El test del reloj: una evaluación cognitiva rápida y sensible al deterioro incipiente / The clock setting test: a quick cognitive assessment sensitive to early deterioration

El test del reloj, utilizado inicialmente como evaluación visuomotora, es de fácil y rápida administración y sirve como indicador de deterioro demencial. Se compararon 15 pacientes con enfermedad de Alzheimer (EA) incipiente (MMSE 23,71 ñ 3,02; GDS 3,50 ñ .76) y 15 controles apareados por edad y educación respecto a la ejecución del reloj (comando y copia), planificación de la hora, lectura horaria, tamaño y ubicación de las agujas. Los enfermos calificaron peor en reloj de comando (6.07 ñ 1.70 vs controles = 9,50 ñ .97 p<.0004); graficación de la hora por código lectoescrito numérico (p<.001) y coloquial (p<.05); ubicación (Chi2 = 10.29 p<.0004), y tamaño de las agujas (Chi2 = 13.89 p<.0001). La planificación horaria en posición 2:50 y 8:40 demostró ser una variable capaz de discriminar el 85% de población en normales y deteriorados leves. Se concluye que las variables consideradas demostraron ser sensibles al deterioro incipiente. Las correlaciones sugirieron que los procesos cognitivos involucrados en esta prueba serían la visuespacialidad, la praxia constructiva, el contenido y el procesado del código específico de la hora, los procesos de transcodificación y la programación frontal

El test del reloj: una evaluación cognitiva rápida y sensible al deterioro incipiente / The clock setting test: a quick cognitive assessment sensitive to early deterioration

El test del reloj, utilizado inicialmente como evaluación visuomotora, es de fácil y rápida administración y sirve como indicador de deterioro demencial. Se compararon 15 pacientes con enfermedad de Alzheimer (EA) incipiente (MMSE 23,71 ñ 3,02; GDS 3,50 ñ .76) y 15 controles apareados por edad y educación respecto a la ejecución del reloj (comando y copia), planificación de la hora, lectura horaria, tamaño y ubicación de las agujas. Los enfermos calificaron peor en reloj de comando (6.07 ñ 1.70 vs controles = 9,50 ñ .97 p<.0004); graficación de la hora por código lectoescrito numérico (p<.001) y coloquial (p<.05); ubicación (Chi2 = 10.29 p<.0004), y tamaño de las agujas (Chi2 = 13.89 p<.0001). La planificación horaria en posición 2:50 y 8:40 demostró ser una variable capaz de discriminar el 85% de población en normales y deteriorados leves. Se concluye que las variables consideradas demostraron ser sensibles al deterioro incipiente. Las correlaciones sugirieron que los procesos cognitivos involucrados en esta prueba serían la visuespacialidad, la praxia constructiva, el contenido y el procesado del código específico de la hora, los procesos de transcodificación y la programación frontal

[Neuropsychological therapy at the computer with the elderly]. / Neuropsychologische Therapie am Computer mit alten Menschen.

Since the end of the 1970s, computers have been used in neuropsychological rehabilitation. This article points out the possibilities, as well as the limits in using computers with the elderly, and is focused on their particular needs. Furthermore, indications are listed whereby computers in neuropsychological therapy in Albertinen-Haus, Hamburg, FRG, have been applied. The need for a neuropsychological diagnostic is shown and illustrated with test examples. Finally, four individual case studies are discussed.

A normative sample using the Loong Computerized Tapping Program.

This article provides results of a comparison between the Halstead-Reitan tapper and a 1988 computerized tapping program by Loong. Care should be taken in using the computerized tapper in diagnosis or assessment.

Gnostic rings: usefulness in sensibility evaluation and sensory reeducation.

The benefit of additional clinical tools for quantifying patients' ability to recognize objects is clear, as well as its correlation with the moving two-point discrimination test. The recognition of letters is such a tool. The authors describe gnostic rings, an additional technique, that is useful for clinical sensibility testing, as well as for sensory reeducation.

Wisconsin Card Sorting Test performance in schizophrenia: remediation of a stubborn deficit.

OBJECTIVE: Schizophrenic patients typically perform poorly on the Wisconsin Card Sorting Test, which is a putative index of prefrontal functioning. The authors attempted to remediate the deficits of schizophrenic patients on this measure by giving detailed instructions and monetary reinforcement. METHOD: Forty-six inpatients with chronic schizophrenia and 20 control subjects with other psychiatric illnesses were given the Wisconsin Card Sorting Test under four conditions that varied in monetary reinforcement and level of instructions. The schizophrenic patients were given the Brief Psychiatric Rating Scale (BPRS) and three information processing measures (the Continuous Performance Test, Span of Apprehension, and Pin Test). RESULTS: Schizophrenic patients performed worse than psychiatric control subjects across most conditions. Monetary reinforcement had little effect on performance, but detailed instructions significantly improved the scores for both groups. When instructions were withdrawn and monetary reinforcement was maintained, both groups continued to show improved performance over baseline. Symptoms were not significantly associated with Wisconsin Card Sorting Test performance. One measure (the Pin Test) correlated significantly with performance on the Wisconsin Card Sorting Test. CONCLUSIONS: The results suggest the importance of combining motivational with instructional factors for training psychiatric patients in problem solving.

Comparison of computerized and examiner-administered neurobehavioral testing techniques.

To better understand the relationship of newly developed computerized neurobehavioral tests to their examiner-administered counterparts, performance on four pairs of tests was compared among 185 solvent-exposed workers in the paint manufacturing industry. Two approaches to the comparison of the test methods (computer or examiner) were employed: (1) the multitrait-multimethod correlation matrix and (2) linear regression modeling of the difference scores between pairs of tests (same functional domain, different test formats). The data revealed that the validity criteria of the multitrait-multimethod technique were met for the tests of simple visual reaction time and attention-concentration (digit symbol substitution). Linear regression analyses demonstrated that the digit symbol substitution and visual memory test pairs were differentially affected by age, vocabulary, solvent exposure, or manual dexterity. Overall, this latter approach holds promise as a means of understanding test format similarities and differences.

A computerized system for measuring time perception in human subjects.

We describe an integrated computerized approach to the design, execution and recording of time perception experiments in human subjects. The program is menu driven and runs on an IBM-compatible microcomputer. The method is easy to use, non-obtrusive to the subjects, and flexible enough to allow the investigator to design studies with a wide range of experimental protocols and study parameters. The fact that the results do not depend on proctor bias or subject-proctor interactions are additional advantages. The technique was applied to study the effects of prompt positive feedback on the time perception of normal human subjects who undergo training. The results of this study are reported.

A new assessment tool for neuropsychopharmacologic research: the Computerized Neuropsychological Test Battery.

The Computerized Neuropsychological Test Battery (CNTB), a new assessment tool for neuropsychopharmacologic research, is based on a neuropsychological approach. While it is based on tests previously shown to be sensitive to subtle changes in neuropsychological functioning, it differs from currently available tools for measuring central nervous system effects of new compounds. It has sensitivity to a broader range of cognitive functioning and is more comprehensive than other measurements in its sampling of neuropsychological functions, providing wider application to diverse clinical populations. The CNTB is valid, reliable, and has two alternative forms. Use of the computer as an expert system maximizes standardization and ease of CNTB administration and data analysis. Using this assessment tool, three groups of subjects were compared: young and elderly neurologically normal subjects and elderly subjects with the dementia syndrome of Alzheimer's disease (AD). The AD subjects' summary score on the CNTB correlated significantly with the Blessed Information Memory Concentration Test score. The CNTB summary score was significantly higher in young subjects than in neurologically normal elderly subjects, demonstrating sensitivity to the effects of aging. The CNTB summary score also was significantly higher in neurologically normal elderly subjects than in elderly subjects with AD dementia.

The computerized Tower of Hanoi: a new form of administration and suggestions for interpretation.

A computerized version of the Tower of Hanoi with a new form of administration was administered to two different groups, 15 men and 22 women, who were university students reporting normal psychological histories, and 24 traumatically brain-injured patients (20 men and 4 women). Scores on this test for both groups can be interpreted as an index of ability to solve problems and of learning strategies. Men and women scored differently on the task, i.e., women used different strategies than men to solve problems.

Neuropsychological rehabilitation: microcomputer-assisted treatment of brain-injured adults.

This study was designed to investigate the contribution of cognitive rehabilitation therapy delivered by computer within an educationally based treatment program for brain-injured adults. The effectiveness of two forms of computer-assisted neuropsychological treatment was examined, 36 head-injured adults received the treatment targeting either attention and memory skills or reasoning and logical thinking skills. Both groups were assessed on three measures of attention and memory and three measures of reasoning before and after the 8-wk. treatment. Analysis indicated significant improvement on five of six measures by both groups. No differential effect was observed by treatment condition. These findings did not support the hypothesis that computer-assisted neuropsychological rehabilitation programs which differ in both content and focus can produce specific effects on cognitive functioning of brain-injured adults.

Slow cortical potentials (SCPS) in schizophrenic patients during performance of the Wisconsin card-sorting test (WCST).

Fifteen schizophrenic patients (diagnosed according to DSM-III-R) and 15 age- and education-matched controls were tested on a computerized version of the Wisconsin card-sorting test (WCST). Slow Cortical Potentials (SCPs) were recorded throughout the performance from frontal, central and parietal electrode sites. As expected, the patients were impaired on the WCST, achieving fewer categories overall and incurring significantly more "unique" errors, although they were not significantly more perseverative than the controls. The patients did not display a generalized impairment in SCPs, differences between the groups emerging only before presentation of the key-cards and after presentation of the feedback regarding the correctness of the response. Neither the choice-card at the beginning of the trial, nor the presentation of the key-cards resulted in attenuated Evoked Potentials (EPs) in the patients. The lack of any abnormality in EPs suggests that the reason for the poor performances of schizophrenic patients on the WCST lies elsewhere than in perceptual stimulus processing. Contrary to expectations no specific impairment in frontal SCPs was detected.

Computer-assisted attention training in schizophrenics. A comparative study.

The evaluation of a computer-assisted attention training program is compared with a cognitive group training program. Both programs were devised to reduce cognitive deficits in schizophrenics. The training programs were given to 30 acute schizophrenics and 30 healthy subjects. Both were shown to be effective in reducing distraction of schizophrenics in reaction-time tasks. By means of training, schizophrenics may attain the same results in reaction time tasks as healthy individuals. The results are discussed under theoretical, methodical and practical aspects.

Differential diagnosis of dementia: a comparison between the expert system EVINCE and clinicians.

The diagnostic performance of the expert system EVINCE was compared with that of 85 clinicians in diagnosing 10 patients suspected of suffering from dementia. A multidisciplinary expert committee provided a standard diagnosis as reference for comparison. The results showed that the syndrome and etiologic diagnoses made by EVINCE were in very close agreement with those of the expert committee and that the diagnostic performance of EVINCE was better than that of the average clinician. The present findings indicate that expert systems, especially those within the realm of complex multidimensional medical problems, could be a valuable aid in medical practice.

The Misplaced Objects Test: a measure of everyday visual memory.

The Misplaced Objects Test is a computerized test of object location recall. The test is structurally similar to tasks used in the evaluation of age and drug effects in preclinical animal research. Delayed recall of 20 common objects which the subject has placed using a touch sensitive screen in a computer-simulated 12-room house is evaluated with three measures. Scores include the number of objects found on the first attempt (Found 1), the number of objects found on the second attempt (Found 2), and the total number of objects found on both attempts (Found T). Performance was evaluated in relation to age, gender, education, and affective status, as well as in relation to several traditional neuropsychological measures. Misplaced Objects Test performance was most strongly associated with age and Wechsler Memory Scale Paired Associate Learning. Additional significant relationships were found with gender, education, and the WAIS Digit Symbol subtest. Potential future applications of the test were discussed.

Computer-assisted attention retraining in head-injured individuals: a controlled efficacy study of an outpatient program.

The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 months postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 weeks with two 2-hr sessions per week for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre and post group comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables.

A computerized visual-search task as a measure of cerebral dysfunction and organization.

This study examined differences in performance on a visual-search task between dysphonetic dyslexic children and three other groups of youngsters (other dyslexic, brain-damaged, and normals) on measures of cerebral dysfunction and cerebral organization. Subjects were required to match a centrally located design to an identical image, yielding a measure of cerebral dysfunction, i.e., latency. Cerebral organization of the diagnostic groups was studied by measuring the conjugate lateral eye movements of each child. Prior research suggests that initial direction of lateral eye movement on a cognitive task is indicative of lateralized cerebral activation. Analysis indicated that the dysphonetic dyslexics group, as predicted, differed significantly on latency from the normal and brain-damaged groups but not from the other dyslexic group. The dysphonetic dyslexic group differed significantly from all other groups on the measure of cerebral organization.

Line-drawing test across ages.

A line-drawing test was standardized for normal subjects to examine effects of normal aging. For this purpose, the results of the test for 168 normal volunteers were quantified using a digitizer and a microcomputer across ages from 9 to 78 yr. Three sets of parallel vertical lines were presented to every subject, the distances between the parallel vertical lines (5, 10, and 15 cm) differed in the three sets. A subject drew an horizontal line starting exactly on the left vertical line and stopped exactly on the right one, and the computer could detect minute inaccuracy at the start and at the stop, which inaccuracy was expressed in mm. In this study, effects of four parameters were evaluated, i.e., ages, sex, distances from the paired vertical lines, and order of trials; all were nonsignificant. The normal range of the deviations was within 2.1 mm (average + 2 SD).

Aphasic and non-brain-damaged adults' descriptions of aphasia test pictures and gender-biased pictures.

Twelve aphasic and 12 non-brain-damaged adult males described the speech elicitation pictures from the Boston Diagnostic Aphasia Examination (BDAE), the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA), the Western Aphasia Battery (WAB), and six pictures representing male-biased or female-biased daily-life situations. For each speech sample we calculated number of words, words per minute, number of correct information units, percentage of words that were correct information units, and percentage of correct information units that were nouns or adjectives (amount of enumeration or naming). The WAB picture elicited more enumeration than the BDAE or MTDDA pictures, and information was produced at a slower rate in response to the WAB picture than the other two pictures. These differences were statistically significant and appear to be clinically important. Gender bias had statistically significant effects on two measures. Male-biased pictures elicited significantly more words and significantly more correct information units than female-biased pictures. However, these differences were small and do not appear to be clinically important. Two of the five measures (words per minute and percentage of words that were correct information units) differentiated non-brain-damaged speakers from aphasic speakers. The magnitude of these differences suggests that these measures provide clinically important information about the problems aphasic adults may have when they produce narrative discourse.

[Computer-assisted assessment of psychologic performance in patients exposed to neurotoxic substances]. / Computergestützte Diagnostik psychischer Leistungsgrössen bei neurotoxisch Exponierten.

A clinico-experimental investigation was conducted to study subjects exposed to neurotoxic pollutants and contaminants by means of the Combitest 2 computer-aided psychometric method. To this end, sensopsychomotor, mnestic and intellectual performance as well as concentration power were evaluated. Single and multiple choice reaction tasks, termometer tracking and maximal tapping were found to be efficient screening methods. Pronounced relationships were seen to exist between psychometric test results and lead concentration levels in blood.