bluuebunny/crossref_metadata_2025 huggingface dataset:
A-99 Influence of TBI on Rate of Cognitive Decline in Clinically Normal Older Adults
Authors: Bove Jessica , Asken Breton M , Kramer Joel H , Bauer Russell M
Published: August 2021

Objective

History of traumatic brain injury (TBI) is a potential risk factor for cognitive decline and neurodegenerative disease later in life, but findings have been inconsistent. We evaluate if past history of TBI affects rate of cognitive decline in clinically normal older adults.

Method

Participants were 190 cognitively normal (CDR < 0.5) older adults (age at baseline: M = 71.6, SD = 7.0) with positive history of TBI (TBI+; n = 83) or no history of TBI (TBI-; n = 107). A comprehensive neuropsychological battery of attention, memory, language, and executive functioning measures as well as functional questionnaires were administered longitudinally (number of visits: M = 3.4, SD = 1.3). Linear mixed effects models assessed the interaction between longitudinal health outcomes and TBI history.

Results

TBI+ showed a faster rate of decline in executive functioning (Stroop interference: p = 0.04), and a faster increase in functional impairment (Physical Activity Scale for the Elderly (PASE) total: p < 0.001; Unified Parkinson’s Disease Rating Scale (UPDRS) total: p = 0.002). Baseline performance on these tests did not distinguish TBI+ from TBI- (Stroop interference, p = 0.4; PASE, p = 0.5; and UPDRS, p = 0.1). TBI+ was not significantly different from TBI- on measures in other cognitive domains.

Conclusions

History of TBI was associated with faster rate of executive functioning decline and more rapid increase in objective and subjective functional impairment in cognitively normal older adults. Findings suggest that sustaining a TBI earlier in life could accelerate cognitive and functional changes even among clinically normal older adults.
A-11 The Neuropsychological Impact of Gender Affirming Treatments: A Systematic Review
Authors: Lemke Jillian , Vichinsky Kristine , Corbin Chris
Published: August 2021

Objective

Currently, there is strong evidence to demonstrate neuroanatomical changes in transgender and gender non-conforming (TGNC) adults following gender-affirming hormonal therapy (GHT). However, there has been no systematic review of the literature pertaining to GHTs’ neuronal effects. Such a review would help develop consensus within neuropsychology regarding standards of assessment with TGNC individuals.

Data Selection

Studies were only included if they assessed neuropsychological or neuroanatomical brain structure changes or functioning following GHT in the TGNC population. Search terms such as “neuropsychology” and “transgender” were entered in Medline, PsychINFO, and ProQuest. The 24 qualifying studies’ methodological and outcome data were critically reviewed by both researchers to reduce bias.

Data Synthesis

Neuroanatomical changes within the subcortical structures are found in TGNC individuals who received GHT over a longer duration. Current guidelines and recommendations do not consider the age of transition, dosage, and duration of GHT when interpreting neurocognitive data of TGNC patients; thus, it can lead to validity issues when selecting appropriate norms and interpreting neurocognitive domains with expected sex differences (i.e., visual, verbal, motor).

Conclusion

The literature review results indicate a paucity of guidelines and analysis related to the ethical practice of neuropsychological evaluation for TGNC individuals. Moving forward, guidelines need to be developed surrounding the age of transition, dosage, and duration of GHT when interpreting brain-behavior relationships on neuropsychological assessments.
A-102 Performance Validity Testing in Telehealth Research: A VA Traumatic Brain Injury Model Systems Study
Authors: O'Rourke Justin , Kanser Robert J , Silva Marc A
Published: August 2021

Objective

Studies on Performance Validity Tests (PVTs) for tele-neuropsychology (TeleNP) are sparse. Verbal PVTs appear to better translate to TeleNP, so the primary objective of this study was to provide initial data on two well-established, verbal PVTs administered via TeleNP for research participants with traumatic brain injury (TBI).

Methods

This secondary analysis of the Veterans Affairs TBI Model Systems data included 53 participants enrolled in a PVT module study (3/01/2020–09/20/2020) with documented moderate-to-severe TBI per Glasgow Coma Score (M = 6.5, SD = 4.4), posttraumatic amnesia duration (M = 42.7 days, SD = 47.1), and/or time to follow commands (M = 10.5 days, SD = 16.3). Participants completed two PVTs—Reliable Digit Span (RDS) and the 21-Item Test (21-IT)—alongside telephone-based cognitive assessment 1–7 years after TBI. Descriptive analyses were performed to compare PVT performances to previously established cut scores. Chi square analyses were employed to examine 21-IT and RDS as dichotomous outcomes (pass/fail) at selected cutoffs.

Results

RDS ranged from 5 to 16 (M = 10.5, SD = 2.4). 21-IT ranged from 7 to 21 (M = 16.4, SD = 3.1). For RDS, 9.8% were invalid with a cutscore of ≤7 and 19.6% using a cutscore of ≤8. For the 21-IT, 7.8% were in invalid using a cutscore of ≤11, and 13.7% using a cutscore of ≤12.

Conclusion(s)

Using previously established cut scores, telephone-administered RDS and 21-IT resulted in relatively low rates of invalid performance among individuals with moderate-to-severe TBI. These findings provide preliminary support for the RDS and 21-IT in TeleNP.
A-106 Mediating Community Factors in TBI Outcomes of Young Adults
Authors: Pscheid Kelsey , Pierson Eric , Finch Maria Hernandez , Finch Holmes
Published: August 2021

Objective

The goal of this study is to determine where racial, ethnic, and socioeconomic differences exist regarding longitudinal outcomes in young adults following a TBI. The Traumatic Brain Injury Model Systems (TBIMS) provides data coded for community, racial and ethnic groups and outcomes. This study maps Poverty Solutions Initiative data from the University of Michigan onto TBIMS outcomes data. We hypothesize SES, racial and ethnic differences predict functional and psychosocial outcomes and broader community factors improve prediction. Minorities in economically disadvantaged areas will have poorer functional and psychosocial outcomes.

Method

Data was obtained from the TBIMS database. Participants included (N = 3251) young adults ages 19–24 at the time of their TBI and outcomes for 1, 2 and 5 years after injury. A table of demographic information is provided in the attached image. The poverty Solutions Index was mapped onto TBIMS data by matching county codes.

Results

A mediation analysis was used to synthesize the data. Predictors include race and preinjury income, outcomes include functional and psychosocial, mediators include community SES, and confounders include injury severity.

Conclusions

When controlling for injury severity, relative preinjury income levels seemingly predict functional outcomes. This poster will discuss if and to what extent community factors are a mediator in TBI recovery.
A-109 Examining Relationship of Brain Injury, Anxiety and Workload on Trail Making Test Performances
Authors: Smith Kristina E , Lopez-Hernandez Daniel W , Olmos Winter , Litvin Pavel Y , Nordberg Bethany A , Saravia Sarah , Victor Tara L , Muñoz Isabel , Ayson Maria A , Arzuyan Anna , Vespa Paul , Hovda David A , Bueno Alexis , Budding Deborah , Woo Ellen , Hardy David J , Wright Matthew J
Published: August 2021

Objective

Both anxiety and traumatic brain injury (TBI) are both related to poorer Trail Making Test (TMT) performances. TBI survivors exhibit a greater incidence of anxiety in contrast to the general population. We evaluated the relationship between TBI and anxiety on TMT and perceived workload ratings.

Method

The sample consisted of 39 moderate-to-severe TBI [(21 with normal symptoms of anxiety (NSA) and 18 with abnormal symptoms of anxiety (ASA)] and 51 healthy comparison (HC; 26 NSA and 25 ASA) participants.

Results

ANCOVA’s, controlling for age, revealed the HC group outperformed the TBI group on TMT part A and TMT part B (TMT-B). An interaction emerged on TMT-B, with TBI-ASA participants outperformed TBI-NSA participants and HC-NSA participants outperformed their counterparts with ASA. Ratings of physical demand and frustration were reported higher in TBI participants compared to the HC participants. Moreover, TBI and anxiety symptoms had interactive effects on NASA-TLX temporal demand and frustration ratings, were TBI-ASA participants reported higher scores in contrast to TBI-NSA. Lastly, an interaction emerged with HC participants with ASA reporting better performances in contrast to HC-NSA.

Conclusions

As expected, TBI participants did worse on both TMT tasks. Next, we found that TBI-ASA participants impacted their TMT-B performance and their perceived workload (i.e., frustration, temporal demand) more than TBI-NSA participants. In the future, studies with a larger sample size should examine if anxiety influences TMT performance and perceived workload in person with mild TBI.
A-121 Functional Outcomes in Bilingual Persons with Traumatic Brain: The Role of Mood
Authors: Olmos Winter , Lopez-Hernandez Daniel W , Munoz Isabel , Schierholz Laura , Rugh-Fraser Rachel A , Munoz Raelynn B , Nordberg Bethany A , Hovda David A , McArthur David L , Vespa Paul , Fuster Joaquin M , Woo Ellen , Lopez Enrique , Hardy David J , Wright Matthew J
Published: August 2021

Introduction

We examined the relationship between depression and anxiety, language, and functional outcomes in persons with traumatic brain injury (TBI).

Methods

The sample consisted of 48 acute TBI (ATBI: 23 Spanish-English Bilinguals; 25 English monolinguals), 30 chronic TBI (CTBI: 17 Spanish English Bilinguals; 12 English monolinguals), and 47 healthy comparison (HC: 29 Spanish-English Bilinguals; 18 English monolinguals) participants. The Hospital Anxiety and Depression Scale was used to measure depression (HADS-D) and anxiety (HADS-A). The Mayo Portland Adaptability Inventory-4 (MPAI-4) was used to measure functional outcomes (ability, adjustment, participation).

Results

An ANCOVA, controlling for age, revealed the ATBI group reported lower anxiety levels compared to the CTBI group, p = 0.034 np2 = 0.06. HC participants demonstrated significantly higher functional ability compared to both TBI groups, p < 0.05, np2 = 0.08–0.19. The ATBI group demonstrated worse participation scores compared to the CTBI and HC groups, p = 0.001, np2 = 0.11. Pearson correlations revealed mood was related to functional status in ATBI monolinguals (HADS-A: r = 0.29–0.64; HADS-D, r = 0.49–0.62). Monolingual participants with ATBI demonstrated correlations between depressive symptoms and functional adjustment (r = 0.57, p = 0.005) and ability (r = 0.44, p = 0.034). For monolinguals with CTBI, HADS-A correlated with functional outcomes, r = 0.60–0.66, p < 0.05. For bilinguals with CTBI, functional outcomes correlated with HADS-A, r = 0.53–0.66, p < 0.05, and HADS-D, r = 0.54–0.66, p < 0.05. For HC monolinguals, functional outcomes correlated with HADS-A, r = 0.53–0.70, p < 0.05, and HADS-D, r = 0.50–0.72, p < 0.05. Finally, for HC bilinguals, functional outcomes correlated with HADS-A, r = 0.59–0.68, p < 0.05.

Conclusion

Our results suggest that a relationship between anxiety and depressive symptoms is related more to functional outcomes in monolingual TBI survivors compared to bilingual TBI survivors.
A-128 Intraindividual Neurocognitive Variability Is Associated with Poorer Prospective Memory in OEF/OIF/OND Veterans with Comorbid Mild Traumatic Brain Injury History and Current Posttraumatic Stress Disorder
Authors: Sheppard David , Rau Holly P , Werhane Madeleine , Peskind Elaine R , Pagulayan Kathleen
Published: August 2021

Objective

Mild Traumatic Brain Injury (mTBI) and Posttraumatic Stress Disorder (PTSD) frequently co-occur in service members, and each are associated with increased neurocognitive intraindividual variability (IIV), a proposed indicator of subtle disruptions in executive control, and prospective memory (PM), or “remembering to remember.” The current study sought to examine possible associations between IIV and PM performances among Veterans with comorbid mTBI and PTSD.

Methods

46 OEF/OIF/OND Veterans with a history of mTBI and current PTSD enrolled in a VA research study of mTBI completed a standardized neurocognitive battery of 12 measures used to calculate the coefficient of variation (CoV) as an index of IIV, and the Memory for Intentions Screening Test (MIST) as a measure of PM. Veterans also completed clinical questionnaires (i.e., Patient Health Questionnaire-9, PTSD Checklist-Military), and a subset of the sample (n = 31) Veterans completed the Prospective and Retrospective Memory Questionnaire (PRMQ) as a measure of self-reported PM.

Results

Controlling for age and education, higher CoV was associated with time-based MIST scores (β = −0.02, p = 0.008, η2 = 0.16) and event-based MIST scores (β = −0.02, p = 0.031, η2 = 0.11). CoV was not associated with mood factors in the sample (ps >0.10). In a subset of the total sample, higher CoV was associated with elevated self-reported PM symptoms (r = −0.36, p = 0.046).

Conclusions

Among Veterans with a history of mTBI and current PTSD, elevated variability of performances across neurocognitive measures was associated with poorer performance-based PM and self-reported PM symptoms. Future studies are needed to examine IIV as a predictor of real-world PM performances (e.g., medication adherence).
A-129 The Association between Parental Migraine History and Persistent Post Traumatic Headaches
Authors: Owens Ronnise , Smith Sherly , Marker Craig
Published: August 2021

Objective

Literature indicates persistent concussive symptoms beyond the typical recovery time of days or weeks are attributable to factors other than concussion or mild traumatic brain injury (mTBI) (Scott et al., 2020). Post traumatic headaches (PTH) are a frequent complaint of pediatric patients who have sustained a mTBI. Research have indicated that parental migraine and mTBI may put children at risk for PTH (Whitecross, 2020). This systematic review aims to further investigate the relationship between parental history of migraine and PTH in pediatric patients who have sustained a concussion.

Data Selection

A search was conducted using, Medline, PubMed, and Google Scholar databases with the terms “pediatric”, “concussion”, “parental”, and “headache” between 2011 and 2021. A total of 200 relevant articles were screened and 14 were selected for this review. Exclusion criteria included studies unrelated child migraines, concussion or mTBI diagnosis, and parental history.

Data Synthesis

A review of literature indicates a 42% heritability and earlier onset of migraine diagnosis for children with parental migraine history (Dao et al., 2018; Eidlitz-Markus et al 2015). This indicates a significant risk factor for persistent post concussive symptoms and possibly direct implications in the slower rate of recovery (Sufrinko et al., 2018).

Conclusion

Overall, this systematic review strongly suggests that a genetic predisposition for migraines may serve as a catalyst for onset and duration of PTH and the earlier diagnosis of pediatric migraines. Consideration of these predispositions can aid the multidisciplinary approach to improve cognitive and neurobehavioral health in the pediatric population.
A-133 Emotion Regulation Strategy Use in Veterans with Subjective Cognitive Complaints in a Neuropsychology Clinic
Authors: Austin Tara , Pazienza Shawneen , Lantrip Crystal
Published: August 2021

Objective

Neuropsychological evaluations reveal individuals with both objective and subjective cognitive complaints. Subjective cognitive complaints (SCC) are often related to potentially modifiable factors, such as mood. One proposed treatment for cognitive complaints is to focus on emotion regulation rather than cognitive rehabilitation. This project examines acceptability and feasibility from the perspective of participants, and determines participant understanding of the relationship between mood and cognition following a brief, one session emotion regulation intervention.

Method

Two study authors interviewed a subgroup of participants enrolled in a larger longitudinal intervention study about their understanding of the impact of mood on cognitive functioning, the acceptability of the intervention, and ease of using the provided strategies. Study authors then used inductive coding to identify common themes in participants’ responses.

Results

Preliminary results reveal the following themes: 1. Participant understanding that current cognitive concerns are related to modifiable factors (e.g., sleep, pain, emotional distress) rather than damage to brain structures or a neurodegenerative process. 2. Participants’ need for attentional and memory strategies to consistently use emotional regulation strategies day to day as well as participate fully in adjunctive psychological treatment. 3. Post-intervention awareness of high levels of everyday rumination.

Conclusion

Individuals with SCCs are amenable to psychological intervention, particularly when delivered with a brain-behavior explanation of how modifiable factors contribute to cognitive difficulties. In order to most successfully apply these strategies, participants may also benefit from targeted cognitive strategies to improve their use of emotion regulation strategies.
A-146 Parent Responses on the Behavior Rating Inventory of Executive Function-2 Are more Reflective of Child Cognitive Functioning than Teacher Responses
Authors: Larson Kera , Wilbur Jessica , Hamilton Elizabeth
Published: August 2021

Objective

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) is widely used to assess executive processes in children and adolescents. The BRIEF-2 manual (2015) indicates small correlations between executive functioning and intellectual performance on the Wechsler Intelligence Scales for Children, Fourth Edition, but no studies have evaluated the BRIEF-2 and the Woodcock Johnson Tests of Cognitive Abilities, Fourth Edition (WJ-IV-Cog). The current study examined whether parent and teacher BRIEF-2 responses were linked to WJ-IV-Cog indices in a rural school-based sample.

Method

A sample of (n = 18) students attending rural school districts was extracted from an archival dataset. Participants (age range 7–17, M = 12.9, SD = 2.5) included 15 males and 3 females, who were referred for psychoeducational assessment.

Results

Correlational analyses indicated a moderate relationship between the BRIEF-2 parent Global Executive Composite (GEC) and the WJ-IV-Cog domains of comprehension-knowledge (Gc), fluid reasoning (Gf), and auditory processing (Ga) (p < 0.05). Subsequent analyses of the three BRIEF-2 indices showed that the Parent Behavioral Regulation Index (BRI) was related to both Gc and Gf (p < 0.05), while the Parent Cognitive Regulation Index (CRI) was significantly associated with Gc, Gf, and Ga (p < 0.05). Teacher ratings of GEC, BRI, and CRI were independent from child intellectual performance. However, Teacher Emotion Regulation Index (ERI) was moderately related with GIA (p < 0.05).

Conclusion

Current findings support a moderate relationship between parent ratings on the BRIEF-2 and specific cognitive domains on the WJ-IV-Cog. Results should be interpreted within the context of both a small sample size and the designation of subjects for psycho-educational assessment evaluations.
A-153 Neuropsychological Effects Assessed Using WISC-IV and WISC-V
Authors: Verani Saba , Golden Charles
Published: August 2021

Objective

This review explores The Weschler Intelligence Scale for Children – Fourth Edition (WISC-IV) and the Weschler Intelligence Scale for Children – Fifth Edition (WISC-V) administered to children with various medical histories including traumatic brain injury, vascular conditions, brain tumor, epilepsy, strokes, sickle cell disease, down syndrome, and neurotoxicity on neurodevelopment. This review aims to explore neuropsychological effects of these medical conditions derived from final scores and scale comparisons.

Data Selection

Peer-reviewed studies between 2000 and 2020 were gathered from EBSCO, Google Scholar, and Science Direct. Criteria was limited to neurological conditions present in children, who were required to be assessed using either WISC-IV or WISC-V. Children with other developmental or learning disabilities were excluded. Data on Weschler Adult Intelligence Scale (WAIS) were excluded along with any other assessment administered to children. Thirteen articles were included based on the criteria along with two articles that discuss the validity of WISC.

Data Synthesis

The components of the WISC-IV or WISC-V demonstrated low average or below average scores on many scales, especially overall FSIQ. The largest impairments were present in Processing Speed Index, Verbal Comprehension Index, Working Memory Index, Visual Spatial Index, and overall FSIQ. All children assessed with preexisting neurological conditions demonstrated deficits in neuropsychological domains. The severity of the neurological condition significantly impacted scores when compared to children with no conditions.

Conclusions

The administration of WISC-IV and WISC-V demonstrated neuropsychological and functioning impairments in children with preexisting neurological conditions. The assessment successfully identified deficit areas and earlier testing can encourage earlier treatments.
A-158 Case Study: Cognitive Deficits Associated with Postoperative Intracranial Hemorrhage Following Meningioma Resection
Authors: Indorewalla Khushnoo K , Phenis Richard
Published: August 2021

Objective

Postoperative intracranial hemorrhages (PIH) are an infrequent complication following cranial tumor resection and associated with prolonged hospitalization as well as long-term neurologic deficits. There is limited research examining the neuropsychological deficits resulting from PIH following meningioma resection, especially with neuropsychological data. Here, we present the neurocognitive profile of a patient who underwent a meningioma resection surgery and subsequently suffered a PIH within the resection cavity.

Method

Mr. Doe is a bilingual male in his late 40s who developed right-side vision loss and an isolated incidence of disorientation, resulting in discovery of a left anterior clinoid meningioma. He underwent a left frontotemporal craniotomy for gross total resection of the mass a month after discovery. Postoperative neuroimaging the following day revealed the appearance of a hematoma and intracranial hemorrhage within the resection cavity, resulting in right hemiplegia, aphasia, and ophthalmoplegia. He underwent neuropsychological evaluation 15 months post-resection, to assess residual cognitive deficits following his hospitalization and subsequent inpatient rehabilitation.

Results

In the context of average premorbid intellectual functioning, Mr. Doe’s neurocognitive profile was notable for deficits in processing speed, receptive and expressive language, and executive functioning associated with speed/verbally mediated tasks. Testing revealed lateralized deficits indicative of left (language-dominant) hemisphere dysfunction secondary to meningioma resection and subsequent PIH within the resection cavity.

Conclusion

The current poster aims to contribute to the limited body of literature examining residual neuropsychological deficits resulting from PIH following intracranial resection of meningioma. This is especially crucial given that long-term cognitive deficits can negatively impact patients’ quality of life over time.
A-169 Remote Cognitive Screening: A Preliminary Study of Location Administration of the Boston Cognitive Assessment (BoCA)
Authors: Ferguson Hayden , Turok Nora , Colby Kelly Ann , Gold Dov , Piryatinsky Irene
Published: August 2021

Objective

Digital, remote, cognitive assessment has become crucial for efficient screening of patients cognitive concerns. The Boston Cognitive Assessment (BoCA) is a brief, digital, global screening instrument that can be administered both in-office on a laptop, or remotely from patients’ homes. Potential differences in performance from completing the BoCA in-office versus completing it at home remain uninvestigated. As such, this study aimed to compared performances across these settings among demographically and cognitively matched patient samples.

Method

Data from 35 cognitively healthy participants who completed the BoCA (18 administered in-office; 17 remotely administered) were retroactively collected; groups were matched by age, education, gender, ethnicity, and global cognitive functioning based on their scores on a separate screening instrument. Overall BoCA scores (total = 30) as well as performance on the eight BoCA subscales (Immediate Recall, Delayed Recall, Verbal Reasoning, Visuospatial Reasoning, Executive Functions, Attention, Mental Math, and Orientation) were compared using nonparametric testing.

Results

A Contingency analysis and an independent samples Mann–Whitney U test confirmed the demographic and cognitive similarities between the two groups. Comparisons of BoCA scores revealed no differences in total scores or any of the BoCA subscales between those who completed the BoCA in-office and those who completed it remotely.

Conclusion

Results from the present study suggest that performance on the BoCA is not influenced by one’s environment at the time of administration. This further adds to the utility of the BoCA as a remote, self-administered, global screening instrument, and may support its adoption in settings where serial screening is indicated.
A-179 Personality Assessment Inventory Cognitive Bias Scale of Scales (CB-Sos): Replication and Comparison to the CBS in an Active Duty Military Sample
Authors: Armistead-Jehle Patrick , Ingram Paul B , Morris Nicole M
Published: August 2021

Objective

The Cognitive Bias Scale (CBS) was developed for the PAI using item-level responses identified based on failed performance validity testing (PVT), with subsequent studies cross-validating the scale. New research developed three alternative forms of the CBS using scale level responses, called the Cognitive Bias Scale of Scales (CB-sos). This study examines the performance of the three different CB-sos scales based on performance on stand-alone PVTs in a military sample.

Methods

Retrospective review of 257 active-duty military individuals referred for outpatient neuropsychological assessment. Each subject was administered the PAI, MSVT, and NV-MSVT. Groups were defined as valid (0 PVT failures) or invalid (1 or more PVT failures), consistent with CB-sos validation. Independent t-tests, effect size estimates, and sensitivity/specificity estimates were then calculated.

Results

Significant t-tests (p < 0.001) and medium effect sizes (0.5 < d < 0.8) were evident across each version of the CBS scale. The largest effect sizes were for the 7-scale CB-sos3 (d = 0.77) and the item-derived CBS (d = 0.70). AUC was similar (AUC = 0.686–0.713) across all scales. Estimates of sensitivity were low (ranging from 0.06 to 0.13) and specificity was high (ranging from 0.94 to 0.98) at the recommend cut values for each scale.

Discussion

It appears Scale of Scale validity indictors calculated from total scale scores, rather than items (i.e., CBS), produce similar levels of effectiveness. Results support the use of the CB-sos scales as potentially useful indicators of invalid responding on the PAI within a military sample (particularly CB-sos3), though sensitivity is relatively low.
A-181 Do Effortful Epilepsy Patients Fall Below Performance Validity Test Cutoffs at Higher Rates than Is Considered Acceptable?
Authors: Kang Hyun Jin , Kim Michelle , Torres Karen
Published: August 2021

Objective

Factors specific to an epilepsy population (e.g., medications, psychiatric comorbidities, localization) may result in higher false positive rates on performance validity tests (PVT), rendering the results more equivocal. This study examined whether specificity is reduced in effortful epilepsy patients on the Warrington Recognition Memory Test - Words (WRMT-W) and Test of Memory Malingering (TOMM).

Method

53 epilepsy patients referred for neuropsychological evaluation through the University of Washington Regional Epilepsy Center were examined. Patients were majority male (56.6%) and Caucasian (79.2%). Average age and education were 36.1 (SD = 13.03) and 13.4 years (SD = 2.39), respectively. Patients with an intelligence quotient of <70, history of brain surgery, and those who seized during testing were excluded. Patients clinically observed to have reduced effort with 2+ PVT failures were excluded (n = 3). Frequency tables for WRMT-W and TOMM performances were utilized to examine specificity based on prior cutoffs identified for these measures.

Results

The WRMT-W cutoff of ≤42 was associated with 88.7% specificity. TOMM Trial 2 and Retention cutoffs of <45 were associated with 98.1% and 100% specificity, respectively. The WRMT-W cutoff was associated with 91.7% specificity in language dominant hemisphere onset epilepsy patients (n = 16). None performed below cutoffs on the TOMM. All nondominant hemisphere onset patients (n = 8) performed above WRMT-W and TOMM cutoffs.

Conclusions

Use of the WRMT-W and TOMM in an epilepsy population is associated with an acceptable false positive rate (specificity around 90%). However, future studies examining the sensitivity of these measures in epilepsy patients should be performed.
A-184 Performance Validity Test Failure Rates in Bilingual Individuals Evaluated in English
Authors: Davis Jeremy , Hromas Gabrielle , Rolin Summer
Published: August 2021

Objective

Classification accuracy of embedded performance validity tests (PVTs) is unknown in cases involving bilingual examinees evaluated in English. This study examined false positive rates in bilingual individuals in an older adult sample.

Method

The project involved secondary analysis of a deidentified dataset (N = 22,688) from the National Alzheimer’s Coordinating Center (NACC). Exclusion criteria were diagnosis of mild cognitive impairment (MCI; n = 5160) or dementia (n = 5550). The initial sample included 11,513 participants grouped as cognitively normal (89.6%) or impaired but not MCI. A subset of 275 participants was identified with a primary language other than English who were evaluated in English. Propensity score matching was conducted by diagnostic group to match bilingual to monolingual participants on age, education, gender, and MMSE score. The final sample included 450 and 100 participants in normal and impaired groups, respectively. Failure rates on five embedded PVTs in the NACC cognitive test battery were examined by language and by diagnosis.

Results

Age, education, gender, and MMSE score were not significantly different by language in either diagnostic group. In the normal group, 4.9% of bilingual and 2.2% of monolingual participants failed two or more PVTs (n.s.). In the impaired group, 12% of bilingual and 6% of monolingual participants failed two or more PVTs (n.s.).

Conclusions

PVT failure rates were not significantly different between bilingual participants evaluated in English and monolingual participants in either diagnostic group. Failure rates, however, increased slightly above a common false positive threshold of 10% in bilingual participants in the impaired group.
A-187 Lack of Agreement between Reliable Digit Span and Rey-15 Item Test as Validity Indicators for Test of Memory Malingering Performance in Youth Athletes
Authors: Murley Rachel M , Baldini Daniel , Flowers Julius , Hall Aiden , Kiefer Jamie P , Tupou Tarah A , Hirst Rayna B
Published: August 2021

Objective

In neuropsychological assessments, it is critical to evaluate examinee performance validity. Reliable Digit Span (RDS) and the Rey-15 Item Test (FIT) are performance validity tests (PVTs) used to assess the accuracy of results during neuropsychological assessment (NA; Lichtenstein et al., 2017). While many studies have examined adult populations, few examined children to determine the base rate level of PVT failure even in a healthy population. The present study assessed RDS and FIT as PVTs in youth athletes, with valid performance operationalized by Test of Memory Malingering (TOMM) performance.

Method

Youth athletes (n = 109, 79% male, Mage = 11.9) completed a NA including RDS (cutoff <7), TOMM Trial 2 (cutoff <50), and FIT (cutoff <26) during baseline evaluation for sport participation. A stringent TOMM cutoff was used to improve sensitivity (Schroeder et al., 2012). Receiver operator characteristic (ROC) curve analysis determined whether RDS or FIT performance accurately categorized participants’ validity test performance, based upon TOMM Pass/Fail.

Results

Both RDS and FIT produced minimal accuracy in categorizing participants performance on TOMM; areas under the curve ranged from 0.41 to 0.60 and did not significantly differ from chance (0.50). Additionally, there was a lack of agreement across PVTs, as no participant failed all three PVTs.

Conclusion

RDS and FIT did not adequately predict TOMM performance in healthy youth. These findings illustrate that even in a brief NA, healthy children demonstrated variable performance across validity measures, with low consistency across three commonly used PVTs. Findings highlight the importance of clinical judgment in evaluating discrepant PVT performance in children.
A-189 Survey Findings of Challenges with Teleneuropsychological Assessment and Advice in Mitigating these Challenges
Authors: Fox-Fuller Joshua T , Rizer Sandra , Andersen Stacy L , Sunderaraman Preeti
Published: August 2021

Objective

Teleneuropsychology (TeleNP) has experienced tremendous uptake during the coronavirus pandemic, and there is a need to document the challenges and practical advice for conducting remote cognitive assessments.

Method

87 respondents (licensed neuropsychologists = 56; others [e.g., trainees] = 31) conducting TeleNP evaluations with adult populations in the United States completed an online survey which was distributed via social media and list-servs in winter 2020–2021. Respondents were asked about their TeleNP experiences, including issues encountered and solutions to TeleNP challenges. Frequency analyses were conducted to examine the proportion of respondents endorsing specific TeleNP challenges. TeleNP advice was thematically coded to identify the most common suggestions to overcome/navigate these challenges.

Results

The most frequently reported TeleNP challenges included: poor internet connectivity (examinee’s home: 82.8%; an unknown source 58.6%); environmental distractions in the examinee’s location (78.2%); poor audio quality (55.2%); examinee’s unfamiliarity with the videoconferencing technology (52.9%); inability to easily conduct visuoconstructional tasks (52.9%) or adapt tests/find TeleNP norms (47.1%); and examinees’ limited access to technology (57.5%) or complete lack of access (35.6%). The most common responses to mitigate these challenges included: providing detailed instructions about the TeleNP visit and examinee expectations in advance; having a clear back-up or assistive plan (e.g., telephone call); and using TeleNP sparingly (e.g., for interview only).

Conclusion

These survey results reflect widely-encountered challenges with remote cognitive assessment and identify priority targets for increasing the feasibility and reliability of TeleNP. Findings can be incorporated into discussion about formalized TeleNP competencies.
A-193 Effects of Sex on Concussion-Related Symptom Reporting in a Diverse Adult Clinical Sample Using the Texas Postconcussion Symptom Inventory
Authors: Meredith-Duliba Tawny , Longoria Anthony , Mokhtari Ben , Hershberger Mary , Champagne Tasha , Hart John , Cullum C Munro , LoBue Christian
Published: August 2021

Objective

Concussion symptoms are non-specific and various symptom inventories are influenced by sex, even in the absence of injury. The Texas Postconcussion Symptom Inventory (TPSI) is a new 66-item concussion-related symptom measure with three empirically-derived indices (Cognitive, Neuropsychiatric, and Somatic). We evaluated if symptom reporting on the TPSI related to sex in a large, mixed clinical sample.

Methods

A diverse clinical sample (N = 319, ages 17–92, M = 48.75), including patients with seizure disorders, dementias, and head injuries, completed the TPSI. Symptom reporting profiles between females (55%) and males (45%) were compared using profile analysis with age as a covariate.

Results

Although females (M = 20.62, 95% CI [18.91, 22.26]) and males (M = 19.14, 95% CI [17.32, 21.04]) endorsed higher scores on the Cognitive index (Possible Range = 0–52), no significant differences on symptom reporting patterns were seen between the groups on the Cognitive (p = 0.24) or Neuropsychiatric (p = 0.56) Indices. However, a significant difference was found on the Somatic index (Possible Range = 0–34), with females (M = 13.06, 95% CI [11.99, 13.94]) reporting higher scores [t(318) = 2.78, p < 0.01, partial η2 = 0.02] than males (M = 10.98, 95% CI [10.01, 12.17]).

Conclusions

In this preliminary study, results indicated sex differences in reporting concussion-associated symptoms on the TPSI across a variety of clinical conditions. Similar to prior studies, females reported more somatic symptoms yet were similar in their reports of Cognitive and Neuropsychiatric symptoms. Because baseline data is rarely available when evaluating concussions in clinical settings, future research aims are to develop normative data stratified by sex and investigate the utility of the TPSI within a concussion cohort.
A-16 MoCA Subtest Analysis: Discriminating between Healthy Controls and MCI
Authors: Ratcliffe Lauren N , McDonald Taylor F , Marker Craig
Published: August 2021

Objective

The Montreal Cognitive Assessment (MoCA) is a suitable, sensitive, and specific cognitive screener for detecting mild cognitive impairment (MCI). Previous research has found markers to discriminate between healthy controls and MCI on MoCA subtest scores. Specifically, MCI performed worse on executive functioning and attention tasks (i.e., inverse digits, serial 7’s, repetition, fluency, abstraction, and word recall). The aim of the present study is to assess for discrimination patterns in MoCA performance between healthy controls and MCI.

Method

Data was collected through the National Alzheimer’s Coordinating Center (NACC). A sample of healthy controls (n = 3776, 65% female, 80% White, 17% Black, 3% Asian/Pacific Islander) and MCI (n = 1143; 51% female, 82% White, 15% Black, 3% Asian/Pacific Islander) were examined.

Results

An initial independent t-test revealed a statistically significant difference in MoCA scores for healthy controls (M = 26.18, SD = 2.78) and MCI (M = 22.01, SD = 3.49; t(4917) = 36.91, p = 0.000, Cohen’s d = 1.32). Additional t-tests were performed to compare MoCA subtest scores and domain scores for diagnostic groups. There was a statistically significant difference for healthy controls and MCI groups across all MoCA subtests and domains. Further examination using normal distribution revealed worse performance on cube copy and word recall in MCI groups.

Conclusions

Consistent with previous findings, word recall was able to discriminate between healthy controls and MCI. However, this study was able to find discrimination in cube copy performance. These findings may guide clinicians to use these interval changes as early cognitive markers for impairment, allowing for early detection and intervention.
A-17 Examining Cognitive Trajectories in SuperAgers within the LonGenity Study
Authors: Villar Daniel , Milman Sofiya , Gao Tina , Barzilai Nir , Weiss Erica F
Published: August 2021

Objective

Rogalski and colleagues (2013) use the term SuperAgers to indicate individuals aged 80 and older who have exceptional memory with the goal of clarifying factors that impact successful aging. Using a modified definition, we explored cognitive trajectories of SuperAgers within our longitudinal study of the genetic factors associated with exceptional longevity (OPEL) in individuals of Ashkenazi Jewish descent.

Method

LonGenity Study participants complete annual physical and cognitive assessments which include the Free and Cued Selective Reminding Test (FCSRT) and WMS-R Logical Memory (LMI). All participants who completed a visit at age 80 were included in the analysis (N = 230; 56.5% female; mean education 17.57 ± 2.74 years; 46.5% OPEL; median follow-up 4 years). Twenty-one participants met modified SuperAger criteria (FCSRT: >38 and LMI: >25; no other cognitive impairment). Descriptive statistics, t-tests, and linear mixed effects models of cognitive trajectories were used to examine the differences between SuperAgers and non-SuperAgers.

Results

Although there were no differences in demographics or familial history of exceptional longevity, SuperAgers were less likely to have a history of cardiac problems (p = 0.02). Overall cognitive functioning remained stable with age in the SuperAgers, whereas non-SuperAgers demonstrated declining overall cognition with age (β = −0.029, CI: −0.036—0.022). Memory task performances demonstrated a similar discrepancy in trajectories.

Conclusion(s)

In our unique and high functioning population, SuperAgers as defined at age 80 do not demonstrate the typical cognitive declines thought to be associated with age. Vascular risk factors appear to play a role, but further investigation including exploring genetic markers and MRI is warranted.
A-22 Effect of Dementia Experience on the Relationship between Subjective Cognitive Decline, Illness Perceptions, and Dementia Worry
Authors: Lambertus Taylor D , Suhr Julie A
Published: August 2021

Objective

Dementia worry (DW) is anxious rumination about personal risk for dementia and may be related to subjective cognitive decline (SCD). Personal experience with dementia may affect DW. Another possibly related factor is illness perceptions, or beliefs about illness which can influence health outcomes. We examined whether SCD and illness perceptions, specifically personal and treatment controllability, predicted DW, and whether dementia experience moderated these effects.

Method

Ohioans (≥50 years old) completed an online survey. 60 participants reported no personal dementia experience. 100 participants endorsed having a biological relative with dementia. Illness perceptions were measured with a modified Illness Perception Questionnaire focused on cognitive decline. DW was measured with the Dementia Worry Scale and SCD was measured with the Cognitive Function Questionnaire (CFQ).

Results

In those with no dementia experience, SCD interacted with personal controllability (p = 0.016) and treatment controllability (p = 0.011) to predict DW. SCD and DW were related only in those with high belief that dementia is not personally (p = 0.018) or professionally controllable (0.002). However, in those with dementia experience, there were main effects for SCD (p < 0.001) and treatment controllability (p = 0.006), but no significant interaction.

Conclusions

Dementia experience and illness perceptions (personal and treatment control) are important factors to consider in the relationship of SCD to DW. Results highlight the importance of illness perceptions and personal dementia experience in health seeking behaviors. Future research should investigate level and frequency of experience in relation to illness perceptions, and examine how educational programs about dementia may influence illness perceptions and DW.
A-24 An Evaluation of Anxiety, Depression, and Neuropsychological Performance before and during the COVID-19 Pandemic
Authors: Castle Mary K , Perez ElliottNell , Pugh Mickeal , Peck Edward A
Published: August 2021

Objective

High levels of depression and anxiety have been consistently linked to performance on neuropsychological evaluations. In this regard, recent evidence of increased emotional distress due to COVID-19 may exacerbate impairment typically demonstrated on evaluations. The current study examined differences in the severity of depression and anxiety ratings reported before and during COVID-19, and the relationship between mood and cognitive functioning before and during COVID-19.

Method

75 adults seeking neuropsychological assessment services from a private outpatient clinic in January 2020 and 2021 were included in the study. Depression, anxiety, and cognitive functioning were measured using the BDI-II, BAI, RDS, FAS, and Trailmaking test. T-tests were conducted to examine mood and cognitive differences between groups. Correlations were used to assess the relationship between mood and cognitive functioning.

Results

T-tests revealed no significant differences between groups for anxiety, depression, performance validity, verbal fluency, and Trailmaking tests. No significant relationship was observed between reported mood level and cognitive functioning before and during COVID-19. A significant correlation was observed between age and anxiety, which showed that older adults reported less anxiety. All statistical findings will be reported fully in the poster.

Conclusions

No significant change in emotional distress was found between pre- and during COVID-19 groups. The absence of measurable change may also suggest measures commonly employed should be reviewed and possibly modified to better capture the distress experienced by patients during the pandemic.
A-27 A Pediatric Case Study of Neurodevelopmental Disorder Associated with Complete Agenesis of the Corpus Callosum
Authors: Norris Courtney L , Smith Alphonso
Published: August 2021

Objective

The corpus callosum is a major white matter pathway of the brain that coordinates the transfer of information between both cerebral hemispheres. Children with complete agenesis of the corpus callosum (ACC) are at increased risk for neurodevelopmental disorders, epilepsy, and genetic abnormalities.

Method

This case study presents the neuropsychological profile of a 6-year-old girl in the 1st grade who was born with complete ACC and presented with a history of attention problems and behavioral-emotional difficulties.

Results

Neuropsychological testing revealed mild to severe deficits in attention, executive functioning, and self-regulation in the context of average intellectual functioning and broadly average to above-average academic achievement.

Conclusions

School recommendations included establishing a 504 plan and weekly counseling sessions with the school social worker in order to provide accommodations to support the child’s attention difficulties in the academic setting. Recommendations for genetic testing and ongoing monitoring by the patient’s neurologist were suggested given the higher rates of genetic abnormalities and seizures in children with ACC as these conditions can adversely impact neurodevelopmental outcomes. Medication management, as well as private behavior therapy with a parent-training component, were recommended for interventions to address the child’s deficits with attention and behavioral regulation. This case study demonstrates the need for prompt neuropsychological evaluation for children with ACC in order to more efficiently facilitate access to targeted assessments and treatments that can lead to improved outcomes.