bluuebunny/crossref_metadata_2025 huggingface dataset:
C-65 Transdiagnostic Factors of Social Impairment in Comorbid Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
Authors: Garagozzo A , Katz L , Scott M , Hunter S
Published: August 2019

Objective

Comorbid Autism Spectrum Disorder (ASD) and ADHD are associated with greater symptom severity, including social impairment. Furthering work by Lerner, Pothoff, and Hunter (2015), we sought to identify unique and shared factors that contribute to parent-reported social deficits in children with ADHD, ASD, and ADHD+ASD. We hypothesized attention, hyperactivity, and motor skills would predict social deficits in ADHD, while functional communication and motor skills would predict social deficits in ASD; and additively, all factors would predict social deficits in ADHD+ASD.

Method

Utilizing a clinical database, we identified 236 participants (4-21 years; Mage = 10.6; 71% male; 28% African American; FSIQ M = 94.31) with diagnoses of ADHD, ASD, and ADHD+ASD. We examined FSIQ from the WISC-4/5, WPPSI-3, or DAS-2, motor skills and social impairment from the SIB-R and attention, hyperactivity, and functional communication from the BASC-2/3.

Results

Using hierarchical linear regression and controlling for FSIQ, hypotheses were partially supported. FSIQ was controlled for in each group. For ADHD, hyperactivity, functional communication, and motor skills contributed significantly to the model (p < .001), while for ASD, motor skills contributed significantly to the model (p < .001). For ASD + ADHD, functional communication and motor skills contributed significantly to the model (p < .001)

Conclusion

Results support previous findings that motor deficits and functional communication are associated with social impairment in children with ADHD and ASD, independently and comorbidly. This suggests that targeting motor dysfunction and functional communication concurrently may be effective for improving social interaction skills in children with ADHD +ASD.
C-68 Expanding Pediatric Performance Validity Tests
Authors: McIntyre K
Published: August 2019

Objective

Effort testing with children has started to gain traction in the literature. The following case presents data from several number recall tasks similar to the Wechsler Digit Span and may expand the opportunities for embedded performance validity tests (PVTs).

Method

For the purpose of psychoeducational testing, a comprehensive battery of standardized neuropsychological tests was administered, including visual and auditory attention, language, visual-motor and fine motor skills, visual and auditory processing, executive functioning, and academics.

Results

The child showed impaired performance on Number Recall from the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and Memory for Digits on the Comprehensive Test of Phonological Processing, 2nd Edition (CTOPP-2) that met the Weschler Digit Span cutoff indicative of poor effort. Evidence of Ganser symptoms (e.g., nearly correct or approximate answers) was present on math calculation performance on the Woodcock Johnson Tests of Achievement, 4th Edition (WJTA-IV). Further, apparently deliberate markings of “X” solely on his incorrect responses on a dichotomous (yes/no) reading task also suggested deliberate feigning of low reading skills.

Conclusions

This case highlights the importance of effort testing in children, especially as poor effort was not apparent to the examiner, nor did there appear to be any obvious gain. Comparing data on tasks similar to already established PVTs may help expand opportunities to test effort systematically and frequently throughout a neuropsychological evaluation, and has implications for other professionals (e.g., School Psychologists, Speech Language Pathologists, etc.) who evaluate children.
A-24 Metacognition and behavioral regulation associated with distinct connectivity patterns in autism spectrum disorder
Authors: Bednarz H , Kana R
Published: August 2019

Objective

Executive function (EF) deficits are well documented in children with autism spectrum disorder (ASD)1-2 and are commonly measured clinically using parent ratings3. No studies have investigated whether parent ratings of EF predict brain connectivity in ASD.

Aim

Examine whether the Behavior Rating Inventory of Executive Function (BRIEF) predicts functional brain connectivity in ASD.

Method

Resting-state fMRI and behavioral data were obtained from the Autism Brain Imaging Data Exchange (ABIDE-II) database6 (n = 106 ASD, ages 5-13). ROI-to-ROI (Region of Interest) connectivity was computed for 132 ROIs spanning the whole brain, defined using Conn Toolbox. Multiple regression analyses examined the effect of BRIEF metacognition on connectivity while controlling for BRIEF behavioral regulation, and vice versa. Age, sex, and full-scale IQ were included as covariates. FDR correction was used (p < 0.05).

Results

More severe deficits in metacognition were associated with stronger connectivity between the left hippocampus and several ROIs, including the cerebellum and planum temporale. More severe deficits in metacognition were associated with weaker right hippocampus – right frontal pole connectivity. More severe deficits in behavioral regulation were associated with stronger connectivity between subcortical regions (i.e., thalamus, putamen, and caudate) and regions involved in motor (superior frontal gyrus) and limbic systems (cingulate gyrus). More severe behavioral regulation deficits were associated with weaker cerebellar-cerebellar connectivity.

Conclusions

Findings suggest that parent-ratings of metacognitive abilities in children with ASD are associated with hippocampal connectivity, while behavioral regulation abilities are associated with thalamic and striatum connections. These results build upon previous studies of metacognition and behavioral regulation 5,6.
A-25 Paced Auditory Serial Addition Test in Individuals with Cocaine Versus Methamphetamine Dependence
Authors: Pollard A , Hauson A , Stelmach N , Sarkissians S , Walker A , Cabral C , Wollman S , Hall M
Published: August 2019

Objective

Research suggests that cocaine and methamphetamine differ in their impact on executive functions (EF). The Paced Auditory Serial Addition Test (PASAT) is used to assess working memory; a component of EF. The purpose of this meta-analysis was to examine the difference between the effect of these two drugs on PASAT scores.

Data Selection

Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared cocaine or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than cocaine or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Six articles were coded and analyzed for the current study.

Data Synthesis

Cocaine studies showed a medium statistically significant effect size (g = 0.370, p = 0.020), while methamphetamine did not (g = 0.198, p = 0.172). There was no heterogeneity in effect sizes for both drugs. Subgroup analysis found no significant difference between the two drugs on the PASAT (Q-between = 0.646, p = 0.421).

Conclusions

In contrast to methamphetamine, cocaine is associated with poorer performance on PASAT. This is in line with previous studies that found that cocaine had more significant impact on EF than methamphetamine. Given the preliminary nature of this meta-analysis and the small number of studies on the topic, future primary studies should directly contrast how these two drugs impact EF.
A-27 Stroop Color-Word Interference Test in Alcohol Use Disorder
Authors: Holt A , Hauson A , Ujj P , Reszegi K , Nemanim N , Flora-tostado C , Connors E
Published: August 2019

Objective

Poor inhibitory control is a characteristic of Alcohol Use Disorder (AUD) that might be associated with worse treatment outcomes because of its contribution to the likelihood of relapse. One valid and efficient tool to examine inhibitory control is the Stroop Color-Word Interference Test (Stroop inhibition). The purpose of this meta-analysis was to examine the consistency of findings on the Stroop inhibition subtest and its relationship to length of use and duration of abstinence in AUD.

Data Selection

Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared participants with AUD to healthy controls and (b) matched groups on either age, education, or IQ. Studies were excluded if participants were reported to have Axis I diagnoses (other than AUD) or comorbidities known to impact neuropsychological functioning. Twelve articles were coded and analyzed for the current study.

Data Synthesis

Studies comparing AUD to controls showed a medium statistically significant effect size (g = 0.355, p < 0.001) with no heterogeneity (I2 = 0). Length of use and duration of abstinence did not predict effect sizes.

Conclusions

The Stroop inhibition measure distinguishes between AUD participants and controls. Given the robustness of this finding, the lack of heterogeneity among studies, and the extensive past use of the Stroop to measure inhibitory control; this test should be considered when examining AUD patients. This is especially important when patients exhibit poor inhibition in daily functioning.
A-31 Trails-X Trail-Level Performance Using the Profile Variability Index
Authors: Greene J , Messer M , Hartman D , Reynolds C
Published: August 2019

Objective

The Trails-X is a new type of trail-making test that emphasizes executive function and does not require either literacy or numeracy. The purpose of this study was to examine performance variability across trails.

Method

Participants were the Trails-X standardization sample and individuals with traumatic brain injury (TBI), learning disabilities (LD), intellectual disabilities (ID), attention-deficit hyperactivity disorder (ADHD), and dementia. Trail-level performance was assessed via the mean Matrix, Connected Circles, and Time to Discontinue scores across trails. The Profile Variability Index (PVI) was calculated (Plake, Reynolds, & Gutkin, 1981) and clinical groups and standardization samples were compared via a one-way ANOVA.

Results

Across all trails, the mean Matrix score was 6 (possible range = 1-12) for the standardization sample and as low as 3 for the dementia and ID samples. The mean Connected Circles score was 16 (possible range = 0-22) and as low as 12 for the dementia sample. The mean Time to Discontinue score was 39 seconds (possible range = 1-75) and as high as 55 for the dementia sample. There was a statistically significant difference on the PVI score (F(5,845) = 6.921, p = .000). The dementia (M = 4.77) and ID (M = 5.11) samples had significantly lower (p < .05) PVI scores than the other samples, which were not significantly different from each other.

Conclusions

The dementia and ID samples were characterized by consistently low performance while the other samples were characterized by moderate amounts of variability, indicating that some variability across trails should be expected within less impaired individuals.
A-33 Visuospatial Working Memory Performance and Adult ADHD Symptom Severity
Authors: LeRoy A , Young C , Cooke H , Jacova Chenoweth C
Published: August 2019

Objective

Working memory performance among adults with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrates variable results across literature. This investigation evaluated performance on a visuospatial working memory task relative to scores on measures of ADHD subtype and severity.

Method

A community sample aged 18 to 77 (n = 31; n men = 15) completed neuropsychological testing and measures of ADHD. The sample was predominantly White (64%; n = 20) and highly educated (Myears = 15.6). Participants were eligible if they were 18 or older, regardless of ADHD symptoms/diagnosis, and excluded if they had neuromedical/neuropsychiatric disorders. Spatial Addition (SA) from the Wechsler Memory Scale (WMS-IV) assessed working memory; the Adult ADHD Clinical Diagnostic Scale (ACDS) and Adult ADHD Investigator Symptom Rating Scale (AISRS) assessed ADHD subtype and burden.

Results

AISRS scores did not explain any variance in SA scores, R2 = 00, p = .970 (β = -.020, p = .970). A one-way between subjects ANOVA demonstrated no significant differences on SA scores between groupings based on ACDS: ADHD (n = 9, M = 13, SD = 4.12), and non-ADHD (n = 20, M = 13.95, SD = 5.27), (F(3,25) = .592, p = .626); ADHD (Inattentive (n = 2, M = 14.4, SD = .707); Hyperactive (n = 1, M = 18.00); Combined (n = 6, M = 11.7, SD = 4.8)). Adjustment for age and education did not change these findings.

Conclusions

Results failed to indicate any association between visuospatial working memory scores and ADHD symptoms but a larger, diversified sample is necessary to corroborate this null finding.
A-37 Effects of Atypical Language Representation in Populations Suffering From Intractable Epilepsy
Authors: Nagele M , Bailey K , Kolessar M , O'Neill T , Yetkin Z
Published: August 2019

Objective

Atypical language laterality, secondary to refractory epilepsy, presents complications to surgical planning/cognitive outcomes. Extant research shows the non-dominant hemisphere reallocates neural resources for language compensation in response to left-sided lesions (resulting in decreased visuoperceptual/visual memory). The present study examined relationships between 1) lesion location and atypical language organization and 2) lesion location/language laterality on performance on memory (California Verbal Memory Test 2nd-edition (CVLT; Delayed Recall), and visuoperceptual (Rey-Osterrieth Complex Figure Test, ROCFT; Copy) tests in relation to lesion location in a sample of patients with intractable epilepsy.

Method

Retrospective data was compiled on patients with refractory epilepsy undergoing interdisciplinary pre-surgical workup (N = 101), mean age of 37.2 (SD = 11.9) and mean education of 12.3 (SD = 3.7). The sample was then stratified by non-lesional (n = 48), left (n = 26), right (n = 21) or bilateral (n = 6) mesial temporal sclerosis (MTL); and, language laterality was confirmed by neuroradiologists via functional Magnetic Resonance Imaging (fMRI) scans.

Results

Analyses showed patients with left MTS were more likely to have atypical language organization, X2 (1, N = 47) = 6.6, p = .01. Moreover, significant differences on T-scores for CVLT, F (3,15) = 3.81, p = .04, 95% Cl [-1.73, -.08] and ROCFT, F(4,28) = 2.85, p = .046 95% Cl [31.62, 46.17] were found between groups stratified by lesion location/language laterality, respectively.

Conclusions

Organization of language in epileptic populations presents atypically in conjunction with left-sided lesions. Additionally, cognitive processes such as verbal memory and visuoperceptual abilities suffer based on lesion presence/location and language laterality in this fMRI confirmed sample.
A-40 Utility of the Spanish Auditory and Visual Naming Test in identifying word- finding difficulty in Spanish-speaking adults with Epilepsy
Authors: Bortnik K
Published: August 2019

Objective

Although visual naming (VN) and complementary auditory naming (AN) have proven clinically useful in the pre-surgical work-up of adults with epilepsy, they are available only in English, which compromises assessment for many native Spanish-speakers. VN is typically assessed with the Pontón-Satz Boston Naming Test (PS-BNT), yet this measure is of questionable validity due to vocabulary confounds and inclusion of culturally unfamiliar items. This pilot study examines the utility of the Spanish Auditory and Visual Naming Test (S-AVNT) in a small sample of native Spanish speakers with epilepsy.

Method

20 adult, native Spanish-speaking patients with unilateral temporal lobe epilepsy (TLE; 12 left, 8 right) were recruited (Mage = 41 years, SD = 10.1; Meducation = 12 years, SD = 2.8). Performance measures included: Accuracy (% correct), response time (RT), and tip-of-tongue errors (TOT; i.e., correct responses > 2 seconds or correct following a phonemic cue).

Results

Results: S-AVNT accuracy was high across RTLE and LTLE groups (93-97%) compared to the PS-BNT (59%; p = .000). There were no significant group-level differences, however within-group analyses revealed that VN was superior to AN across all performance measures (all ps < .01).

Conclusions

These preliminary findings represent the first step towards valid, culturally appropriate AN and VN tests for use with native Spanish speakers. The significant within-subjects differences are promising, particularly with respect to RT (i.e., slower auditory RT compared with visual RT) and TOT errors (i.e., auditory TOT > visual TOT), and may provide a more complete picture of naming ability than accuracy scores alone. Funded by NAN Clinical Research Grant.
A-43 Factorial Relationships Among Copy and Memory Trials of the Benton Visual Retention Test
Authors: Gukasyan M , Bhowmick c , Moses J
Published: August 2019

Objective

We investigated the factorial relationships among categorical error groups on the Benton Visual Retention Test (BVRT) copy and memory trials.

Methods

A sample of 523 ambulatory American Veteran patients who presented for clinical evaluation with a wide variety of mixed neuropsychiatric diagnoses and general medical diagnoses were studied. There were no demographic or diagnostic exclusion criteria.

Results

Frequency summary scores for the six types of BVRT errors (omission, misplacement, size, distortion, perseveration, and rotation errors) were factored jointly by means of principal component analysis. Omission, misplacement, and size errors grouped factorially across copy and memory domains by error type. Results showed the factorial relationships are primarily defined by the type of error. Omission, size, and misplacement errors were grouped together regardless of whether they occurred on copy or memory trials. Rotation, distortion, and perseveration errors were factorially grouped on both the copy and memory trials, but the groupings of these similar error groups formed independent factors for the copy and memory trials. The copy error factor explained the most variance and the memory error factor o explained the least variance.

Conclusions

Omission, size, and misplacement errors on the BVRT copy and memory trials appear to be due to similar encoding process errors. Distortion, rotation, and perseveration errors on the BVRT copy and memory trials are related to each other within each trial type but different cognitive processes account for errors of this kind on the copy and memory trials.
A-46 Impairments in Memory for “Who”, “When”, and “Where” are Detectable in Middle-Aged Adults
Authors: Mustafa A , Beltran-Najera I , Gilbert P , Graves L , Holden H , Lopez F , Sumida C , Van etten E
Published: August 2019

Objective

We conducted a cross-sectional study to examine age-¬related differences in performance on a new test assessing memory for “who, when, and where” and associations among these elements. The test was designed to assess aspects of episodic memory by simulating an everyday experience of meeting a series of different people in different places across time.

Method

Healthy young (ages 18¬-25), middle-aged (ages 40-55), and older adults (ages 60+) were asked to remember a sequence of pictures of different faces paired with different places. After viewing the sequence, the participants were asked to pair each face with the correct place and put the face-place pairs in the correct sequence. Participants also completed a battery of standardized neuropsychological tests.

Results

Young adults remembered significantly more face-place pairs in the correct sequence than middle-aged (p < .05) and older adults (p < .05). There were no significant differences between middle-aged and older adults in the number of face-place pairs in correct sequence. Furthermore, young adults remembered significantly more face-place pairs irrespective of sequence than older adults (p < .05). There were no significant differences between young and middle-aged adults or between middle-aged and older adults in the number of correct face-place pairs irrespective of sequence.

Conclusions

Using a new test that incorporates aspects of episodic memory, we found evidence for age-related differences in test performance beginning in middle age. We found that performance on the test correlated with performance on standardized measures of verbal memory and executive functioning but not visual confrontation naming.
A-49 Visual Memory Errors and Intelligence: The Role of Verbal Mediation
Authors: Hakinson K , Moses J , RIvera J , Guerra A , Davis M , Greenman K
Published: August 2019

Objective

Examine the relationship of verbal mediation with visual memory errors and intelligence to understand the role of spoken language on other assessment measures.

Method

Assessment records were obtained from a Veteran Affairs clinic for veterans (n=100) with diverse neuropsychiatric conditions who completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Multilingual Aphasia Examination (MAE), and Benton Visual Retention Test (BVRT). A Principal Component Analysis (PCA) was used to examine the interrelationship among these assessments. The components of spoken language, types of errors on the BVRT, and the four factors of the WAIS-III were factored using the PCA to identify common sources of variance.

Results

A principal component analysis revealed a six-factor model explaining 68.16% of the shared variance among the WAIS-III factors, MAE components, and BVRT Errors. Omission errors loaded with Processing Speed and Controlled Word Association. Distortions and size errors loaded with Perceptual Organization. Size errors also loaded with Verbal Comprehension and Visual Naming. Misplacements loaded with Working Memory and Sentence Repetition. Misplacements, perseverations, and omissions loaded with the Token Test (a measure associated with auditory comprehension). Rotation errors loaded with Perceptual Organization.

Conclusions

Results indicated significant shared variance between visual memory errors, spoken language, and intelligence factors. This suggests that spoken language is involved in the process of visual memory, and deficits in spoken language may result in increased errors on visual memory tasks. Therefore, treatment recommendations for visual memory difficulties should take into consideration verbal capabilities and intelligence factors to better individualize treatment.
A-52 An Exploratory Factor Analysis Investigation of the Role of Verbal Mediation in the Interaction between Intelligence and Visual Memory Tasks
Authors: Rivera J , Moses J , Davis M , Guerra A , Hakinson K
Published: August 2019

Objective

Examine whether verbal mediation may play a role in the interaction between visual memory tasks and the four-factor model of intelligence as operationalized by standard neuropsychological assessment instruments.

Method

The assessment records of 101 American Veterans with diverse neuropsychiatric conditions were examined using Exploratory Factor and Principal Component Analyses (EFA and PCA respectively). There were no exclusion criteria. All participants completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Benton’s Visual Retention Test (BVRT), and Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using PCA. The factor solution of the BVRT was co-factored with the scales of the WAIS-III, then the resulting factor scales were again factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-step analysis revealed a four-factor model explaining 69.44% of the shared variance: 1) Items 1-4 of the BVRT (BVRT-E) loaded with Verbal Comprehension and Visual Naming. 2) BVRT-E also loaded with Processing Speed and Controlled Word Association. 3) Items 5-10 of the BVRT (BVRT-L) loaded with Perceptual Organization and the Token Test. 4) Working Memory loaded with Sentence Repetition on a fourth factor.

Conclusions

The results indicate a strong relationship between assessed performance on visual memory tasks and performance on measures based on the four-factor model of intelligence. The results also appear to support the idea that verbal mediation plays a role in the interaction between visual memory and intelligence, particularly when comparing performance on simple versus more complex visual memory tasks.
A-55 Memory Complaint Inventory Cutoff Scores: Differentiating Genuine Clinical Presentation from Insufficient Effort
Authors: Huber B , Jones R , Capps S , Buchanan E
Published: August 2019

The Memory Complaints Inventory (MCI) is a self-report questionnaire developed as a symptom validity test to assess exaggerated memory complaints and to compliment performance validity tests in neuropsychological settings.

Objective

The current study utilized archival MCI scores in clinical (Alzheimer’s Disease, Vascular Dementia, Mild Cognitive Impairment, and Pseudodementia) and insufficient effort populations to determine clinical cutoff scores for utilization of the MCI in neuropsychological settings.

Method

Data were gathered from the archives of an outpatient neuropsychology clinic based on diagnosis, resulting in a total of 244 participants for inclusion. Participants were subsequently separated into clinical (n = 195) or insufficient effort (n = 49) groups based on diagnosis. Data were analyzed using Receiving Operator Characteristic (ROC) curve analyses, consisting of area under the curve (AUC), specificity, sensitivity, diagnostic odds ratios (DOR), and Youden’s indices.

Results

Data suggested a cutoff of 10.35 (42% endorsement) for the Overall score of the MCI to differentiate clinical populations from insufficient effort with acceptable sensitivity (55%) and specificity (90%). Further, cutoff values for each scale of the MCI were calculated, including the Plausible and Implausible imbedded validity scales.

Conclusions

The findings provided further evidence for the use of the MCI as a symptom validity measure. The identified cutoff scores can differentiate between insufficient effort and clinical populations with acceptable specificity and sensitivity to aid clinician accuracy in detecting insufficient effort and non-credible symptom endorsement.
A-58 Rare Case of Klinefelter Syndrome with 13/14 Balanced Translocation and Absence Epilepsy: Impact of Combined Genotypes on Cognitive Neuropsychological Phenotype
Authors: Shagalow S , Facchini R , Masur D , Weiss E , Schneider S , Jacobs S , Yozawitz E , McGinley J
Published: August 2019

Objective

Klinefelter syndrome (KS) and Robertsonian translocation of 13/14 [rob t(13;14)] are the most common sex-chromosome disorder and chromosome rearrangement, respectively (Engels et al., 2008; Skakkebæk, Wallentin, & Gravholt, 2015). Both are associated with increased risk of cognitive/intellectual disability (ID). A case of KS and de novo (i.e., unbalanced) rob t(13;14) was previously reported (Gül & Şayli, 1994). A case of KS with balanced rob t(13;14) and well-controlled generalized absence epilepsy will be presented with consideration for pediatric neuropsychological practice.

Method

Neuropsychological evaluation of a 12-year-old, right-handed boy diagnosed with comorbid KS, rob t(13;14), and generalized absence epilepsy. Particular attention was given to language given his KS diagnosis. The patient is in a 12:1:1 self-contained classroom with speech-language therapy and social skills groups in place. The patient’s mother is confirmed to have rob t(13;14), whereas paternal contribution is unknown.

Results

Adolescent with a history of language difficulties, especially comprehension. Recent school-based WISC-V FSIQ was in the extremely low range (SS = 53), with weaker verbal comprehension and working memory. Academic achievement was globally very low. Expressive and receptive language, visual perception and motor coordination were extremely low to low average. Verbal list learning and visual attention were near average to average.

Conclusions

This case contributes to the very limited body of pediatric neuropsychological data on the combined genotype of KS with rob t(13;14) and absence epilepsy. Both the KS and rob t(13;14) cognitive phenotypes have been characterized as highly variable, with the comorbidity a likely increased risk for ID.
A-59 Sensitivity and Specificity of Neuropsychological Performance on Successful Return to Driving One Year Post Assessment
Authors: Mullen C , Novack T
Published: August 2019

Objective

A significant concern for patients as well as practitioners is patient safety for return to driving (RTD) after a traumatic brain injury (TBI). Numerous studies have examined neuropsychological test performance and decision making of patients to RTD. However, there is limited information pertaining to longitudinal outcomes on such performance.

Method

This was a retrospective study of TBI patients (n = 36) seen at UAB Spain Rehabilitation Center who completed neuropsychological testing. Measures that have previously demonstrated relationships with RTD were examined: Trail Making Test-Part B (TMT-B), Useful Field of Vision (UFOV), California Verbal Learning Test (Test), and Wisconsin Card Sorting Test (WCST). Performance on the Cog-Log was also examined. Patients were followed across time as part of the Traumatic Brain Injury Model System study. Safe RTD one year post neuropsychological evaluation was measured by patient report. Accuracy of determining safety of RTD based on neuropsychological performance and respective cut scores was determined with receiver operating characteristic curve analysis.

Results

The Cog-Log Total Score and TMT-B demonstrated statistically significance in predicting safe RTD (AUC = .803, SE = .100, p = .023; AUC = .788, SE = .109, p = .030). Cut points of sensitivity and specificity for each measure will be presented. Positive predictive value (PPV) of the Cog-Log was 70.59% for scores less than 25 out of 30, indicative of impairment. PPV of various completion times of the TMT-B will be presented.

Conclusion

Preliminary results can help inform practitioners of essential measures to include in cognitive testing in consideration of long-term safety of RTD.
A-64 The Relationship between Big-5 Personality Factors and Cognitive Health
Authors: Beach J , Ricketts H , McCaskey V , Taylor S , Harrell M , Aita S , Calamia M , Hill B
Published: August 2019

Objective

The purpose of the current study was to examine the relationship between factors of personality and cognitive health.

Methods

Two hundred and two participants (M age = 19.51, SD = 3.33; M education = 12.40, SD = .75; 72.3% Female, 55.3% White, 36.0% African American, 4.6% Asian, 4.1% Other) completed the cognitive health questionnaire (CHQ) and a 120-item International Personality Item Pool Representation of the NEO-PI-R (IPIP-NEO) as a part of a larger battery in an institutional setting. A CHQ total score was calculated based on items of four positive factors of cognitive health including social/intellectual activities, nutrition, exercise, and eating habits.

Results

A multiple linear regression using backwards elimination was calculated to predict scores on the Cognitive Health Questionnaire utilizing the five personality factors of the IPIP-NEO. The overall five-factor regression model yielded a significant regression equation (F(5,196) = 7.76, p < .001), with an R2 of .165. The final three-factor regression model consisting of extraversion, openness, and consciousness yielded significant results (F(3,198) = 12.70, p < .001), with an R2 of .161.

Conclusions

This exploratory study investigated the relationship between factors of personality and cognitive health. Although a multiple regression model involving all five factors of personality were significantly predictive of cognitive health, the results of this study indicate that greater variance of cognitive health is predicted by extraversion, openness and conscientiousness than neuroticism and agreeableness. Further research should investigate each factor of cognitive health and how these components are predicted by features of personality.
A-65 Verbal Abilities May Influence Performance in Assessment of Verbal Short-Term Memory Tasks
Authors: Guerra A , Moses J , Rivera J , Davis M , Hakinson K
Published: August 2019

Objective

Examine whether verbal abilities may help explain the learning strategies people employ when completing a short-term verbal memory task.

Methods

The assessment records of 296 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Benton Serial Digit Learning Test – 9 Digits (SDL-9) and Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-9 was co-factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-factor solution of the SDL-9 separated trials into three overlapping factors consisting of early (SDL-9_Early), middle (SDL-9_Middle), and late (SDL-9_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a four-factor model explaining 67.85% of the shared variance: 1) SenRep loaded with SDL-9_Early, 2) COWAT loaded with SDL-9_Middle and SDL-9_Late, 3) Token loaded with SDL-9_Late, and 4) Vis Nam loaded with SDL-9_Late.

Conclusions

The results suggest that individuals may engage verbal abilities differently as they progress from simpler to more difficult verbal short-term memory tasks. It appears performance in early trials is mostly associated with rote repetition and performance on middle trials is mostly associated with verbal fluency, while performance on the late trials is associated with a combination of verbal fluency, auditory comprehension, and conceptual organization/naming. This may therefore indicate a shift in learning strategy to meet increased cognitive demands.
A-67 Where the Test of Premorbid Functioning (TOPF) Goes, the Hopkins Adult Reading Test (HART) may (not) Follow
Authors: Strang J , Mitchell A , Tang D
Published: August 2019

Objective

To determine if significant differences exist in estimates of premorbid intellectual functioning between the Test of Premorbid Functioning (TOPF) and Hopkins Adult Reading Test (HART) in a diverse sample of U.S. Veterans.

Method

Retrospective analysis of data obtained for routine clinical purposes. 102 Veterans (16% female), predominantly self-identified as African American (53.9%), with an average age of 61.79 years (SD = 13.29, range = 21-90 years) and an average education level of 14.45 years (SD = 2.73, range = 9-20 years); 48% received a neurocognitive diagnosis and 72.5% a psychiatric diagnosis. TOPF and HART standard scores and demographically predicted IQ scores were compared in terms of their linear relationship, absolute agreement, absolute magnitude of change, and discrepancy scores, including the degree to which discrepancy was affected by specific demographic factors.

Results

Despite strong Pearson correlations, concordance correlation coefficients (CCC) showed poor strength of agreement. Root-mean-squared differences (RMSD) was 10.284 (SD = 5.903) between standard scores and 9.948 (SD = 8.183) between predicted IQ scores. Discrepancy scores indicated 41.2% (46.1% for predicted IQ) performed equally well, with 58.8% (53.9%) performing significantly better on one measure than the other. Demographic comparisons for predicted IQ found those who performed better on the HART were older and those who performed better on the TOPF had more years of education.

Conclusions

The TOPF and HART have a strong linear relationship but insufficient agreement when differences in mean and standard deviation are taken into consideration. Estimates are inconsistent and not interchangeable, especially among older individuals and those with more education.
A-70 Beyond Validity: The Utility of the Test of Memory Malingering in Assessing Cognitive Functioning in Veterans
Authors: Clark J , Zaccari B , Tadrous-Furnanz S , Storzbach D
Published: August 2019

Objective

The objective of the present analyses was to replicate analyses from an interim sample which found that scores on the Test of Memory Malingering (TOMM) predicted objective cognitive outcomes in the domains of attention and verbal learning even when invalid TOMM scores were excluded.

Methods

Participants consisted of 92 United States Veterans from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) enrolled at the VA Portland Health Care System and recruited for a larger study on the role of blast exposure. Veterans were included if they had a valid performance on the TOMM (Trial 2 score > 47) were not currently substance dependent. Data was analyzed through linear regressions examining raw TOMM Trial 1 scores to predict objective cognitive performance on measures of memory and attention from the Neuropsychological Assessment Battery (NAB).

Results

In performance on the tasks of Driving Scenes (Beta = .328, p < .01), Initial Story Learning (Beta = .209, p < .05), and Attention Index Percentile (Beta = .208, p < .05) of the NAB, TOMM Trial 1 was a significant predictor. TOMM scores were also predictive of years of education (Beta = .303, p < .01).

Conclusion

These findings replicate results derived from interim data. TOMM Trial 1 significantly predicted objective cognitive performance in OEF/OIF Veterans even when invalid performance was excluded. This suggests that TOMM has a utility in assessing cognitive functioning and not just valid performance. Similarly, results also suggest that the TOMM may be sensitive to education as well.
A-72 Cross Validation of the Automated Neuropsychological Assessment Metrics (ANAM) Performance Validity Measure in Active Duty Service Members
Authors: Grills C , Armistead-Jehle P , Cooper D
Published: August 2019

Objective

The Automated Neuropsychological Assessment Metrics (ANAM) is the currently mandated Neurocognitive Assessment Tool (NCAT) for the Department of Defense for pre-deployment baseline testing and is the recommended tool for post-concussion evaluation and return to duty decision making. An ANAM performance validity measure has undergone initial validation (Roebuck-Spencer, Vincent, Gilliland, Johnson and Cooper, 2013). However, cross validation in other samples is warranted, particularly in order to establish cut-points for utilization in the evaluation of mTBI/concussion. The current study retrospectively examined the operating characteristics of the ANAM PVI relative to a more established performance validity test (PVT) in a sample of active duty Service Members referred for neurocognitive screening postconcussion in an Army brain injury clinic.

Method

Retrospective review of 172 US Service Members referred for neurocognitive screen for possible mild traumatic brain injury/concussion on average 3.8 years post injury (range = 8 days to 27 years) and administered the ANAM, Word Memory Test (WMT), and Neuropsychological Assessment Battery Screening Module (NAB-S).

Results

Utilizing the WMT as the criterion measure, ROC analysis was significant with AUC = 0.894 (p < 0.001). At 90.09% specificity (95% CI = 83.0% - 94.9%), the optimal cut-point was ANAM PVM ≥ 6, and resulted in 67.21% sensitivity (95% CI = 54.0% - 78.7%).

Conclusions

The standard ANAM PVI clinical report utilizes a cut-point of 14; however, the current data indicate a cut-point of ≥ 6 may be better suited for patients with mTBI/concussion.
A-74 Patients with Psychogenic Non-Epileptic Events Differentially Report Emotional Distress and Activities of Daily Living Completion When Controlling for Performance Validity
Authors: Grabyan J , Proto D , Tierney S , Collins R , Chen D
Published: August 2019

Objective

While the use of validity testing in neuropsychological assessments to assist in differentiation between epileptic seizures (ES) and psychogenic non-epileptic events (PNEE) is becoming common, validity considerations regarding symptom self-reporting is seldom examined. This study seeks to add clarity by examining performance validity tests (PVT), and self-report measures of emotional symptoms and daily functioning, in a sample of those with either ES or PNEE.

Methods

Patients: Consecutive Veteran patients referred to an epilepsy monitoring unit for evaluation of intractable seizures, and subsequently diagnosed with ES (32) or PNEE (75). A fixed battery of psychological (Beck Depression Inventory-II, Patient Competency Rating Scale, Quality of Life in Epilepsy) and PVT (Test of Memory Malinger, Word Memory Test) measures were administered as part of a broader neuropsychological assessment. Patients were classified by both their diagnostic, and PVT pass/fail, statuses (PNEEpass, PNEEfail, & ESpass – ESfail was too small to analyze).

Results

PNEE reported more severe symptoms/impairments than ES (each p < .01) when ignoring PVT results. Importantly, when PVTs were considered, PNEEfail reported worse symptoms/impairments than PNEEpass (each p < .01), and PNEEpass and ESpass did not differ on emotional distress (p = .07).

Conclusions

Those with PNEE who fail PVTs report worse psychological distress and functional abilities than both those who pass and those with ES. This is likely due to symptom exaggeration. Validity testing should thus be considered a crucial component of assessment of these individuals: if invalid self-reporting is not accounted for, clinicians put themselves at risk for coming to faulty conclusions while more parsimonious explanations are available.
A-78 What You Said is NOT What You Did
Authors: McKinstry A , Salman A , Schieszler-Ockrassa C , Wisinger A , Korinek D , Jasinski N , Bylsma F
Published: August 2019

Objective

To determine if individuals referred for Attention Deficit/ Hyperactivity Disorder (ADHD) differential diagnosis, who do and do not fail performance validity tests (PVTs) present themselves differently on self-report measures of executive functioning (Behavioral Rating Inventory of Executive Function; BRIEF) and ADHD (Conner’s Adult ADHD Rating Scales; CAARS).

Method

A convenience sample of 83 adults referred to an outpatient neuropsychology private practice for neuropsychological assessment for ADHD was collected. MANOVA was performed comparing individuals who passed PVTs (Word Memory Test or WAIS-IV Reliable Digit Span) to individuals who failed PVTs on the Behavioral Regulation Index and Metacognitive Index of the BREIF and Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability, Problems with Self-Concept, DSM-IV Inattentive Symptoms, DSM-IV Hyperactive-Impulsive Symptoms of the CAARS.

Results

All statistical comparisons were non-significant at the p = < .05.

Conclusions

Individuals who fail PVTs are indistinguishable from individuals who pass PVTs on the BRIEF and the CAARS. This is consistent with past research suggesting that validity of self-report cannot be inferred from performance validity testing (Van Dyke, Millis, Axelrod, & Hanks, 2013; Bush, et al., 2005). Also, this data highlights the importance of self-report measures containing their own validated measures of symptom validity.
B-01 Cognitive Deficits Following Hemorrhagic Stroke in Reversible Cerebral Vasoconstriction Syndrome: A Case Study
Authors: Schultz E , DeDios-Stern S , Ovsiew G , Pliskin N
Published: August 2019

Objective

Reversible cerebral vasoconstriction syndrome (RCVS), a relatively rare condition presenting as severe thunderclap headache with or without neurological deficits, is characterized by vasoconstriction of cerebral arteries which often resolves within three months and may be associated with stroke. Previous case reports examining neuropsychological profiles of RCVS patients demonstrated stroke-specific and/or diffuse global impairments that often exceed impairment expected post-acute phase of clinical stroke and possibly suggest residual deficits related to RCVS alone (Perdices & Herkes, 2018).

Method

The present case is a 36-year-old right-handed African-American male who sustained a left thalamic hemorrhage with extension into the ventricular system following marijuana use. Cerebral angiogram was suggestive of RCVS. The Montreal Cognitive Assessment (MoCA), Western Aphasia Battery (WAB), Repeatable Battery for the Assessment of Neuropsychological Status- Update (RBANS), and Peabody Picture Vocabulary Teat- 4th edition (PPVT-4) were administered at bedside.

Results

Neuropsychological testing was abnormal with severe global impairments on tasks requiring attention and processing speed, visuospatial abilities, immediate and delayed memory, and executive functioning. The patient’s expressive speech was characterized by fluent output with pronounced provoked and unprovoked phonemic and semantic paraphasias. Additionally, he evidenced confabulatory responses during memory testing and lost mental set during tasks requiring simultaneous attention.

Conclusions

Considering the patients clear sensorium at the time of the evaluation, these deficits extend beyond what would be expected by a single thalamic lesion and implicate more generalized cerebral dysfunction secondary to his RCVS. Consistent with previous case studies, this case demonstrates how RCVS may confound and contribute to neurocognitive deficits even after hemorrhagic stroke.
B-02 Neuropsychological Deficits Following Right Hemisphere Cerebrovascular Accidents in a Patient with Human Immunodeficiency Virus, Hepatitis C, and Polysubstance Abuse
Authors: Olzmann A , Inscore A
Published: August 2019

Objective

In right hemisphere cerebrovascular accident (CVA), expected deficits might include inattention syndromes, visuospatial impairment, or neglect. This case study adds to the literature by presenting neuropsychological data from a patient with a complex medical history who experienced two right hemisphere CVAs. The aim is to demonstrate that neuropsychological deficits following CVA may not be as expected in patients with comorbidities, and to highlight the importance of neuropsychological assessment in such cases.

Method

The patient is a 69-year-old, right-handed, African American man who presented with reading and memory difficulties, problems recognizing faces, and vision impairment following right occipital and temporoparietal ischemic CVAs. Comprehensive neuropsychological evaluation was conducted. Formal measures were utilized, but the examiners were also required to devise appropriate bedside measures.

Results

The patient had difficulty recognizing his caregiver’s face. He could not identify facial expressions made by examiners, but commented on individual facial features. Design copies were distorted/fragmented, and he evidenced difficulty integrating visual components into a whole. He also demonstrated spelling and verbal memory impairment (BDAE Oral Spelling raw = 0; HVLT-R recall and recognition < 1st percentile). Full results are included in a supplemental data table.

Conclusions

Results were strongly suggestive of simultanagnosia, though this disorder typically results from bilateral parietal-occipital lesions. Additionally, the neuropsychological impairments noted extended beyond those typical of right hemisphere CVA, likely related to the patient’s history of multiple comorbidities (e.g., infectious disease, polysubstance abuse). This case highlights the importance of neuropsychological assessment in the care of medically complex patients, and the unique ability of neuropsychologists to conduct such evaluations.