Clinical Utility of the Neuropsychological Assessment Battery Judgment Subtest in the Evaluation of Older Adults.

OBJECTIVE: The purpose of this retrospective archival study was to explore the clinical utility of the Judgment subtest of the Neuropsychological Assessment Battery (NAB) in older adults who were referred because of cognitive concerns. Specifically, we were interested in how NAB Judgment covaried with other measures of executive functioning. METHOD: 226 adults, aged 61-89 years (48% dementia, 35% mild cognitive impairment, 18% cognitively intact) completed NAB Judgment. They also completed Trail Making Test (TMT) A and B. In addition, Behavior Rating Inventory of Executive Function (BRIEF-A) informant and self-reports were obtained to measure executive functioning in daily life. RESULTS: Scores on NAB Judgment did not correlate significantly with BRIEF-A informant ratings. However, there was a statistically significant correlation between BRIEF-A informant ratings and TMT B. Better performance on TMT B was associated with fewer informant concerns. Furthermore, subgroups with versus without informant BRIEF-A Metacognition indices in the range of impairment demonstrated a statistically significant difference on TMT B but not on Judgment. CONCLUSIONS: Executive functioning in older adults should not be assessed using NAB Judgment alone. Such an evaluation should be supplemented with other in-person tests as well as informant ratings of daily functioning.

Correlates of performance on the Child and Adolescent Memory Profile (ChAMP) in a mixed pediatric sample.

This study aimed to determine some of the factors that influence performance on a comprehensive test of verbal and visual memory in children, the Child and Adolescent Memory Profile (ChAMP) in a mixed clinical sample (n = 178; 56% male, 67% White, median age 12 years). We used hierarchical linear regression analyses with ChAMP standard scores as the dependent variable, and parental education as well as Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) factor index scores as the independent variables. WISC-V Processing Speed and (to a lesser extent) Working Memory were statistically significant predictors of most ChAMP Index scores. In addition, WISC-V Verbal Comprehension contributed to the model for ChAMP Verbal Memory, and WISC-V Visual Spatial to the model for ChAMP Visual Memory. In each case better performance on the WISC-V was predictive of higher scores on the ChAMP, with large effect sizes. WISC-V variables also mediated the positive effect of parental education on ChAMP scores. We conclude that clinicians should consider performance on measures of speed of processing, working memory, language and visual-spatial skills as potential influences on ChAMP results that may suggest a specific memory deficit.

Parent ratings of children's daily functioning in a mixed clinical sample.

Parent questionnaires pertaining to executive and emotional/behavioral functioning are routinely included in neuropsychological evaluations to complement face-to-face cognitive tests. We evaluated in a clinical sample of 198 6-16 year-old children the degree of overlap and divergence between two common parent rating scales: the Behavior Assessment System for Children-Third Edition (BASC-3) and the Behavior Rating Inventory of Executive Function-Second Edition (BRIEF-2). This sample was 66% male, 70% white, and included both neurological diagnoses (e.g., 33% traumatic brain injury, 12% cerebral palsy) and neurodevelopmental ones (e.g., 10% attention-deficit/hyperactivity disorder). Inter-correlations between composite indices from the respective instruments were moderate (.41-.77). They disagreed about the presence or absence of impairment in 26% of the cases. Cluster analysis revealed four subtypes: Cluster 1 had mild externalizing and executive concerns, Cluster 2 had global emotional/behavioral and executive concerns, Cluster 3 had normal functioning, and Cluster 4 had mild internalizing and executive concerns. Clusters 2 and 3 differed in age and parental education, whereas Clusters 1 and 4 differed in Full Scale IQ. We conclude that BASC-3 and BRIEF-2 provide complementary information about a child's functioning that can inform treatment of neurobehavioral dysfunction. Elevations as well as patterns of the respective profiles on these instruments may help direct such treatment (e.g., cognitive rehabilitation, behavioral management and/or psychotherapy).

Psychological Correlates of Self-Rated Resilience in the Context of Subjective Cognitive Concerns in Older Adults.

OBJECTIVE: The purpose of this study was to evaluate psychological correlates of self-rated resilience, as assessed with the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC-10), in older adults. In particular, we were interested in the degree to which self-rated resilience might be a protective factor against cognitive decline. METHOD: In total, 100 adults aged 60-90 years who had been referred because of subjective cognitive concerns completed self-report measures of resilience, symptoms of anxiety and depression, and satisfaction with life. They also completed a test of learning and memory. Ratings about daily functioning at home and in the community were obtained from both participants and proxy informants. RESULTS: Resilience ratings correlated strongly negatively with concurrent self-rated symptoms of anxiety and depression, and strongly positively with self-rated life satisfaction. However, only informant ratings of daily functioning correlated with actual participant performance on a test of learning and memory, with lower ratings being associated with worse test performance. CONCLUSIONS: Self-rated resilience, as measured by the CD-RISC-10, is primarily related to subjective well-being and does not inform sufficiently about relative risk for cognitive dysfunction in older adults.

Performance and Symptom Validity in Outpatient Pediatric Neuropsychological Evaluations.

This study aimed to clarify the value of using different types of validity measures in pediatric neuropsychological evaluations. We examined the relationship between performance (PVT) and symptom (SVT) validity tests as well as demographic variables and results from a screening test of learning and memory (i.e. Child and Adolescent Memory Profile [ChAMP]) in a mixed pediatric sample (n = 103). There was minimal overlap between PVT and SVT failures. Regression analyses demonstrated that PVT results, parental education, and history of special education were statistically significant predictors of ChAMP results, whereas SVT results were not.

Utility of CVLT-3 response bias as a measure of performance validity after traumatic brain injury.

OBJECTIVE: We sought to determine the utility of a new performance validity index that was recently proposed. In particular, we wanted to determine if this index would be associated with a specificity of at least .90, a sensitivity of at least .40, and an Area Under the Curve of at least .70 in a traumatic brain injury (TBI) sample. METHOD: We used logistic regression to investigate how well this new index could distinguish persons with TBI (n = 148) who were evaluated within 1-36 months after injury. All participants had been classified on the basis of at least two independent performance validity tests as having provided valid performance (n = 128) or invalid performance (n = 20). RESULTS: The new performance validity index had acceptable specificity (.96) but had suboptimal sensitivity (.35) and Area Under the Curve (.66). It was concerning that almost half (5/12) of the cases that were identified by this index as providing invalid effort were false positives. Although a slightly more liberal cut-off improved sensitivity, the problem with poor positive predictive power remained. The conventional Forced Choice index had relatively better classification accuracy. CONCLUSION: Differences in base rates between the original sample of Martin et al. and the current one most likely affected positive predictive power of the new index. Although their performance validity has excellent specificity, the current results do not support the application of this index in the clinical evaluation of patients with traumatic brain injury when base rates of invalid performance differ markedly from those in the original study.

Cognitive complaints in older adults: relationships between self and informant report, objective test performance, and symptoms of depression.

This study explored the relationships between objective measures of cognitive functioning, self and informant reports of cognitive problems in daily life, and depression screening in older adults who had been referred because of reported or suspected cognitive changes. We used archival data from 100, predominantly White (97%), typically educated (M = 13.25 years), older adults (M = 70.38 years) who received an outpatient neuropsychological evaluation. We characterized the cognitive performance using the CVLT-II Total score. We characterized patient and collateral reports using the BRIEF-A MI index, a normed scale of cognitive problems in daily life. We also incorporated a depression screener (PHQ-9) into our analyses. Multiple linear regression analysis revealed that only the informant reported problems in daily life, using the BRIEF-A MI index, was a significant predictor of objective cognitive deficits, as defined by CVLT-II Total scores. Self BRIEF-A MI index scores were not significant predictors of CVLT-II Total performance after we accounted for depression using the patient's PHQ-9 score. Additionally, elevated depression widened the discrepancy between raters, with elevated depression associated with worsening sself-report scores compared to informant-reported scores. As informant-reported problems were the strongest predictor of cognitive deficits, we recommend routine collection of collateral informant reports in the neuropsychological evaluation of older adults referred for cognitive concerns. We also recommend incorporating self-ratings of daily life functioning and screening for depression to contextualize patient complaints and address their concerns, even in the absence of objective cognitive dysfunction.

Performance on, and correlates of, the Brief Visuospatial Memory Test-Revised after traumatic brain injury.

OBJECTIVE: This study investigated the performance on, and correlates of, the Brief Visuospatial Memory Test - Revised (BVMT-R) in patients with traumatic brain injury (TBI). METHODS: Participants included 100 patients with TBI and 100 demographically matched controls. We first used regression analysis to determine predictors of BVMT-R performance in the clinical group. We then used analysis of variance as well as logistic regression to determine how BVMT-R findings differed between the clinical and control groups. RESULTS: Injury severity and visuospatial ability both contributed to the prediction of BVMT-R Total Recall and Delayed Recall scores in the TBI group. Mean differences between the TBI and control groups on these variables were statistically significant, but overall individual classification accuracy was limited at 59%. CONCLUSIONS: The BVMT-R has some clinical utility in the evaluation of patients with TBI but should not be used in isolation.

Clinical Utility of the Child and Adolescent Memory Profile (ChAMP) After Pediatric Traumatic Brain Injury.

Sixty-one children and adolescents with traumatic brain injury completed the Child and Adolescent Memory Profile (ChAMP; Sherman & Brooks, 2015) within 1 to 12 months post injury. Most of the ChAMP index scores demonstrated statistically significant negative correlations with time to follow commands following traumatic brain injury. Compared with demographically matched neurologically healthy controls, selected from the ChAMP standardization sample, participants with traumatic brain injury had statistically significantly lower scores on all ChAMP index scores but sensitivity and specificity were suboptimal. We conclude that the ChAMP has modest clinical utility as part of a more comprehensive evaluation of sequelae of traumatic brain injury in children and adolescents.

Utility of the D-KEFS color word interference test as an embedded measure of performance validity after traumatic brain injury.

ObjectiveWe sought to determine the accuracy of embedded performance measures for the D-KEFS Color Word Interference Test that were recently proposed by Eglit et al. In particular, we wanted to determine if these indices would be associated with a specificity of at least .90, an Area Under the Curve of at least .70 and a positive likelihood ratio of at least 2. Method: We used logistic regression to investigate how well these indices could distinguish persons with traumatic brain injury (n = 169) who were evaluated within 1-12 months after injury. All participants had been classified on the basis of at least three independent performance validity tests as valid performance (n = 145) or invalid performance (n = 24). Results: None of the three indices that Eglit et al. had proposed as embedded performance measures for the D-KEFS Color Word Interference Test achieved the a priori defined minimally acceptable level of specificity. One of them did meet the criteria for Area Under the Curve as well as positive likelihood ratio. Conclusion: The current results do not support the application of the Eglit et al. embedded performance validity measures for the D-KEFS Color Word Interference Test in the clinical evaluation of patients with traumatic brain injury.

Clinical utility of the GAD-7 in identifying anxiety disorders after traumatic brain injury.

To determine if the GAD-7 provides incremental value, predicting a final diagnosis of an anxiety disorder after traumatic brain injury (TBI). Retrospective analysis of archival data of 100 patients with TBI, who underwent neuropsychological evaluation 1-12 months after injury. Receiver Operating Characteristic analysis determined the optimal cutoff point for clinically significant symptoms on the GAD-7. Hierarchical logistic regression analyses determined the relative contributions of premorbid psychiatric history, injury severity, and GAD-7 results in predicting a final diagnosis of anxiety disorder. GAD-7 cutoff point of ≥7 yielded the best combination of sensitivity and specificity regarding a final diagnosis of anxiety disorder. Within hierarchical logistic regression models, injury severity did not statistically significantly add to prior psychiatric history in predicting a final diagnosis of anxiety disorder. When GAD-7 was added, it made a statistically significant contribution in accounting for such a diagnosis and increased sensitivity from 71% to 91%. The GAD-7 holds diagnostic utility as a screening measure for anxiety disorders in patients with TBI. It should not be used in isolation but as part of a more comprehensive interview and history. The GAD-7 can benefit clinicians in assisting with timelier identification and treatment of symptoms of anxiety.

Sluggish cognitive tempo in children with traumatic brain injuries.

This exploratory study is the first to investigate whether the construct of sluggish-cognitive tempo (SCT) is related to slowed processing speed in children with traumatic brain injury (TBI), while also considering pre-morbid and injury variables. The study evaluated SCT, as measured by the Child Behavior Checklist (CBCL), and processing speed, as assessed with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV Processing Speed Index), in children who sustained TBI with a wide range of injury severity. Injury variables examined included the length of coma, presence of neuroimaging findings, and time between injury and assessment. Children's cognitive reserve, as estimated by parental level of education, was a non-injury variable. The participants included 50 children, ages 6-16 years, without co-morbid neurological or psychiatric conditions who underwent a neuropsychological evaluation within 1-12 months after injury. Results indicated no significant correlations between SCT and any of the WISC-IV index scores. Children with a moderate-severe TBI did not differ from those with uncomplicated mild TBI on SCT but they had statistically significant lower WISC-IV Processing Speed. Although parents of children with uncomplicated mild TBI had higher levels of education as compared to parents of children with moderate-severe TBI, there was no statistically significant relationship between the level of parental education and either SCT or Processing Speed. This study suggests that SCT, as measured by the CBCL, is not a sensitive measure of sequelae of pediatric TBI.

Patterns of Performance and Symptom Validity Test Findings After Mild Traumatic Brain Injury.

OBJECTIVE: The purpose of this study was to evaluate the presence of demographic, injury and neuropsychological correlates of distinct patterns of performance validity test and symptom validity test results in persons with mild traumatic brain injury (mTBI). METHOD: One hundred and seventy-eight persons with mTBI completed the Test of Memory Malingering (TOMM; performance validity) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; symptom validity) within 1-12 months postinjury. Four groups were compared: (a) pass both TOMM and MMPI-2-RF validity criteria, (b) pass TOMM and fail MMPI-2-RF, (c) fail TOMM and pass MMPI-2-RF, and (d) fail both TOMM and MMPI-2-RF. RESULTS: Compared to Group a, participants in combined Groups b-d were more than twice as likely to be engaged in financial compensation-seeking and about four times less likely to have neuroimaging evidence of an intracranial lesion. The average performance of Group d on an independent test of verbal learning was more than 1.5 standard deviations below that of Group a. Participants in Group b were more likely to have intracranial lesions on neuroimaging than participants in Group c. CONCLUSION: Performance and symptom validity tests provide complementary and non-redundant information in persons with mTBI. Whereas financial compensation-seeking is associated with increased risk of failure of either PVT or SVT, or both, the presence of intracranial findings on neuroimaging is associated with decreased risk of such.

Clinical Utility of the Patient Health Questionnaire-Adolescent in Adolescents With Traumatic Brain Injury.

OBJECTIVE: To determine the clinical utility of the Patient Health Questionnaire-Adolescent (PHQ-A) in screening for depressive disorders in adolescents following traumatic brain injury (TBI). DESIGN: Retrospective analysis of data collected as a part of routine clinical care over a period of 4 years. SETTING: Regional rehabilitation facility. PARTICIPANTS: Adolescents (n = 101) with mild to moderate-severe TBI who were referred for an outpatient neuropsychological evaluation within 1 to 12 months postinjury. MAIN OUTCOME MEASURES: PHQ-A, PHQ-A_2 (2-item version), and Processing Speed Index (PSI) from the Wechsler scales of intelligence. RESULTS: Both premorbid depressive disorder and PHQ-A scores predicted a postinjury diagnosis of depressive disorder, with a combined sensitivity of 0.91 and specificity of 0.59. PHQ-A_2 did not reach acceptable levels of sensitivity in predicting suicidal thoughts. PHQ-A scores did not add significantly to the prediction of PSI results after accounting for TBI severity. CONCLUSIONS: PHQ-A has clinical utility as a screening instrument for depressive disorders in outpatient adolescents with TBI when the cutoff for clinically significant concern is set at more than 4 and premorbid psychiatric history is also taken into account.

Utility of abbreviated versions of the test of memory malingering in children with traumatic brain injury.

We evaluated the classification accuracy of two abbreviated versions of the Test of Memory Malingering (TOMM) in prediction of results on the full-length instrument in a sample of 126 children who were evaluated within 1-12 months after traumatic brain injury. Both a version based on administration of Trial 1 and a version based on administration of only the first 10 items of Trial 1 had acceptable specificity (i.e., > .90) and sensitivity (i.e., > .60) with regard to prediction of pass/fail results on the complete TOMM. Failure on the TOMM suppressed performance on measures of processing speed that were otherwise sensitive to severity of traumatic brain injury. We conclude that these abbreviated versions of the TOMM can be used in clinical practice with children with traumatic brain injury, at the discretion of the neuropsychologist.

The incremental value of neuropsychological assessment: A critical review.

Objective: The purpose of this critical review was to evaluate the current state of research regarding the incremental value of neuropsychological assessment in clinical practice, above and beyond what can be accounted for on the basis of demographic, medical, and other diagnostic variables. The focus was on neurological and other medical conditions across the lifespan where there is known risk for presence or future development of cognitive impairment.Method: Eligible investigations were group studies that had been published after 01/01/2000 in English in peer-reviewed journals and that had used standardized neuropsychological measures and reported on objective outcome criterion variables. They were identified through PubMed and PsychInfo electronic databases on the basis of predefined specific selection criteria. Reference lists of identified articles were also reviewed to identify potential additional sources. The Grades of Recommendation, Assessment, Development and Evaluation Working Group's (GRADE) criteria were used to evaluate quality of studies.Results: Fifty-six studies met the final selection criteria, including 2 randomized-controlled trials, 9 prospective cohort studies, 12 retrospective cohort studies, 21 inception cohort studies, 2 case control studies, and 10 case series studies. The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.Conclusions: Neuropsychological assessment can improve both diagnostic classification and prediction of long-term daily-life outcomes in patients across the lifespan. Future high-quality prospective cohort studies and randomized-controlled trials are necessary to demonstrate more definitively the incremental value of neuropsychological assessment in the management of patients with various neurological and other medical conditions.

MMPI-2-RF patterns after traumatic brain injury.

Individuals who sustain traumatic brain injury (TBI) may report various cognitive, emotional, and somatic symptoms. To formally assess the possibility of subtypes of symptom profiles following TBI, we examined patterns of Minnesota Multiphasic Personality Inventory-2-Restructured form (MMPI-2-RF) restructured clinical scales in 201 persons with TBI, 1 to 12 months post injury. We also evaluated how these patterns varied according to injury, demographic, and premorbid variables. Cluster analysis identified 4 distinct MMPI-2-RF profiles. Clusters 1 and 4 differed primarily in overall profile elevation, while Clusters 2 and 3 varied in pattern. Although Cluster 1 endorsed the most distress across clinical scales, they were also most likely to have highly elevated Symptom Validity scales. In addition, they had relatively greater prevalence of prior personal and substance abuse histories than Cluster 4. In contrast, Cluster 4 did not endorse any significant elevations on clinical scales, even though it comprised relatively more patients with positive neuroimaging findings. Cluster 2 was predominantly female and endorsed prominent somatization on the MMPI-2-RF, whereas Cluster 3 was predominantly male, and their MMPI-2-RF pattern was characterized by subclinical levels of guardedness and restlessness. Compared with Cluster 2, Cluster 3 had relatively greater proportions of participants with positive neuroimaging findings as well as prior substance abuse histories. The present study is consistent with research that suggests that subjective symptom reporting following TBI is associated to a considerable degree with premorbid factors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effect of Cognitive Reserve on Children With Traumatic Brain Injury.

OBJECTIVES: Traumatic brain injury can result in cognitive impairments in children. The objective of this retrospective study was to determine to what extent such outcomes are moderated by cognitive reserve, as indexed by parental education. METHODS: Sixty 6- to 16-year-old children completed the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) within 30-360 days after having sustained a traumatic brain injury (TBI). Their Full-Scale IQ and factor index scores were compared to those of demographically matched controls. In addition, regression analysis was used to investigate in the TBI group the influence of injury severity in addition to parental education on WISC-V factor index scores. RESULTS: Cognitive reserve moderated the effect of TBI on WISC-V Full Scale IQ, Verbal Comprehension, and Visual Spatial. In the TBI group, it also had a protective effect with regard to performance on the Verbal Comprehension, Visual Spatial, and Fluid Reasoning indices. At the same time, greater injury severity was predictive of lower Visual Spatial and Processing Speed index scores in the TBI group. CONCLUSIONS: Cognitive reserve as reflected in parental education has a moderating effect with regard to children's performance on the WISC-V after TBI, such that higher cognitive reserve is associated with greater preservation of acquired word knowledge and understanding of visual relationships. Measures that emphasize speed of processing remain affected by severity of TBI, even after accounting for the protective effect associated with cognitive reserve. (JINS, 2019, 25, 355-361).

The Influence of Cognitive Reserve on Recovery from Traumatic Brain Injury.

OBJECTIVE: we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance. METHOD: retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury. RESULTS: regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model. CONCLUSIONS: cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.