen on the EI across time. Overall, the findings suggest low temporal stability of the EI in two geriatric samples. In particular, individuals with poorer cognition at baseline could present with poorer effort across time. These findings also suggest the need to further examine the temporal stability of other effort measures.

Intersubtest discrepancies on the RBANS: results from the OKLAHOMA study.

The present study provides supplemental data for the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) by reporting base rate data on discrepancies between subtests of this measure. These discrepancies are organized by general level of ability and include both age and education corrections. The data come from the Oklahoma Longitudinal Assessment of Health Outcomes in Mature Adults study and include cognitive performances of 718 community-dwelling older adults. These findings offer the possibility of increased sensitivity at detecting clinically significant differences that might not be identified when relying on base rate data from a greater age range. Similarly, these data highlight the mediating effects of the global level of cognitive functioning on discrepancy scores.

The RBANS Effort Index: base rates in geriatric samples.

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

Gender differences on the Repeatable Battery for the Assessment of Neuropsychological Status subtests in older adults: baseline and retest data.

Gender differences have been widely reported across a range of cognitive ability tasks, and these differences appear to persist across the lifespan into later adulthood. The current study assessed the influence of gender on the subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a large cohort (n = 718) of older adult primary care patients. Males (n = 300) were compared to females (n = 418) on the 12 subtests of the RBANS, after controlling for age and education. Significant differences were found on 9 of the subtests. Therefore, gender corrected normative data were calculated, which also control for age and education. Test-retest data were also examined in a subset of this sample (n = 446) that was reevaluated at 1 year. Males and females were comparable on 1-year practice effects. By controlling for additional systematic bias in RBANS scores (e.g., gender effects), these findings allow clinicians and researchers to better match patients and participants when using this screening battery.

Assessment of the RBANS Visual and Verbal Indices in a sample of neurologically impaired elderly participants.

With increases in the older adult population, brief assessments sensitive to dementia are essential. This study assessed the effectiveness of the verbal memory and visual processing indices proposed by Duff et al. (2009) to differentiate participants with neurological disorders. Participants included individuals diagnosed with mild cognitive impairment (MCI; n = 38), Alzheimer's disease (AD; n = 100), or Parkinson's disease (PD; n = 35), with ages ranging from 65-93 years. In addition, normal control participants (n = 100) within the same age range were used for comparison. ANOVA and posthoc analyses revealed that the normal control and AD groups were significantly different from all groups for Verbal and Visual Indices. However, the MCI and PD groups did not differ from each other. Predictive discriminant analysis (PDA) assessed classification rates of the groups, and the normal participants were classified best (63% to 92%). The AD group followed with percentages ranging from 64% to 76%. Specifically, when classifying the normal and AD groups using both Verbal and Visual Indices of the RBANS together, sensitivity was 92.0% (n = 92) and specificity was 79.0% (n = 79). Overall classification rates for this analysis were 85.5%. Overall, the RBANS Verbal and Visual Indices may provide additional information when working with neurologically impaired older adults, with overall classification rates ranging from 61.5% to 85.5%.

Final version of the Distance Randot Stereotest: normative data, reliability, and validity.

PURPOSE: Measurement of distance stereoacuity may be useful in assessing strabismic patients, especially those with intermittent exotropia. We developed the Distance Randot Stereotest as an easily administered quantitative test for distance stereoacuity in children. By using a prototype, we reported testability, validity, and normative data. Here we report normative and validity data for the final, commercially available version of the test. METHOD: We administered both the Prototype and the Final Version Distance Randot Stereotest to 156 normal volunteers (2-40 years of age) and 77 strabismic patients (4-62 years of age). Test-retest data were collected for the Final Version. RESULTS: Normative Final Version scores were similar to those obtained with the Prototype; 96% were < or = 100 arcsec. Test-retests were identical in 82% and within one disparity level in 100%. Final Version scores were correlated with Prototype scores (rs = 0.64, p < 0.001). Among strabismic patients, 62.3% had abnormal stereoacuity; those with normal scores had incomitant or intermittent deviations. Nil stereoacuity was found in 27 patients, confirmed in 90.9% of retests; 17 had measurable stereoacuity, confirmed in 96.3% of retests. Patients with constant strabismus were more likely to have nil stereoacuity than patients who had intermittent strabismus (95% vs 12.2%). CONCLUSIONS: Distance Randot scores from normal subjects have low variability within each age group and high test-retest reliability. There is little overlap between Distance Randot scores from normal control and strabismic patients. The Distance Randot Stereotest is a sensitive measurement of binocular sensory status that may be useful in monitoring progression of strabismus and/or recovery after strabismus surgery.

Normative data on and psychometric properties of Verbal and Visual Indexes of the RBANS in older adults.

The original structure of the RBANS includes five Indexes; however, recent factor analyses support a two-factor solution (Duff et al., 2006; Wilde, 2006). Unfortunately, normative and psychometric data do not currently exist on these two new Indexes. Building on prior work, the current study provides age- and education-corrected normative data to calculate the factor-derived Verbal and Visual RBANS Indexes (Duff et al., 2006) in a large cohort (n = 718) of older adult primary care patients. Psychometric data (e.g., discrepancy scores, internal consistency, retest reliability) on these new Indexes are also presented. These data might allow clinicians and researchers to better assess laterality effects of brain dysfunction when using the RBANS, although clinical validation is needed.

Premorbid intellect and current RBANS performance: discrepancy scores in three geriatric samples.

Assessing cognitive change during a single visit requires the comparison of estimated premorbid abilities and current neuropsychological functioning. As newer instruments are developed to measure current cognitive functioning, their relationships with premorbid estimates need to be evaluated. The current study examined the clinical utility of discrepancy scores between an estimate of premorbid intellect derived from demographic variables (i.e., Barona) and the Total score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in three geriatric samples. A large community-dwelling "control" sample and two clinical samples were examined. As expected, there was little difference between estimated premorbid intellect and current RBANS Total Scale scores in the community-dwelling sample, while estimated premorbid intellect obtained from the two clinical samples significantly differed from obtained RBANS Total scores. Similar findings were observed on Discrepancy scores for the five Indexes of RBANS. The current findings, along with normative data on these discrepancy scores, can provide additional confidence for clinicians and researchers who need to determine cognitive decline when using these screening measures of neuropsychological status.

Retention rates on RBANS memory subtests in elderly adults.

Identification of memory impairment is important for neuropsychological diagnostic and research applications, and retention rates on verbal and visual memory tests can provide useful information when characterizing a variety of neurological and psychiatric disorders. Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is becoming a popular screening battery for cognitive functions, normative data on retention rates are not available. The retention rates of verbal and visual material were evaluated in a sample of clinical patients (n = 109) compared to a healthy control group (n = 718). Individual subtest retention rates were converted to age-corrected scaled scores based on the cumulative distribution of raw scores obtained by an elderly community-dwelling sample. Compared with the healthy normative sample, the percent retention found for the clinical group was significantly lower on all 3 RBANS memory subtests. These preliminary data suggest that retention rates of the RBANS memory subtests may add to the clinical utility of this test as a neuropsychological diagnostic and research tool.