Neuropsychological Test Performance Differentiates Subgroups of Individuals With Adult Moyamoya Disease: A Cross-Sectional Clinical Study.

BACKGROUND AND OBJECTIVES: Moyamoya disease (MMD) is a rare noninflammatory disorder involving progressive intracranial vasculopathy and impaired cerebral blood flow in the anterior circulation, resulting in stroke and cognitive impairment. We aimed to characterize cognitive impairment and the possible predictive value of sociodemographic and clinical characteristics of adults with MMD. METHODS: This cross-sectional study examined neurocognitive performance in a group of 42 consecutive adult patients (mean age = 40.52 years; 69% female) referred for a presurgical neuropsychological evaluation. Neuropsychological functioning was assessed with a comprehensive battery, and cognitive dysfunction was defined as 1.5 SDs below the mean. Neurocognitive performance correlated with clinical/demographic characteristics and disease markers. RESULTS: Most patients (91%) had a history of stroke, and 45% had cognitive deficits, most notably on measures of attention/speed (48%), executive functioning (47%), visuoconstruction (41%), and memory (31%-54%). Only higher educational attainment and poor collateral blood flow in the right hemisphere differentiated cognitively impaired (n = 19) and intact groups (n = 23), and MMD-related characteristics (eg, disease duration, stroke history) did not differentiate the 2 groups. CONCLUSION: Consistent with previous work, frontal-subcortical cognitive deficits (eg, deficits in mental speed, attention, executive functioning) were found in nearly half of patients with MMD and better cognitive performance was associated with factors related to cognitive reserve. Angiographic metrics of disease burden (eg, Suzuki rating, collateral flow) and hemodynamic reserve were not consistently associated with poorer cognitive outcomes, suggesting that cognition is a crucial independent factor to assess in MMD and has relevance for treatment planning and functional status.

A systematic review of how spinal cord injury impacts families.

PURPOSE/OBJECTIVE: This systematic review synthesizes the existing literature on the impact of spinal cord injury (SCI) on families, including parenting, marital relations, and caregivers' psychological adjustment. RESEARCH METHOD/DESIGN: Seven databases were searched for relevant peer-reviewed studies. Dissertations, chapters, editorials, and review articles were excluded. Sixty-six studies that examined SCI's impact on caregivers and families were included. RESULTS: The review included 55 quantitative studies, 10 qualitative studies, and one study that utilized both methodologies. Among the quantitative psychosocial adjustment studies, as well as the qualitative studies, lack of social support was associated with an increased sense of burden, stress, depression, anxiety, and poorer physical health in caregivers. In the family relationship studies (n = 7), few significant differences were found in family functioning. Marital relationship studies (n = 12) frequently examined intimacy (sex, partner affirmations, and emotional support) as an important facet for determining positive or negative outcomes when one partner had SCI. However, divorce rates appeared to increase over time postinjury. Though few studies investigated caregiver needs and interventions (n = 5), needs for social support and information were identified, and several interventions (e.g., family education, more social support, and problem-solving training) were beneficial for promoting caregivers' psychosocial adjustment. CONCLUSIONS: SCI significantly impacts caregivers' sense of burden and psychological distress, with major implications for family functioning and caregivers' physical, mental, and social health. These issues occurred internationally and endured over time. Findings indicated the need for focused interventions to support caregivers' psychosocial adjustment after SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining independent and combined accuracy of embedded performance validity tests in the California Verbal Learning Test-II and Brief Visuospatial Memory Test-Revised for detecting invalid performance.

The California Verbal Learning Test-Second Edition (CVLT-II) Forced Choice Recognition (FC) and Brief Visuospatial Memory Test-Revised (BVMT-R) Recognition Discrimination Index (RD) are embedded performance validity tests (PVTs) assessing material-specific neuropsychological processes (i.e., verbal and visual memory, respectively). Prior research demonstrated the utility of these PVTs independently; however, no study has compared their diagnostic accuracy for identifying invalid performance relative to each other and in combination within a single sample. This cross-sectional study included an adult neuropsychiatric sample who underwent neuropsychological evaluation. Validity groups were determined via independent criterion PVT performance, and consisted of 103 participants with valid and 25 with invalid neurocognitive performance. FC and RD were not significantly correlated (r = .154), yet both differed between validity groups (ηp2 = .14-.19). Previously established FC (≤14) and RD (≤4) cutoffs evidenced 32-40% sensitivity/90-98% specificity, though receiver operating characteristic (ROC) analyses indicated a more liberal FC cutoff (≤15) was optimal. Logistic regression models utilizing both embedded PVTs indicated that FC did not significantly improve classification accuracy above and beyond RD. Results support the clinical utility of existing cutoffs for FC and RD for independently identifying invalid performance, though the latter showed relatively better ability to detect invalid performance when both are used together.

The Impact of Learning and Memory on Performance Validity Tests in a Mixed Clinical Pediatric Population.

OBJECTIVE: This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample. METHOD: Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children's Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included. RESULTS: Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%-26%). Verbal learning/memory performance accounted for 5%-16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group. CONCLUSIONS: Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP's embedded validity measure was most strongly impacted by learning/memory performance.

Comparing the Psychometric Properties of Eight Embedded Performance Validity Tests in the Rey Auditory Verbal Learning Test, Wechsler Memory Scale Logical Memory, and Brief Visuospatial Memory Test-Revised Recognition Trials for Detecting Invalid Neuropsychological Test Performance.

This cross-sectional study evaluated eight embedded performance validity tests (PVTs) previously derived from the Rey Auditory Verbal Learning Test (RAVLT), Wechsler Memory Scale-IV-Logical Memory (LM), and Brief Visuospatial Memory Test-Revised (BVMT-R) recognition trials among a single mixed clinical sample of 108 neuropsychiatric patients (83 valid/25 invalid) with (n = 54) and without (n = 29) mild neurocognitive disorder. Among the overall sample, all eight recognition PVTs significantly differentiated valid from invalid performance (areas under the curve [AUCs] = .64-.81) with 26% to 44% sensitivity (≥89% specificity) at optimal cut-scores depending on the specific PVT. After subdividing the sample by cognitive impairment status, all eight PVTs continued to reliably identify invalid performance (AUC = .68-.91) with markedly increased sensitivities of 56% to 80% (≥89% specificity) in the unimpaired group. In contrast, among those with mild neurocognitive disorder, RAVLT False Positives and LM became nonsignificant, whereas the other six PVTs remained significant (AUC = .64-.77), albeit with reduced sensitivities of 32% to 44% (≥89% specificity) at optimal cut-scores. Taken together, results cross-validated BVMT-R and most RAVLT recognition indices as effective embedded PVTs for identifying invalid neuropsychological test performance with diverse populations including examinees with and without suspected mild neurocognitive disorder, whereas LM had more limited utility as an embedded PVT, particularly when mild neurocognitive disorder was present.

They're not just little adults: The utility of adult performance validity measures in a mixed clinical pediatric sample.

Performance validity tests (PVTs) have become a standard part of adult neuropsychological practice; however, they are less widely used in pediatric testing. The current study aimed to obtain a better understanding of the application of PVTs within a mixed clinical pediatric sample with a wide range of diagnosis, IQ, and age. Cross-sectional data were analyzed from 130 consecutive pediatric patients evaluated as part of clinical care and diagnosed with a variety of medical/neurological, developmental, and psychiatric disorders. Patients were administered a battery of neuropsychological tests; results of intellectual functioning measures (i.e., Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV]), and PVTs (i.e., Test of Memory Malingering [TOMM] and Digit Span [DS] subtests of the WISC-V/WAIS-IV) were analyzed to assess PVT performance across the sample as well as age- and Full-Scale IQ-related (FSIQ) effects on pass rate. Results suggested that the TOMM is an effective validity test for youth, as the TOMM adult cutoff score was also valid for children (88% pass rate on TOMM trial 1 cut-score ≥41, 71% pass rate on TOMM trial 1 cut-score ≥45). In contrast, Reliable Digit Span (RDS) was less accurate (34% failed RDS [cut-score ≤6], 54% failed RDS-r [cut-score ≤10], and 25% failed DS ACSS [cut-score ≤5]) using standard adult cutoffs. Notably, although TOMM scores were not strongly influenced by IQ, DS scores increased as IQ increased. Overall, further analysis of PVTs can champion new standards of practice through additional research establishing PVT accuracy within pediatric populations.

A pediatric case of NF1 and moyamoya syndrome: Neuropsychological evaluation pre- and post-EDAS.

Studies have shown that a subset of patients with neurofibromatosis type 1 (NF1) experience associated vascular conditions, with moyamoya syndrome one of the most common comorbidities. While NF1 and moyamoya syndrome are each associated with neurocognitive deficits, no neuropsychological data has been presented for an individual with comorbid NF1 and moyamoya syndrome, particularly pre- and post-re-vascularization surgery. The present case describes the neuropsychological profile of a bilingual Latina girl with NF1 and moyamoya syndrome, who was assessed pre- (age 5 years, 9 months) and post-EDAS (age 6 years, 1 month). Each evaluation included a clinical interview and comprehensive battery of neuropsychological tests. Results of pre-EDAS evaluation documented significant deficits in sustained attention, daily executive functioning, and academic abilities, and she met criteria for ADHD-combined type. Results of post-EDAS evaluation revealed generally stable abilities with relative improvements in social, emotional, and behavioral functioning, but relative decline in visuospatial skills, visual spatial learning/memory, and aspects of executive functioning. Math abilities also remained consistently poor and she was diagnosed with a specific learning disability (mathematics). This case study adds to the current literature by being among the first to present pre- and post-surgical neuropsychological data for a child with NF1 and moyamoya syndrome. Findings are discussed in the context of previous literature, the importance of individual socio-cultural considerations in the case (i.e., language, education, culture), and recommendations for future research.

Case of right hemispatial neglect and transcortical sensory aphasia following left occipitotemporoparietal glioblastoma resection.

The neurobehavioral syndrome of hemispatial neglect, which can result from insults such as stroke, brain tumor, or head injury, has most frequently been described as occurring for the left-side of hemispace following lesions to the right hemisphere. While right hemispatial neglect/inattention may occur following left hemisphere lesions as well, it has received limited attention in the scientific literature. The present case describes an inpatient neuropsychological evaluation with a 67-year-old, African American man presenting with right hemispatial neglect following resection of a large glioblastoma in the left occipitotemporoparietal region. The evaluation included a clinical interview, neurobehavioral status examination, and a battery of neuropsychological tests. Results documented consistent evidence of right hemispatial neglect across the administered tests, which could not be attributed to an established right visual field cut. Neuropsychological testing also revealed nearly global deficits in complex visuoperception, posterior/receptive language, memory, and complex attention/executive functioning abilities, while basic attention remained intact. Further remarkable findings of this case included color anomia and transcortical sensory aphasia. Findings from the case are discussed in the context of the preexisting literature on hemispatial neglect and the theoretical specialization of the parietal lobe for spatial attention/awareness.

Comprehensive neuropsychological findings in a case of Marchiafava-Bignami disease.

OBJECTIVE: Marchiafava-Bignami disease (MBD) is a rare complication associated with chronic heavy alcohol use, with case reports documenting a range of cognitive outcomes. Given the variability in MBD presentation and outcomes, milder cases may remain undiagnosed and few studies or case reports have presented a comprehensive neuropsychological profile of these patients. The objective of this case study was to describe the neuropsychological presentation and findings of a case of likely MBD. METHOD: The patient was a 46-year-old, African American female with a complex history of malnutrition and alcohol abuse presenting for outpatient neuropsychological evaluation. She was administered a comprehensive battery of neuropsychological tests as part of routine clinical care. RESULTS: Neuropsychological data demonstrated severe deficits in executive functions, complex visuoconstruction, and motor dexterity, as well as an amnestic verbal and visual memory pattern. CONCLUSIONS: Overall, data and the patient's initial presentation of acute behavioral change were consistent with some reports of cognitive and behavioral sequela of MBD. Additionally, the patient's history of chronic poor nutritional intake with exacerbation from chronic heavy alcohol use, and imaging findings of severe cerebral/corpus callosum white matter loss and bilateral frontoparietal atrophy, were highly suggestive of MBD.

Working Memory, Processing Speed, and Memory Functioning Are Minimally Predictive of Victoria Symptom Validity Test Performance.

A sound performance validity test is accurate for detecting invalid neuropsychological test performance and relatively insensitive to actual cognitive ability or impairment. This study explored the relationship of several cognitive abilities to several performance indices on the Victoria Symptom Validity Test (VSVT), including accuracy and response latency. This cross-sectional study examined data from a mixed clinical sample of 88 adults identified as having valid neurocognitive test profiles via independent validity measures, and who completed the VSVT along with objective measures of working memory, processing speed, and verbal memory during their clinical neuropsychological evaluation. Results of linear regression analyses indicated that cognitive test performance accounted for 5% to 14% of total variance for VSVT performance across indices. Working memory was the only cognitive ability to predict significant, albeit minimal, variance on the VSVT response accuracy indices. Results show that VSVT performance is minimally predicted by working memory, processing speed, or delayed verbal memory recall.

Prevalence of Psychiatric Diagnoses in Pediatric Chiari Malformation Type 1.

This cross-sectional study investigates the prevalence and risks for psychiatric diagnoses in a large cohort of children with Chiari malformation type 1 (CM1) presenting for neurosurgical evaluation. Children between the ages of 6 and 17 years who were evaluated and diagnosed with CM1 at a neurosurgery clinic were identified. Eighty-six participants were recruited for this study with an average age of 11 years. Parents of participants completed a pediatric medical history questionnaire and a semistructured interview regarding the child's psychiatric, developmental, medical, and family history. A review of medical records was completed to complement interview data. Elevated rates of psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD) (22.1%), anxiety (12.8%), and depression (10.5%), were identified in the study population when compared to published norms in the general population documented by the American Psychiatric Association in 2013. In addition, elevated rates of psychiatric diagnoses in first-degree relatives of study participants were also identified. A 2-step binary logistic regression analysis revealed that maternal complications during pregnancy (Wald = 6.52, p = 0.01) increased the risk of a psychiatric diagnosis 9-fold. Premature birth (Wald = 6.79, p = 0.01) also significantly predicted a psychiatric diagnosis amongst participants. The current findings suggest a high prevalence of psychiatric illness in children with CM1. Pregnancy complications were associated with a high risk of a psychiatric diagnosis. Early CNS developmental disturbance may explain this relationship. Prematurity only slightly improved the prediction model. Limitations and future directions are discussed, including the cross-sectional nature of the present study, possible self-selection bias, and the importance of future investigation of other causative and/or associative factors of CM1, such as cognitive, psychiatric, and medical influences on health status.

Clinical utility and psychometric properties of the Brief: Coping With Problems Experienced with caregivers.

The Brief Coping with Problems Experienced (COPE) is designed to assess the varying coping strategies used by individuals in response to stress. It comprises 14 scales, each of which assesses the degree to which a respondent utilizes a specific coping strategy. This brief summary provides a review of the psychometric properties of the Brief COPE with caregivers. (PsycINFO Database Record

Blame, coping, and psychosocial outcomes in caregivers of individuals with brain injury.

OBJECTIVE: Acquired brain injury (ABI) is associated with many physical and psychiatric conditions. Oftentimes, the individual's family members are responsible for providing long-term care, leaving caregivers vulnerable to negative effects of caregiving including stress, depression, and decreased quality of life. Attribution theory suggests that caregivers may blame the individual with the ABI for their injury as a way to understand their own circumstances. The objective of this study was to investigate caregiver coping strategies as possible mediators between caregiver family member blame and caregiver psychosocial outcomes among caregivers of individuals with ABI. METHOD: Caregivers of individuals with ABI (n = 94) completed an online survey of self-report measures regarding coping (emotion-focused, problem-focused, and dysfunctional strategies), blame (direct, indirect, and preoccupation with blame), depressive symptoms, and quality of life (QOL). Bootstrapping mediation analyses were conducted to investigate the mediating role of caregiver coping strategies between blame attributions, and either depressive symptoms or QOL. RESULTS: Results demonstrated that the use of more dysfunctional coping strategies significantly mediated the relationship between indirect blame, and depressive symptoms and QOL. Furthermore, using more dysfunctional coping strategies also significantly mediated the relationship between preoccupation with blame and depressive symptoms. CONCLUSIONS: Results of this study point to the important role blame attributions play in the use of coping strategies and subsequent psychosocial outcomes. By understanding the relationships between blame attributions, coping behavior, and psychosocial outcomes, clinicians may better tailor treatments to optimize QOL and promote the psychological well being of caregivers and care recipients. (PsycINFO Database Record

Parent-Reported Executive Dysfunction in Children and Adolescents with Chiari Malformation Type 1.

BACKGROUND: Children with Chiari malformation type 1 (CM1) have increasingly presented to neurosurgery clinics. Limited research relating to the cognitive dysfunction experienced by this population has been completed. In adults, inhibition problems and executive dysfunction have been documented. METHODS: Seventy-seven parental reports of children with CM1 were included in the study. Parents completed questions on a scale rating daily executive functioning as well as reporting on common neurological symptoms. RESULTS: The sample consisted of 41 males and 36 females with a mean age of 133.57 ± 42.18 months. Thirty-eight subjects had had decompression surgery. The most common neurological symptoms included: headache (69%), a history of pain (31%) and gait disturbance (20%). One third of the sample demonstrated overall executive functioning impairment, with working memory elevations being most prevalent (44%). Depression, gender, age and decompression surgery were not related to executive dysfunction. CONCLUSIONS: The parental report of executive dysfunction in children with CM1 was higher than the standardized healthy sample. Metacognitive problems, especially working memory and initiation problems were most prevalent. A quick parental rating scale identifying children with executive dysfunction may be beneficial for neurosurgeons and assist with referrals for a more comprehensive neuropsychological assessment.

Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis.

BACKGROUND: Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. However, gender differences in psychosocial adjustment among caregivers have not been fully explored. OBJECTIVE: The purpose of this study was to explore gender differences in the need for various supports and type of social support needed, caregiver strain, and quality of life among caregivers for individuals with MS. METHODS: 106 caregivers participated in this study. Independent sample t-tests and multiple regression analyses were conducted to examine gender differences in strain, need for supports, social support, and quality of life. RESULTS: Analyses revealed gender difference among important psychosocial variables. Specifically, women reported higher levels of caregiver strain, higher needs for emotional support, and higher perceived social support. Additionally, multiple regression analyses revealed an inverse relationship between expressed emotional needs and quality of life for men, but not for women. CONCLUSIONS: MS caregivers experience significant strain that diminishes quality of life. Social support and needs fulfillment can act to buffer this stress; however, results indicate that this varies by gender, with gender differences observed in strain, perceived support, and expressed needs among MS caregivers. The study implications for rehabilitation research are discussed.