Rehabilitation professionals still do not communicate effectively about cognition.

OBJECTIVE: To examine current use of descriptive labels for levels of cognitive impairment and types of memory to explore whether rehabilitation disciplines are now communicating more effectively. DESIGN: Survey of rehabilitation professionals. SETTING: Hospital rehabilitation programs. PARTICIPANTS: Respondents (N=130) representing 8 facilities in 5 states completed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responses to survey questions about severity and types of memory impairment were examined with the Kruskal-Wallis test to determine the impact of profession on ratings. Post hoc Mann-Whitney U test comparisons of the 2 professions with the most cognitive assessment experience, psychologists/neuropsychologists and speech-language pathologists, were conducted. RESULTS: Ratings of various deficit levels differed significantly by profession (mild: H=39.780, P<.000; moderate: H=43.309, P<.000; severe: H=38.354, P<.000), but not by program location. In comparing psychologists/neuropsychologists and speech-language pathologists specifically, we found a significant discrepancy in ratings for percentile ranges associated with the terms mild (U=103.000, P<.001), moderate (U=78.000, P<.000), and severe (U=109.000, P<.001). Disagreement on the meaning of descriptive memory terms was noted among rehabilitation professionals in general, with large percentages of respondents not agreeing on the meanings of terms. CONCLUSIONS: A significant lack of consensus persists regarding the understanding of common cognitive terminology. This miscommunication affects cognitive impairment descriptors (eg, mild, moderate, severe) and categorization of types of memory. Only half of rehabilitation professionals appear aware of this discrepancy, suggesting that education is necessary to bring greater awareness of the potential for miscommunication.

The attitudes of socially marginalized men toward physician-assisted suicide.

Bioethics and public policy literature suggests that socially marginalized populations may be at increased risk for overuse of physician-assisted suicide (PAS) were it to become more accepted. Yet the attitudes of socially marginalized populations toward PAS have not been widely studied. The present study surveyed a sample of men in a substance abuse recovery program. Participants completed a PAS attitude questionnaire and a religiosity measure. Support for PAS was fairly evenly split, with 52.2% indicating general opposition to PAS and 46.9% indicating general support. Greater religiosity was associated with more negative attitudes toward PAS. Higher educational level was associated with more acceptance. Overall attitudes toward PAS were considerably more negative than those of Dr. George Domino's (2003) general population sample.

Interdisciplinary assessment strategies for capturing the elusive executive.

Executive theory states that the executive functions are activated selectively based on the subjective perception that the immediate task is too difficult to handle through behavioral habits and too important to risk failure. Consequently, tests intended to assess the executive functions can serve their intended purpose only when they are so perceived. Because individual differences in motivation and attitudes are extensive, no single test can be presumed to measure executive function for all subjects. Executive assessment should use a variety of diverse measurement procedures to define a range of functioning. The transdisciplinary team possesses powerful advantages in conducting a diversified assessment of this kind.

Personality assessment in neuropsychology: the nonspecificity of MMPI-2 neurocorrection methods.

Three established methods of neurocorrection claim to improve Minnesota Multiphasic Personality Inventory (MMPI)/MMPI-2 validity with closed-head injury (CHI) patients. These methods (which suggest removing "neurological" items from scoring) were employed here comparing 35 CHI patients with 35 psychiatric patients with elevated profiles. The 14-item correction changed 2-point codes for 41% of CHI and 31% of psychiatric profiles, the 30-item system changed 77% of CHI and 71% of psychiatric profiles, whereas the 37-item system changed 80% of CHI and 71% of psychiatric profiles. There were no significant differences between the two groups in number of profiles changed or number of neurocorrective items endorsed. Using each of the three correction systems, the following percentage of profiles remained elevated: 99%, 87%, and 89%, respectively.

A multidimensional approach towards malingering detection.

A validation study using 62 subjects was conducted on the Multidimensional Investigation of Neuropsychological Dissimulation (MIND), a new neuropsychological instrument used to detect exaggeration of brain-injury symptoms. This instrument has eight scoring indices that use multiple, empirically based strategies to detect poor effort. Discriminant function analysis was used to classify three groups of subjects: normals responding in a sincere manner (N=24); normals who were educated about mild to moderate head injuries and given substantial incentives to malinger without obvious detection (N=21); and clinically diagnosed, brain-injured patients with mild to moderate impairments (N=17). A univariate F test indicated significant group differences on six of the eight original predictor variables. Using these six variables, there was an overall classification rate of 68%, reflecting only a 10% false negative rate in the dissimulating group. For a two-group classification (i.e., dissimulating and mildly to moderately brain-injured subjects), an 82% overall accuracy rate was achieved. The MIND appears to have potential for identifying individuals exaggerating mild to moderate neuropsychological deficits.