Linking Patient-Centered Outcomes to Neuropsychological Practice: A Conceptual Framework and Opportunities for Research.

In the current healthcare climate, reimbursement for services is increasingly linked to the ability to demonstrate beneficial patient outcomes. Neuropsychology faces some unique challenges in outcomes research, namely, that neuropsychologists often do not follow patients over time and the effect of neuropsychological services on patient outcomes may not be fully realized until under another provider's care. Yet there is an urgent need for empirical evidence linking neuropsychological practice to positive patient outcomes. To provide a framework for this research, we define a core set of patient-centered outcomes and neuropsychological processes that apply across practice settings and patient populations. Within each area, we review the available existing literature on neuropsychological outcomes, identifying substantial gaps in the literature for future research. This work will be critical for the field to demonstrate the benefit of neuropsychological services, to continue to advocate effectively for reimbursement, and to ensure high-quality patient care.

The Word Completion Memory Test (WCMT): a new test to detect malingered memory deficits.

In recent years, much research has focused on developing tests to detect malingering. A drawback of existing tests is their poor ability to detect malingerers possessing more "sophisticated" knowledge of neuropsychological deficits. The current study presents preliminary validation data on a new measure, the Word Completion Memory Test (WCMT), which is the first malingering test to utilize a sophisticated coaching methodology in its development. The WCMT was administered to control participants, memory-impaired patients, and coached simulators. The coached simulators were provided with specific information about and examples of memory deficits commonly experienced following closed head injury (CHI; e.g., anterograde vs. retrograde amnesia). They also read a detailed scenario describing the lifestyle and motivations likely experienced by CHI litigants, and then practiced their roles by taking a quiz about their deficits. Results showed that 93% of coached simulators and 100% of control and memory-impaired participants were correctly classified by the WCMT.

External validation of the equivalence of two computational formulas for a WAIS-R seven-subtest short form.

The usefulness of an abbreviated form of the Wechsler Adult Intelligence Scale-R (WAIS-R) has been noted by several researchers. A 7-subtest short form yielding estimates of Verbal, Performance, and Full Scale IQs (FSIQs) has shown good reliability and validity. Both weighted and prorated formulas have been used interchangeably to compute estimated IQs derived from this short form. The purpose of this study was to compare the equivalence of these formulas with the full WAIS-R in a mixed clinical sample. Results show that both formulas produce nearly identical results, with neither formula emerging as clearly superior over the other; validity coefficients for WAIS-R IQs ranged from .95 to .97. A very slight absolute advantage was noted for the prorated over the weighted formula in that it resulted in fewer IQ differences greater than 2 standard errors of measurement, fewer misclassifications of FSIQ, and stronger correlations with WAIS-R Verbal, Performance, and FSIQs.

Cross-validation of the two- and three-subtest short forms of the Wechsler Memory Scale-Revised.

Researchers have noted the usefulness of an abbreviated form of the Wechsler Memory Scale-Revised. A number of studies have suggested that estimating General Memory and Delayed Recall scores using 3-subtest or 2-subtest equations decreases testing time without sacrificing reliability or clinical accuracy. The purpose of this study was to cross-validate previous results in a mixed clinical sample, as well as to examine the validity of the 2-subtest equations. Results of this study provide support for the use of the 3-subtest short form to estimate memory ability in normal and cognitively impaired patients. However, using only 2 subtests to estimate index scores resulted in a decline in predictive accuracy.

Reconstructive memory bias in recall of neuropsychological symptomatology.

Subjective recall of symptoms among nonlitigants with closed-head and back injuries and non-injured participants with high and low levels of life stressors was evaluated. All participants completed a demographic questionnaire, the Brief Symptom Inventory, and a symptom checklist. Recall of symptoms by participants with closed-head and back injuries was consistent with perceptions of being worse now than they were before their injuries. The results further suggest that these participants tend to overestimate the actual degree of change that has taken place by recalling fewer pre-injury symptoms than control participants. In addition, participants with closed-head injuries, but not with back injuries, showed significantly higher levels of symptom endorsement now than controls.