Examining the validity of eye tracking during the computerized Wisconsin card sorting test in a sample of stroke patients and healthy controls.

INTRODUCTION: Each year, approximately 50,000 Canadians, one million Americans, and millions of people worldwide are hospitalized for stroke. Cognitive impairment is common after experiencing a stroke and is known to affect functioning on daily tasks. While neuropsychological assessments are often employed to assess cognitive abilities and make inferences about functional capabilities, there is growing interest in integrating contemporary technologies to augment assessment. Eye tracking allows previously overlooked information, such as overt visual attention based on fixations and saccades, to be quantified to help elucidate how responses are made during testing. METHOD: The current study investigated the validity of eye tracking during completion of the computerized Wisconsin Card Sorting Test (cWCST), a common test of higher level cognition, in a sample of inpatients recovering from stroke (n= 41) and a control group of healthy individuals (n = 46). RESULTS: Results provided supporting evidence for the construction, criterion, and ecological validity of eye tracking on the cWCST with inpatients recovering from a stroke. Specifically, eye tracking metrics differentiated between inpatients and controls; fixations on cWCST areas of interest differed between type of response (conceptual versus non-conceptual); and average time per fixation predicted functional status early after a stroke as well as recovery during inpatient rehabilitation, above-and-beyond cWCST scores. Time spent on testing negated the effects of fixation and saccade counts for predicting cWCST performance, due to the substantial overlap in variance. CONCLUSION: Current findings of this preliminary study provided support for the validity of eye tracking, integrated with the cWCST, for inpatients recovering from a stroke. Implications and areas for future research are discussed.

A systematic review of the effects of cannabis on cognition in people with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a chronic demyelinating disease which leads to sensory, motor, autonomic, and cognitive symptoms. Cannabis is a common way for persons with MS (pwMS) to seek symptomatic therapy. Given the capacity for both cannabis and MS to cause cognitive impairment, it is important to determine whether there is any negative impact when the two co-occur. The objective of this systematic review was to evaluate the effects of cannabis and medicinal cannabinoid products on cognition in pwMS in order to provide guidance to clinicians and enable them to make evidence-based recommendations regarding cannabis and cannabinoid products. METHODS: A systematic review was carried out searching common keyword combinations for cannabis and MS across five databases, producing 840 unique articles, 18 of which were included in a qualitative synthesis. RESULTS: Aggregate data from existing studies to date highlight potential impairments from chronic whole-plant cannabis use in commonly affected cognitive domains in multiple sclerosis, including attention and working memory, and to a lesser extent, visual memory, verbal memory, and executive function. Results also suggest that in the short-term, medicinal cannabinoid preparations do not significantly impair cognition and may even ameliorate cognitive symptoms in the context of obtrusive MS disease. The findings are limited by disparities in detail of cannabis use data reported across whole-plant cannabis publications. CONCLUSION: Existing literature on co-occurrence of cannabis use and MS lacks high quality evidence to recommend for or against cannabis and cannabinoid therapies for pwMS based on cognitive effects. Existing data suggest that cognition may be differentially impacted in pwMS depending on the type of product, the duration of use, and the indication. Future studies on whole-plant cannabis require comprehensive cannabis use data reporting including frequency, dosing, duration, and type of cannabis product. Future studies on medicinal cannabinoid products should be long-term to assess the effects of chronicity.

A psychometric examination of the PAI-SF in persons with recent stroke.

Objective: The present study evaluated the psychometric properties of the Personality Assessment Inventory-Short Form (PAI-SF) for use with patients with recent stroke. Method: Study participants (N = 170) were inpatients in a tertiary hospital in Western Canada admitted to a rehabilitation department who completed a neuropsychological evaluation as part of their care. All participants completed the full-form of the PAI (344 items) and both full- and short-form (160 items) versions were scored from the same protocol. Results: Internal consistency for the PAI-SF scales was assessed by Cronbach's coefficient alpha. Alpha coefficients for clinical scales fell between the range of 0.53 (ANT) to 0.88 (ANX), with three scales (ANT, ALC, and DRG) falling below satisfactory (<0.70). Alpha coefficients were unsatisfactory for validity, treatment, and interpersonal scales. Absolute differences between mean clinical scale t scores between the full and short-form PAI clinical scales ranged from 0.04 (DEP) to 1.18 (MAN). For an individual, absolute differences in scale t scores between the full- and short-forms ranged from 0 to 30 t scores. On average, an individual varied 3.75 t scores between the PAI full- and short-form across all validity, clinical, interpersonal, and treatment scales. Component structure was similar across the full- and short-forms. Conclusions: Findings are somewhat consistent with previous literature on the PAI-SF as the full- and short-forms had minimal differences and similar psychometric properties. However, caution is warranted for the clinical utility for both forms given the lower alpha coefficients and different structure. Only certain clinical scales appear to have strong psychometric properties.

Does Happiness Improve Health? Evidence From a Randomized Controlled Trial.

Happier people are healthier, but does becoming happier lead to better health? In the current study, we deployed a comprehensive, 3-month positive psychological intervention as an experimental tool to examine the effects of increasing subjective well-being on physical health in a nonclinical population. In a 6-month randomized controlled trial with 155 community adults, we found effects of treatment on self-reported physical health-the number of days in the previous month that participants felt healthy or sick, as assessed by questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Questionnaire. In a subsample of 100 participants, we also found evidence that improvements in subjective well-being over the course of the program predicted subsequent decreases in the number of sick days. Combining experimental and longitudinal methodologies, this work provides some evidence for a causal effect of subjective well-being on self-reported physical health.

ENHANCE: Evidence for the efficacy of a comprehensive intervention program to promote subjective well-being.

Building from the growing empirical science of happiness, or subjective well-being (SWB), we have developed a 12-week comprehensive intervention program-Enduring Happiness and Continued Self-Enhancement (ENHANCE)-to increase SWB and enable a thorough examination of the mechanistic processes of program content and administrative structure for SWB change over time. In a randomized controlled trial, participants (N = 155; 55 using the in-person format, 100 online format) were randomly assigned to participate in ENHANCE or to a waitlist control condition. All participants completed assessments of SWB, including non-self-report measures, and process variables at baseline, posttest, and follow-up (3 months). We found evidence supporting the efficacy of ENHANCE for increasing SWB, whether administered in-person or online. Furthermore, development of the skills targeted in the program (e.g., gratitude, mindfulness) accounted for SWB improvements. This study provides initial evidence that ENHANCE can promote SWB and offers insights regarding the processes involved in these changes. To bolster these findings, we present additional data (n = 74) from a fourth assessment showing within-person maintenance of SWB gains over 6 months in the original treatment condition (n = 39) and a replication of the immediate ENHANCE treatment effects in the waitlist condition (n = 36). We discuss potential avenues for the utilization of ENHANCE in basic research and applied disseminations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Allocentric Versus Egocentric Neglect in Stroke Patients: A Pilot Study Investigating the Assessment of Neglect Subtypes and Their Impacts on Functional Outcome Using Eye Tracking.

OBJECTIVE: Few studies have investigated the assessment and functional impact of egocentric and allocentric neglect among stroke patients. This pilot study aimed to determine (1) whether allocentric and egocentric neglect could be dissociated among a sample of stroke patients using eye tracking; (2) the specific patterns of attention associated with each subtype; and (3) the nature of the relationship between neglect subtype and functional outcome. METHOD: Twenty acute stroke patients were administered neuropsychological assessment batteries, a pencil-and-paper Apples Test to measure neglect subtype, and an adaptation of the Apples Test with an eye tracking measure. To test clinical discriminability, twenty age- and education-matched control participants were administered the eye tracking measure of neglect. RESULTS: The eye tracking measure identified a greater number of individuals as having egocentric and/or allocentric neglect than the pencil-and-paper Apples Test. Classification of neglect subtype based on eye tracking performance was a significant predictor of functional outcome beyond that accounted for by the neuropsychological test performance and Apples Test neglect classification. Preliminary evidence suggests that patients with no neglect symptoms had superior functional outcomes compared with patients with neglect. Patients with combined egocentric and allocentric neglect had poorer functional outcomes than those with either subtype. Functional outcomes of patients with either allocentric or egocentric neglect did not differ significantly. The applications of our findings, to improve neglect detection, are discussed. CONCLUSION: Results highlight the potential clinical utility of eye tracking for the assessment and identification of neglect subtype among stroke patients to predict functional outcomes. (JINS, 2019, 25, 479-489).

Comparison of the Buschke Selective Reminding Test and the California Verbal Learning Test - Second Edition in a heterogeneous sample of people with traumatic brain injury.

This study examined score and classification differences between the Buschke Selective Reminding Test (SRT) and the California Verbal Learning Test - Second Edition (CVLT-II) in a TBI sample. Seventy-nine participants with traumatic brain injury (TBI) were included and were comprised of 49 mild TBI, 11 moderate TBI, and 14 severe TBI. The majority of participants with mild TBI were involved in litigation. Scores were compared between the CVLT-II and SRT on the total sample and after segregating TBI severity. Correlations between the SRT and CVLT-II were variable (r = .23 to .72). Total List score was lower on the SRT across all levels of TBI severity (p < .006). Learning score was lower on the SRT in mild and severe TBI groups (p < .006). Long delay free recall score was lower on the SRT in mild TBI group only (p < .006). Across TBI severity, lower scores were found on the CVLT-II between severe and mild TBI (p = .04). Scores on the SRT did not differ between TBI severities. The two tests appear to provide different clinical interpretations in a TBI sample. Results may be due to features of the normative data, test procedures, and/or word lists. Clinical implications and limitations are discussed.

Assessing the predictive value of a neuropsychological model on concurrent function in acute stroke recovery and rehabilitation.

Objective: Few studies have examined the relationship between cognition and function for acute stroke inpatients utilizing comprehensive methods. This study aimed to assess the relationship of a neuropsychological model, above and beyond a baseline model, with concurrent functional status across multiple domains in the early weeks of stroke recovery and rehabilitation. Method: Seventy-four acute stroke patients were administered a comprehensive neuropsychological assessment. Functional domains of ability, adjustment, and participation were assessed using the Mayo-Portland Adaptability Inventory - 4 (MPAI-4). Hierarchical linear regression was used to assess a neuropsychological model comprised of cognitive tests scores on domains of executive function, memory, and visuospatial-constructional skills (VSC), after accounting for a baseline model comprised of common demographic and stroke variants used to predict outcome. Results: The neuropsychological model was significantly associated, above and beyond the baseline model, with MPAI-4 Ability, Participation, and Total scores (all p-values < .05). The strength of association varied across functional domains. Analyzing tests of executive function, the Color Trails Test-Part 2 predicted MPAI-4 Participation (ß = -.46, p = .001), and Total score (ß = -.32, p = .02). Conclusion: Neuropsychological assessment contributes independently to the determination of multiple domains of functional function, above and beyond common medical variants of stroke, in the early weeks of recovery and rehabilitation. Multiple tests of executive function are recommended to develop a greater appreciation of a patient's concurrent functional abilities.

Psychological disturbance and cognitive functioning in TBI patients.

The current study examined psychopathology and neuropsychological test performance in a traumatic brain injury (TBI) patient sample. Previous research has found that the Minnesota Multiphasic Personality Inventory - Second Edition (MMPI-2) indices of psychological disturbance were related to specific neuropsychological tests of attention and memory. Furthermore, higher scores on clinical scale 2 (Depression) and higher scores on the content scales of Fears and Bizarre Mentation of the MMPI-2 were related to poorer performance in, most notably, Attention and List Learning factors. The present study sought to extend the research by adding a neuropsychological measure of conceptual reasoning. A sample of 116 TBI patients referred for evaluation at a private practice clinic were administered a battery of neuropsychological measures of list learning, working memory, verbal memory, visuographic memory, and conceptual reasoning, as well as the MMPI-2 to assess emotional functioning. Regression analysis indicated that an overall model of MMPI-2 indices significantly predicted poorer performance on List Learning. More specifically, higher scores on the content scales of Obsessions and Fears were most robustly associated with poorer neuropsychological test performance for List Learning and Working Memory respectively. Findings suggest psychopathology is correlated with performance on neuropsychological measures for TBI patients.

Comparison of the Buschke Selective Reminding Test and the California Verbal Learning Test-Second Edition in a stroke population.

There are many tests of learning and memory; however, not all yield analogous results and thus are not interchangeable. This study examined the relationship between the California Verbal Learning Test-Second Edition (CVLT-II) and the Buschke Selective Reminding Test (SRT) in a stroke population. Data from stroke inpatients (N = 102) referred for rehabilitation were collected from medical records. Both tests were administered, as part of a larger neuropsychological assessment. Analyses were conducted on Z-scores from the List Total, Learning, and Long Delay Free Recall (LDFR) subscales of the two tests. SRT and CVLT-II scores were significantly correlated (r = .34 to .52, all p values <.001). However, scores were significantly worse on the SRT compared to the CVLT-II (d = -.90 to - 1.46, all p values <.001). Left hemisphere strokes performed worse than right hemisphere strokes on both tests; however, this trend was not significant. The SRT appeared to be more sensitive to impairment than the CVLT-II; thus, the two tests may not be interchangeable in a stroke population.