Is the montreal cognitive assessment superior to the mini-mental state examination in detecting subtle cognitive impairment among middle-aged outpatient U.S. Military veterans?

The Montreal Cognitive Assessment (MoCA) is a relatively newly designed test that was developed as a tool to screen patients with mild cognitive problems that are not typically detected by the Mini-Mental State Exam (MMSE). While early research suggests that the MoCA is more sensitive to subtle cognitive impairment than the MMSE, there is concern about potential decreased specificity when using the MoCA. The aim of the present study was to examine the comparative utility of using the MoCA and the MMSE to detect subtle cognitive impairment among a group of 82 middle-aged U.S. military veterans referred for outpatient neuropsychological testing. Using receiver operating characteristic analyses, the MoCA was shown to be a better predictor of subtle cognitive impairment on neuropsychological testing than the MMSE. When using an adjusted cutoff, the MoCA was shown to be more sensitive (i.e., 0.72 vs. 0.52) and nearly as specific as the MMSE (0.75 vs. 0.77).

Evidence of carry-over in memory test batteries using RBANS and screening measures.

When testing memory and cognitive abilities, clinicians often administer batteries including multiple tests with similar content. Care must be taken so that such similarities do not unduly impact test performance. This brief report reviews findings from our own clinic, where administration of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in tandem with other screening instruments has led to apparent carry-over at an overall rate of more than one third of cases. Specific combinations of RBANS plus three other instruments are reported, along with cautions and caveats for appropriate interpretation.

Validity of the Wechsler Test of Adult Reading (WTAR): effort considered in a clinical sample of U.S. military veterans.

The current study represents an examination of the construct validity of the Wechsler Test of Adult Reading (WTAR) among a sample of U.S. military veterans referred for outpatient neuropsychological evaluation that included a measure of negative response bias, namely, the Test of Memory Malingering (TOMM). This retrospective data analysis examined the relationship between the WTAR and measures of current verbal general intellectual function and current cognitive skills. Findings showed that, among patients passing the TOMM (N = 98), WTAR scores were most highly correlated with current verbal IQ but also showed significant correlations with verbal memory and lesser, but still significant, correlations with measures of visual-spatial memory. Discriminant validity for the WTAR was also shown among the group passing the TOMM in the sense that the WTAR, which is designed to measure verbal premorbid general intellectual skill, was not as highly correlated with measures of learning and memory as was a measure of current verbal general intellectual skill. Whereas scores on most study measures did significantly differ between the groups that passed versus failed the TOMM (N = 26), scores on the WTAR did not, suggesting that the WTAR may remain robust even in the face of suboptimal effort.

Utility of the response bias scale (RBS) and other MMPI-2 validity scales in predicting TOMM performance.

The present study represents a replication and extension of the original Response Bias Scale (RBS) validation study. In addition to examining the relationship between the Test of Memory Malingering (TOMM), RBS, and several other well-researched Minnesota Multiphasic Personality Inventory 2 (MMPI-2) validity scales (i.e., F, Fb, Fp, and the Fake Bad Scale), the present study also included the recently developed Infrequency Post-Traumatic Stress Disorder Scale and the Henry-Heilbronner Index (HHI) of the MMPI-2. Findings from this retrospective data analysis (N=46) demonstrated the superiority of the RBS, and to a certain extent the HHI, over other MMPI-2 validity scales in predicting TOMM failure within the outpatient Veterans Affairs population. Results of the current study confirm the clinical utility of the RBS and suggest that, particularly if the MMPI-2 is an existing part of the neuropsychological assessment, examination of RBS scores is an efficient means of detecting negative response bias.

Associations of anxiety-related symptoms with reported history of childhood sexual abuse in schizophrenia spectrum disorders.

OBJECTIVE: Research suggests that persons with schizophrenia tend to experience significant levels of anxiety and that history of childhood sexual abuse may predispose some with schizophrenia to experience significant levels of persistent anxiety. It is unclear whether childhood sexual abuse is more closely linked to specific forms of anxiety including symptoms of post-traumatic stress disorder (PTSD). METHOD: Data were gathered from April 2004 through November 2004 on trauma history, PTSD symptoms, social anxiety, and state and trait anxiety from 45 men with a SCID-I-confirmed diagnosis of schizophrenia or schizoaffective disorder and 11 with a SCID-I-confirmed diagnosis of PTSD with no history of psychosis. Participants with schizophrenia spectrum disorders (schizophrenia group) were divided into those with and without history of childhood sexual abuse. Five participants in the schizophrenia group with a history of adult but not childhood sexual assault were excluded from analyses. RESULTS: Analysis of variance comparing the childhood sexual abuse (N = 21) and non-abused (N = 19) schizophrenia groups and the PTSD group on all anxiety assessments revealed that the sexually abused schizophrenia group had significantly higher levels of dissociation, intrusive experiences, and state and trait anxiety than the non-abused schizophrenia group. The schizophrenia groups did not differ statistically on levels of anxious arousal, defensive avoidance, or social anxiety. When compared with participants with PTSD and no psychosis, the sexually abused schizophrenia group had significantly lower levels of state anxiety, anxious arousal, intrusive experiences, and fearful social avoidance but failed to differ statistically on other scores. CONCLUSION: These results, if replicated, could lead to identification of those at risk for anxiety and PTSD and to targeted interventions.