Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes.

Background and purpose In patients with squamous cell carcinoma of the head and neck (HNSCC), extracapsular spread (ECS) of metastases in cervical lymph nodes affects prognosis and therapy. We assessed the accuracy of intravenous contrast-enhanced computed tomography (CT) and the utility of imaging criteria for preoperative detection of ECS in metastatic cervical lymph nodes in patients with HNSCC. Materials and methods Preoperative intravenous contrast-enhanced neck CT images of 93 patients with histopathological HNSCC metastatic nodes were retrospectively assessed by two neuroradiologists for ECS status and ECS imaging criteria. Radiological assessments were compared with histopathological assessments of neck dissection specimens, and interobserver agreement of ECS status and ECS imaging criteria were measured. Results Sensitivity, specificity, positive predictive value, and accuracy for overall ECS assessment were 57%, 81%, 82% and 67% for observer 1, and 66%, 76%, 80% and 70% for observer 2, respectively. Correlating three or more ECS imaging criteria with histopathological ECS increased specificity and positive predictive value, but decreased sensitivity and accuracy. Interobserver agreement for overall ECS assessment demonstrated a kappa of 0.59. Central necrosis had the highest kappa of 0.74. Conclusion CT has moderate specificity for ECS assessment in HNSCC metastatic cervical nodes. Identifying three or more ECS imaging criteria raises specificity and positive predictive value, therefore preoperative identification of multiple criteria may be clinically useful. Interobserver agreement is moderate for overall ECS assessment, substantial for central necrosis. Other ECS CT criteria had moderate agreement at best and therefore should not be used individually as criteria for detecting ECS by CT.

Comparison of personality characteristics on the bear-fedio inventory between patients with epilepsy and those with non-epileptic seizures.

This study used the Bear-Fedio Personality Inventory (BFI) to compare 41 individuals with temporal lobe epilepsy (TLE) and 37 with psychogenic non-epileptic seizures (NES). Both groups exhibited similar elevations on the BFI, although TLE individuals show greater endorsement of at least one hypergraphia symptom, as compared with those with NES. The correlates of the BFI with demographic and seizure characteristics differed between the groups. These results argue against a specific TLE personality syndrome and suggest that personality characteristics may be related to the experience of having repeated seizures, rather than the specific underlying pathophysiology of temporal lobe epilepsy.

The relation of executive functioning to CVLT-II learning, memory, and process indexes.

Previous research has found that executive functioning plays a role in memory performance. This study sought to determine the amount of variance accounted for in the California Verbal Learning Test-Second Edition (CVLT-II) by a global executive-functioning factor score. Archival data were extracted from 285 outpatients in a mixed neurologic sample. Measures used included: CVLT-II, Wisconsin Card-Sorting Test (Perseverative Errors), Trail-Making Test-Part B, Controlled Oral Word Association Test, Animal Naming, and Wechsler Adult Intelligence Scale-Third Edition Similarities. Executive data were reduced to a single executive-functioning factor score for each individual. Regression was used to determine the amount of variance accounted for by executive functioning in CVLT-II performance. Executive functioning accounted for minimal variance (0%-10%) in the following CVLT-II indexes: Total Learning (Trials 1-5), Semantic Clustering, Repetitions, Intrusions, and False Positives. However, executive functioning accounted for substantial variance (24%-31%) in CVLT-II performance for both Short- and Long-Delay Recall indexes and most discriminability indexes. CVLT-II indexes that would intuitively be associated with executive functioning accounted for a smaller-than-expected amount of variance. Additionally, level of executive functioning was related to level of CVLT-II performance. These results suggest that clinicians should consider executive deficits when interpreting mild-to-moderate memory impairments in recall and discriminability functions but that executive abilities have little effect on other aspects of memory.

The influence of ethnicity on Symbol Digit Modalities Test performance: an analysis of a multi-ethnic college and hepatitis C patient sample.

Neuropsychologists routinely assess patients from racially, ethnically, and culturally diverse populations. Despite this fact, there remains a paucity of research investigating the influence of these variables on neuropsychological test performance. The Symbol Digit Modalities Test (SDMT) is a widely used measure of attention, visual scanning and tracking, and psychomotor speed. The purpose of the present study was to assess the relation between ethnicity and SDMT performance in ethnically diverse cognitively normal and cognitively impaired samples. Participants were 168 college students (81 Caucasian, 49 African American, 20 Asian American, and 18 Hispanic) and 24 patients (12 Caucasian and 12 Hispanic) chronically infected with hepatitis C. Results revealed no significant group differences in SDMT performance in either the student or patient sample. Furthermore ethnicity accounted for only 2 and 3 percent of the variance in SDMT scores for the patient and student samples, respectively. These findings provide preliminary support for the use of the SDMT across ethnically diverse populations in both clinical and normal samples though further analysis is warranted.

Examining the Test Of Memory Malingering Trial 1 and Word Memory Test Immediate Recognition as screening tools for insufficient effort.

Assessing effort level during neuropsychological evaluations is critical to support the accuracy of cognitive test scores. Many instruments are designed to measure effort, yet they are not routinely administered in neuropsychological assessments. The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are commonly administered symptom validity tests with sound psychometric properties. This study examines the use of the TOMM Trial 1 and the WMT Immediate Recognition (IR) trial scores as brief screening tools for insufficient effort through an archival analysis of a combined sample of mild head-injury litigants ( N = 105) who were assessed in forensic private practices. Results show that both demonstrate impressive diagnostic accuracy and calculations of positive and negative predictive power are presented for a range of base rates. These results support the utility of Trial 1 of the TOMM and the WMT IR trial as screening methods for the assessment of insufficient effort in neuropsychological assessments.

Regulations governing the out-of-state practice of psychology: implications for forensic neuropsychologists.

Many states allow psychologists licensed in other jurisdictions to practice temporarily without obtaining a full license. However, both the restrictions of practice and the procedures required before practice is allowed vary extensively among states. This article examines the regulations of U.S. and Canadian territories governing temporary practice of nonresident psychologists. Current licensing laws were obtained from each state's respective psychological board or related Web sites from May to July 2004. Results highlighted vast regulatory and procedural differences for temporary practice among jurisdictions. Due to the degree of variability in each jurisdiction's regulations governing, caution must be taken so that psychologists comply with up-to-date guidelines before practicing outside of the regions in which they are licensed. The out-of-state psychologist must contact the appropriate state or provincial licensing board for guidelines and pertinent regulation.

Coverage of the Test of Memory Malingering, Victoria Symptom Validity Test, and Word Memory Test on the Internet: is test security threatened?

In forensic neuropsychological settings, maintaining test security has become critically important, especially in regard to symptom validity tests (SVTs). Coaching, which can entail providing patients or litigants with information about the cognitive sequelae of head injury, or teaching them test-taking strategies to avoid detection of symptom dissimulation has been examined experimentally in many research studies. Emerging evidence supports that coaching strategies affect psychological and neuropsychological test performance to differing degrees depending on the coaching paradigm and the tests administered. The present study sought to examine Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it. Steps that could be taken to improve this situation and limitations to this exploration are discussed.

Is poor performance on recognition memory effort measures indicative of generalized poor performance on neuropsychological tests?

The detection of suboptimal effort has become crucial in clinical neuropsychological practice in order to make accurate diagnoses, prognoses, and referrals. Symptom Validity Testing (SVT) has been the most commonly utilized model for assessing effort, and frequently includes recognition memory tasks. Some conflicting views on this model purport, however, that measures of effort gathered from a recognition memory paradigm do not necessarily extend to effort in other cognitive domains and other areas of performance. The present study sought to investigate whether performance on an SVT measure, which utilizes recognition memory, the TOMM, could predict performance on other measures that do not evaluate recognition memory or just memory per se in a group of mildly traumatic brain-injured litigants. Results indicated that poor performance on the TOMM was significantly correlated with poorer performance on the WAIS-R and the HRNB-A. Further, experimental exploration of these results indicated that the overall neuropsychological performance of litigants with suboptimal effort was poorer than what is generally expected from mild TBI individuals, and was also lower than the other mild TBI examinees in the study, who were not classified by the TOMM as exhibiting suboptimal effort. These findings support the proposition that poor effort as measured by recognition memory effort measures is not restricted to recognition and memory measures. In fact, in the present study it appears that a poor performance on the TOMM is predictive of a generalized poorer performance on standardized measures such as the WAIS-R and the HNRB-A.

An examination of the California Verbal Learning Test II to detect incomplete effort in a traumatic brain-injury sample.

Clinical neuropsychologists are frequently called on to distinguish people who appear impaired on neuropsychological testing due to putting forth incomplete effort from those who have genuine cognitive deficits. Because traditional measures of effort are becoming accessible over the Internet and within the legal community and their purpose may be obvious to potential malingerers, nontraditional effort measures have been newly investigated. Using discriminant function analysis, this study explores whether five California Verbal Learning Test-Second Edition (CVLT-II) variables could differentiate between head-injured patients who were putting forth full effort and those who were putting forth incomplete effort. The discriminant function seemed to best predict those who put forth adequate effort while testing (95.6% correct) but not those who failed to put forth adequate effort during testing (only 13.8% correct). Hence, although the overall classification rate was moderately impressive (75.8%), the model's sensitivity in classification of the incomplete effort group was low. Cautious applications for these findings are discussed.