Neuropsychological predictors of health and safety abilities in dementia.

The Independent Living Scales Health and Safety (ILS HS) scale is commonly used by neuropsychologists when evaluating older adults' instrumental activities of daily living (IADLs). However, there is a minimal amount of research on its use in dementia populations and, specifically, its relationship to other neuropsychological measures. The present study investigated relationships between the ILS HS scale and measures of cognition and depression. The study utilized archival data from a sample (N = 142) of older adults (mean age = 77.85) diagnosed with dementia, who were evaluated at Saint Louis University Medical Center and administered the ILS HS scale as part of a larger clinical neuropsychological evaluation. Multiple regression analyses demonstrated that up to 37% of the variance in ILS HS performance was accounted for by demographic variables, premorbid intelligence, and cognitive functioning (e.g., global cognition, delayed verbal recall, and executive functioning), and regression models demonstrated medium to large effect sizes. Depression and self- or informant-reported IADLs were unrelated to the ILS HS scale. Results suggest that older adults' ability to function in health and safety-related situations requires a range of cognitive abilities. Performance on these measures may help guide clinical decision making regarding independent living and treatment planning.

A single case report of Moyamoya disease presenting in a psychiatric setting.

Moyamoya disease (MMD) is a rare cerebral vasculopathy with limited information on the associated cognitive and emotional sequelae, particularly presenting in a psychiatric setting. We present the case of a 25-year-old female with a history of MMD and depressive disorder. She underwent revascularization surgery following an ischemic stroke at age 15 years. Magnetic resonance imaging at the time of the current assessment revealed markedly abnormal appearance in the anterior cerebral circulation with extensive periventricular collateral vasculature involvement. Neuropsychological assessment data revealed deficits in inhibition and problem-solving, consistent with frontal lobe dysfunction. We discuss the importance of further research on the neuropsychological sequelae of MMD.

Neurocognitive dysfunction in adult moyamoya disease.

We wanted to determine the neurocognitive profile of adult patients with moyamoya disease prior to neurosurgical intervention. The experience of three United States medical centers, Columbia University, University of Illinois at Chicago, and the University of Texas Southwestern Medical Center at Dallas, were combined. Clinical data from adult patients (N = 29) referred for neuropsychological evaluation from 1996 to 2008 were reviewed. Neurocognitive functioning was assessed using standardized neuropsychological tests and all data were converted to z-scores. Memory, attention, processing speed, verbal memory, visuo-spatial, language, and executive functions were examined. Cognitive dysfunction was defined as performance in two or more cognitive domains 1.5 standard deviations below age-corrected normative means OR one or more cognitive domains two standard deviations below age-corrected normative means. Manual strength and dexterity, as well as depressive symptoms, were also assessed. Two-thirds of patients demonstrated neurocognitive dysfunction. A large proportion of patients were found to have pronounced cognitive dysfunction (>2 SD below the mean) on tests of processing speed (29%), verbal memory (31%), verbal fluency (26%) and executive function (25%). Manual strength and dexterity were also affected in many patients, with impairment found in 36-58% of patients. Twenty-eight percent of patients reported moderate to severe depression, but depressive symptoms did not correlate with neurocognitive findings. A large proportion of adults with moyamoya disease demonstrate disruption of neurocognition in a broad range of functions, particularly those mediated by subcortical and frontal regions. The pattern of deficits suggests a mechanism of diffuse small vessel disease possibly caused by chronic hypoperfusion.

Detecting feigned impairment with the digit span and vocabulary subtests of the Wechsler Adult Intelligence Scale-third edition.

The WAIS-III Digit Span and Vocabulary subtests were investigated as indicators of feigned cognitive impairment. Participants included 64 undergraduates randomly assigned to control, symptom-coached, or test-coached groups. Six previously researched validity indicators were examined. We hypothesized that symptom-coached participants would perform worse relative to test-coached simulators. Analyses determined both simulator groups performed lower than controls on all indicators except Vocabulary. Symptom-coached participants, however, did not differ from test-coached participants on any indicator. Classification accuracies for these six indicators ranged from 42 to 78%. While the WAIS-III validity indicators hold some promise, they should not be employed as independent measures.