Interrater reliability of three clock drawing test scoring systems.

This study demonstrates the reliability of 3 Clock Drawing Test (CDT) scoring systems when applied to the protocols of stroke patients. The sample included 20 randomly selected sets of both freehand and predrawn circle versions ofthe CDT completed by patients undergoing comprehensive stroke rehabilitation. The protocols were scored independently by 2 raters using each of 3 published scoring systems (Freedman et al., 1994; Libon, Malamut, Swenson, Sands, & Cloud, 1996; Rouleau, Salmon, Butters, Kennedy, & McGuire, 1992). Interrater agreement and intrarater consistency were measured using the intraclass correlation coefficient (ICC). The results demonstrate that the raters used comparable criteria for each score (high interrater reliability) and that each applied similar scoring criteria throughout the set of protocols (high intrarater consistency). Scores related to the overall contour of the clockface tended to have lower ICCs. Reliability coefficients were comparable for both CDT versions. The results provide evidence for the accurate and consistent scoring of the CDT in stroke.

A double-blind placebo-controlled crossover study of phenytoin in individuals with impulsive aggression.

The present study examines the behavioral and psychophysiological effects of phenytoin (PHT) in individuals who display impulsive-aggressive outbursts. In a double-blind placebo-controlled crossover design, individuals meeting previously established criteria for impulsive aggression were administered PHT and placebo during separate 6-week conditions. The efficacy measures used were the Overt Aggression Scale (OAS) and the Profile of Mood States (POMS). Psychophysiological measures (evoked potentials) were taken at baseline and at the end of each 6-week condition. Photic stimulation was used to evoke the mid-latency P1-N1-P2 waveform complex. Analysis indicated a significant decrease in the frequency of impulsive-aggressive outbursts during PHT administration compared to baseline and placebo. Analysis of the psychophysiological data showed significantly increased P1 amplitude and significantly longer N1 latency during PHT administration. In addition, a reduction in N1 amplitude during PHT administration was also suggested. These findings indicate reparation of physiological abnormalities previously observed in impulsive-aggressive individuals and imply more efficient sensory processing and effective orienting of attention. Taken together, these results provide insight as to the physiological mechanisms by which PHT serves to ameliorate impulsive-aggressive behavior.

The WCST-64: a standardized short-form of the Wisconsin Card Sorting Test.

The Wisconsin Cart Sorting Test (WCST) is a well-established measure of executive function. Practical and financial constraints have increased the need for abbreviated neuropsychological procedures. A number of abbreviated versions of the WCST have been introduced and cogent arguments can be made for one over another in certain situations. However, the single deck, 64-card WCST (WCST-64) is the most logical and practical short form. Psychological Assessment Resources (PAR) has recently published a new manual with comprehensive norms for the WCST-64. This paper reviews the new product, discusses the comparability of the WCST-64 and the standard version, and suggests directions for future research.

Personality and neurocognitive correlates of impulsive aggression in long-term survivors of severe traumatic brain injury.

This study addresses a common outcome of severe traumatic brain injury (TBI), disinhibited aggressive behaviour. This behaviour has been classified in aggression literature as 'impulsive aggression' (IA). The purpose was to: (1) characterize those TBI patients who are likely to be an aggression risk, and (2) determine if TBI patients with IA demonstrate personality style and neurocognitive performance similar to that seen in other IA groups. Participants were 45 survivors of severe TBI (26 of whom had persisting problems with IA), who were clients of a residential brain injury treatment facility. IA participants had a higher incidence of pre-morbid aggressive behaviour, were younger, had a shorter tenure in the programine, and were more impulsive, irritable, and antisocial than the non-aggressive control participants. Unlike past research, no neurocognitive differences were found. The results are discussed in terms of the conceptualization, identification, and treatment of persisting IA in severe TBI.

Classification accuracy of the portland digit recognition test in traumatic brain injury.

This study examined the classification accuracy of the Portland Digit Recognition Test (PDRT) in traumatic brain injury (TBI). It differs from past studies in assigning patients to malingering and control groups on the basis of compensation-seeking status and the presence of external markers for malingering. Sensitivity and Specificity were.77 and 1.00, respectively. Past research comparing compensation-seekers to noncompensation-seekers reported Sensitivities of.33 or lower (Specificity is always high). This study demonstrates that past research has seriously underestimated the Sensitivity of the PDRT and raises questions about the true Sensitivity of other malingering techniques as well.

Symptom validity testing: a critical review.

This paper provides a comprehensive review of the published literature on symptom validity tests (SVT) and, with the accompanying tables, serves as a reference to assist in their selection, interpretation, and defense. Because malingering is inherently an applied problem that frequently arises in a medico-legal context, the use of SVTs must meet certain standards. Thus, a number of methodological and theoretical weaknesses of SVT research which limit the use of SVTs as clinical tools and sources of evidence are highlighted. These criticisms incorporate recommendations which must be addressed if conclusions based on SVT data are to meet the increasingly rigorous standards for the admissibility of scientific evidence.

Paced Visual Serial Addition Test: an alternative measure of information processing speed.

The Paced Auditory Serial Addition Test (PASAT; Gronwall, 1977; Gronwall & Sampson, 1974) is a measure of attention and information processing speed sensitive to mild traumatic brain injury (MTBI), but it is aversive and inappropriate for many other neurologically impaired patients. This study examines a simpler, less aversive visual analog of the PASAT (the Paced Visual Serial Addition Test; PVSAT) in a sample of 74 college students (26 with a history of TBI). Results indicated that the PVSAT is moderately correlated with and less difficult than the PASAT. Both tests had identical relations to other measures of attention. Neither the PVSAT, PASAT, nor the other attentional measures differentiated participants with MTBI from normal controls in a college population. This preliminary study thus demonstrates the comparability of the two tests and presents the PVSAT as a viable alternative to the PASAT. Directions for future research and applications of these findings are discussed.

Developmental changes in California Card Sorting Test performance.

The purpose of the present study was to determine 1) if performance on the California Card Sorting Test (CCST) follows the same developmental gradient as other measures of concept formation and 2) whether the components of concept formation tapped by the CCST are developmentally dissociable. Participants were 68 children and young adults in four age-based groups: 7 to 9 years (n = 13); 10 to 12 years (n = 16); 17 to 19 (n = 20); and, 20 to 22 years (n = 19). All were of average or higher measured intelligence and screened for neurological, psychiatric, reading and attentional disorder. The findings of the present study suggest that like many other concept formation tasks, CCST performance approximates adult levels by age 10. Further, the different components of concept formation measured by the CCST are dissociable in the youngest children with the development of concept recognition preceding sorting ability.

Construct validity and predictive value of the Hooper Visual Organization Test in stroke rehabilitation.

The Hooper Visual Organization Test (HVOT; Hooper, 1958) is a commonly used measure of visual perceptual function. However, serious questions have recently been raised about its construct validity (i.e., the role of object naming). This study further examined the HVOT's construct validity and began exploring its contribution to outcome prediction in stroke rehabilitation. Participants were 101 rehabilitation inpatients suffering from recent cerebrovascular accidents. Each participant was administered the HVOT as part of a comprehensive neuropsychological evaluation. Wechsler Adult Intelligence Scale-Revised (Wechsler, 1981) Object Assembly, Picture Completion, and Cognistat Naming were significantly and uniquely correlated with the HVOT and accounted for about 45% of its variance. The HVOT's value in outcome prediction was examined by correlating HVOT with admission and discharge Functional Independence Measure (FIM; Granger & Hamilton, 1990; Hamilton, Granger, Sherwin, Zielezny, & Tashman, 1987) scores. While correlating weakly with some FIM domains, when admission FIM was controlled, the relation between HVOT and discharge FIM became nonsignificant. Implications of these data for the HVOT's clinical utility are discussed.

Temporal stability of the Wisconsin Card Sorting Test in an untreated patient sample.

This study evaluates the temporal stability of the Wisconsin Card Sorting Test (WCST). The only previous similar study found unacceptably low test-retest stability in a non-patient elderly sample. In contrast, the present study utilizes 29 untreated obstructive sleep apnea patients who are more typical of persons likely to receive the WCST clinically. The 11 WCST scores examined demonstrated test-retest correlations from .34 to .83 (mean = .64). Six of 11 correlations were within .10 of the .80 criterion for clinical utility and there was minimal change across sessions. The current findings justify greater optimism regarding the test-retest reliability of the WCST.

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 Wisconsin Card Sorting Test in stroke rehabilitation: factor structure and relationship to outcome.

The present study attempted to replicate the findings of previous factor analytic studies of the Wisconsin Card Sorting Test (WCST) in a homogeneous sample of patients suffering recent cerebrovascular accidents and being treated in a comprehensive inpatient physical rehabilitation program. In addition this study examined the relationship of the WCST to standard measures of functional ability used in many rehabilitation programs. The results confirmed the previously reported three-factor structure and replicated past findings concerning the test's construct validity. A small but significant relationship was noted between the WCST and functional status, though the WCST did not make a unique contribution to the prediction of functional status at discharge. This study highlights the similarities and differences in WCST factor structure in a stroke sample compared to a more general neurological sample and raises questions about the utility of the WCST in stroke rehabilitation.

Cognitive and emotional sequelae of cerebellar infarct: a case report.

The cerebellum has long been the subject of scientific investigation, but its role in nonmotor functions has only recently begun to receive serious consideration. Despite the growing literature linking the cerebellum to nonmotor/cognitive functions in humans, some controversy remains concerning the cerebellum's role in these processes. We present a patient who developed both specific language processing and verbal memory deficits and emotional changes in the context of normal intelligence following a bilateral cerebellar ischemic stroke. Despite having multiple localized cerebellar lesions, this patient had no significant motor problems, nor was there radiological evidence of focal forebrain lesions to which the cognitive and emotional effects might be attributed. The role of the cerebellum in cognition and the relevance of cerebellum-associated cognitive/emotional dysfunction to the practicing clinician are discussed.

Latent structure of the Wisconsin Card Sorting Test in a clinical sample.

The aims of this study were to: (a) examine the consistency of the published Wisconsin Card Sorting Test (WCST) factor structures; (b) determine the factor structure of the WCST in a large, heterogeneous sample; and (c) compare the WCST factor analytically with other neuropsychological procedures. Two WCST factors (concept formation/perseveration and Failure-to-Maintain-Set [FMS]) were consistently reported in the literature. Our analysis of data from 473 clinical cases replicated the two factors previously reported and revealed a third on which nonperseverative errors (NPE) was the sole salient variable. This pattern was maintained in three of four diagnostically distinct subgroups. These factors are potentially clinically meaningful, with each seeming to reflect one of three qualitatively different performance styles. In the construct validation factor analysis, WCST scores loaded independently of other neuropsychological variables, indicating that the WCST contributes uniquely to neuropsychological evaluation. Nevertheless, despite the rational interpretation of the factors, the cognitive processes underlying WCST performance remain poorly understood. Future directions for the application of these factor analytic findings are discussed.

Emotion processing in Alzheimer's disease.

Emotion processing deficits may have an important effect on the quality of life of Alzheimer's disease (AD) patients and their families, yet there are few studies in this area and little is known about the cause of such deficits in AD. This study sought to determine if some AD patients have a disruption in a specific right hemisphere emotion processing system, and to determine if the processing of emotional facial expression is more vulnerable to the pathology of AD than is the perception of emotional prosody. It was specifically hypothesized that patients with greater right hemisphere dysfunction (low spatial AD patients) would be impaired on emotion processing tasks relative to those with predominantly left hemisphere dysfunction (low verbal AD patients). Both groups showed impairment on emotion processing tasks but for different reasons. The low verbal patients performed poorly on the affect processing measures because they had difficulty comprehending and/or remembering the task instructions. In contrast, low spatial AD patients have emotion processing deficits that are independent of language and/or memory and may be due to a more general visuoperceptual deficit that affects the perception of static but not dynamic affective stimuli.

Factorial structure of the Wisconsin Card Sorting Test.

This study examined the factorial structure of the Wisconsin Card Sorting Test (WCST) in normal university students (N = 135) and a mixed clinical sample (N = 139). Two highly stable orthogonal factors were observed accounting for 70 and 21 per cent of the variance, respectively. Factor I was interpreted as reflecting undifferentiated executive function while Factor II may measure cognitive abilities associated with attentional function. This work can serve as the basis for further examination of the construct validity of the WCST and has implications for its use.

The California Card Sorting Test may dissociate verbal and non-verbal concept formation abilities.

Most neuropsychological measures of executive function provide only global indices of performance and are relatively insensitive to lateralized dysfunction. The present paper presents a right temporal lobectomy patient whose performance indicates that the California Card Sorting Test, a new measure of executive function, may dissociate verbal and non-verbal concept formation abilities. This case highlights the potential research and clinical value of this test compared to that of existing tests of executive function.

The role of attention in Wisconsin Card Sorting Test performance.

The present study sought to test the hypothesis that the second factor (consisting of Failure-to-Maintain-Set and other scores) found in two recent factor analyses of the Wisconsin Card Sorting Test reflects attentional function. The effect of color overlays (an experimental manipulation known to influence neural systems linked to attention) was examined in 17 normal control and 14 attention-disordered children (ages 8 to 12). Group and Color main effects were found for Factor 1 (which consists largely of measures of perseveration) and a Color main effect was observed for Factor 2. The Color effect for Factor 2 supported the contention that this factor reflects attentional processes. A hypothesis concerning the relationship between problem solving and attention on the WCST is offered and a means for testing it is discussed.

A psychometric analysis of the California Card Sorting Test.

The purpose of this study is to begin to characterize performance on the California Card Sorting Test (CCST), a relatively new measure of executive function specifically designed to fractionate problem-solving ability into its cognitive components. Data describing the performance of 135 neurologically intact young adults on the CCST and four other common measures of executive function are presented. Factor analyses indicated that the CCST is a valid measure of concept formation and abstract ability and that the CCST taps abilities different from those measured by commonly used tests of executive function. While further work must be done, the CCST seems to hold promise as a neuropsychological assessment instrument.