bluuebunny/crossref_metadata_2025 huggingface dataset:
A-168 Do Family Members’ Subjective Perceptions of Decline in Executive Functioning Skills Reflect Objective Cognitive Dysfunction?
Authors: H Clark , R Schroeder , P Martin
Published: August 2020

Objective

On behavior rating scales completed by family members, executive functioning is often operationalized in terms of subdomain abilities (e.g., problem-solving, multitasking, and organizing). It is unclear, however, how well collateral assessments of these abilities reflect patients’ actual executive functioning. The current study investigated the relationship between family members’ reported perceptions of change in patients’ problem-solving, multitasking, and organizing abilities and objective neuropsychological test findings.

Method

Patients undergoing dementia evaluations (n = 56, mean age = 71.4, mean education = 13.0 years) minimally completed subtests from the Delis-Kaplan Executive Function System (D-KEFS; Trail Making, Verbal Fluency, Color-Word, Tower) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Information from family members was obtained via a questionnaire asking about degrees of change (no change, mild change, moderate change, or severe change) in problem-solving, multitasking, and organizing. Spearman correlations were calculated between family members’ perceptions of change and cognitive dysfunction, as measured by D-KEFS (subtests and combined averaged scaled score) and RBANS index scores.

Results

Perceived changes in problem-solving, multitasking, and organizing did not significantly correlate at p < .05 with either D-KEFS subtest scores or the combined scaled score. Perceived changes significantly correlated with RBANS Immediate Memory (problem-solving: rs = −.338, p = .014; multitasking: rs = −.323, p = .017; organizing: rs = −.293, p = .028) and Language (problem-solving: rs = −.306, p = .027) indices.

Conclusions

Family members’ perceptions of change in problem-solving, multitasking, and organizing did not correspond with objective executive dysfunction observed on neuropsychological testing. Future research should attempt to cross-validate these findings. If cross-validated, results would suggest limited utility in using these terms to operationalize executive functioning on behavior rating scales.
A-172 Monolingual Advantage in Visual Task-Shifting in English-Speaking Individuals When Compared to English-and-Spanish-Speaking Bilingual Individuals
Authors: A Chester , E Gracian , C Gallagher , F Sabb , R Bilder
Published: August 2020

Objective

Researchers reported that bilinguals have an advantage in visual task-shifting (VTS) and associated this advantage with executive functions (EF). We found self-reported monolinguals were faster than bilinguals when comparing switch (SW) and no-switch (NSW) incongruent trials on VTS, and that memory and age were significant predictors, not EF. Our aim is to repeat previous analyses with a sample of individuals matched on language fluency.

Method

Participants were 881 adults (Age: M = 31.64 ± 8.64; Men = 517; Monolingual = 646; Bilingual = 235; Education: M = 14.92 ± 2.05) from the Consortium for Neuropsychiatric Phenomics (UL1DE019580, PL1MH083271). Participants completed VTS, Memory, and EF tasks, including English Letter Fluency and, if bilingual, Spanish. Participants were dichotomized into the monolingual group if English letter fluency was at least low average, and the bilingual group if English/Spanish letter fluencies were at least low average.

Results

Response times (RTs) for short and long incongruent trials were computed in two-way ANCOVAs with Group (monolingual, bilingual) as between-participant and Trial Type (SW, NSW) as within-participant factors, and Age and Education as covariates. Short trials revealed main effects of Group (p = .034), as monolinguals achieved faster RTs than bilinguals, and main effects of Trial Type (p < .001), as RTs for NSW was faster than SW. Long trials were nonsignificant (p > .05). Hierarchical stepwise regressions revealed EF (p = .032) and Age (p = .004) significantly predicted Primary and Residual VTS performance.

Conclusions

Our results are inconsistent with literature. We found English monolinguals were faster than English/Spanish bilinguals when controlled for Age and Education. Further, the neuropsychological correlates revealed Age and EF are important predictors of VTS that should be further examined.
A-174 Language Impairments Following Subcortical Infarct: An Aphasia Case Study
Authors: E Schultz , R Churchill , A Malina
Published: August 2020

Objective

Subcortical aphasia associated with internal capsule and adjacent structure lesions often involve impaired naming, grammatical but slow dysarthric speech, impaired syntactic comprehension, repetition impairments, and apraxia. Furthermore, neuropsychiatric disturbances, such as diminished motivation and emotional dysregulation are additionally expected given connections to frontal lobe circuits. Overall, the type and severity of aphasia varies following subcortical stroke and the pattern of symptoms associated with subcortical aphasia have not been fully explored.

Method

The present case is a 34-year-old right-handed African-American female who sustained an acute infarct involving the left splenium, thalamus, and internal capsule, who was evaluated at bedside.

Results

Upon initial exam, the patient was aphasic, exhibiting difficulties with expression, fluctuating comprehension and frequent paraphasic errors. Repetition and single-step command following were impaired and apraxia was evident. She demonstrated poor insight and awareness into her current deficits. She additionally demonstrated low motivation and mild emotional dysregulation with heightened anxiety and depression. During recovery she demonstrated improved comprehension, verbal output, and reduced emotionality.

Conclusions

Consistent with previous studies, this case demonstrates the extreme variability of subcortical lesions in their aphasic manifestations and may suggest that subcortical aphasias are generally milder than that of cortical aphasias with generally faster symptom recovery.
A-176 Primary Components of Spoken Language are Specifically Associated with Dimensional Components of Intelligence
Authors: R Maciel , J Moses , A Boese , A Vickery , J Lyu
Published: August 2020

Objective

We compared the factorial dimensional structure of the four components of spoken language from the Multilingual Aphasia Examination (MAE) with the factorial dimensions of the WAIS-III to test the hypothesis that these intellectual and linguistic components are systematically related.

Method

Factorial components of spoken language from MAE subtest measures of visual naming (VN), verbal fluency (VF), sentence repetition (SR), and auditory comprehension (AC) were factor analyzed with the factorial components of the WAIS-III index score measures. The sample consisted of 107 neuropsychiatric patients who were administered the WAIS-III and the MAE as clinical procedures. There were no exclusion criteria.

Results

Specific, independent, robust relationships were demonstrated between each of the four components of spoken language and each of the four factorial components of the WAIS-III. The factorial model explained 70.42% of the total variance among the component measures. VN loaded uniquely with the Verbal Comprehension component. SR loaded uniquely with the Working Memory component. VF loaded uniquely with the Processing Speed component. AC loaded uniquely with the Percentual Organization component.

Conclusions

The four components of spoken language each provide a unique component of verbal mediation for each of the verbal and nonverbal modular components of the WAIS-III cognitive dimensions. These findings suggest that systematic evaluation of spoken language abilities would complement the assessment of intellectual abilities in both clinical and empirical examinations.
A-178 Characterizing Memory Measurement in Cognitively Normal Individuals Using Latent State Trait Modeling of Neuropsychological Tests
Authors: W Goette , J Schaffert , A Carlew , H Rossetti , L Lacritz
Published: August 2020

Objective

Characterize trait and state measurement of memory in a longitudinal, cognitively normal (CN) sample.

Method

Data were taken from 515 participants (81.17% white; Mage = 64.78, SD = 8.20; Medu = 13.04, SD = 4.39; 73.40% female) deemed CN for 5 consecutive visits in the Texas Alzheimer’s Research and Care Consortium. The memory trait was measured by the CERAD (total learning and delayed recall) and WMS-III Logical Memory (LM) and Visual Reproduction (VR) I and II subtests. Multiple-indicator growth models were used as the primary analysis.

Results

Assumption screening revealed the memory trait was characterized by three domain factors: list learning (CERAD learning and recall), story memory (LM I and II), and visual memory (VR I and II). Generalized second-order growth models demonstrated best overall fit. Scores demonstrated a positive latent growth process such that trait memory scores actually increased over time. Consistency and specificity coefficients suggest less situation-specific error occurs as individuals are tested over time with the first evaluation having the largest portion of situation-specific measurement error (Supporting Figure).

Conclusions

Measurement accuracy of memory in CN individuals improved over repeated administrations. Accurate identification of cases with normal memory in memory disorders research may require serial assessments to account for (a) improved measurement accuracy of the trait after multiple assessments and (b) reducing the influence of state-specific sources of error that are greatest at the first assessment time. Further research is needed to determine whether the observed positive growth in trait scores is unique to CN samples and whether measurement accuracy changes in cognitive domains other than memory.
A-182 Convergent and Divergent Validity of the ChAMP with the CVLT-C and RCFT in Children with Epilepsy
Authors: C David , B Brooks , W Macallister
Published: August 2020

Objective

As new measures of memory become available, clinicians may be cautious to adopt them without evidence supporting their validity. The present study assesses the convergent and divergent validity of the Child and Adolescent Memory Profile (ChAMP), with the California Verbal Learning Test Children’s (CVLT-C) and the Rey Complex Figure Test (RCFT) in children with epilepsy.

Method

Twenty four clinically referred children (16 female, 8 male, - age = 12.37 years, SD = 2.68) completed the ChAMP, CVLT-C, and RCFT. Pearson correlations assessed the ChAMP’s convergent and divergent validity with the CVLT-C and the RCFT. Base rate of impairment was calculated for scores ≤2nd percentile.

Results

The ChAMP verbal tasks demonstrated strong relations with CVLT-C (lists; r = 0.678 p = < .001, instructions; r = 0.724 p = < .001 with CVLT-C learning trials and ChAMP lists free recall with CVLT-C long delay r = 0.580 p = .003). The ChAMP visual tasks correlated strongly with the RCFT delay (objects; r = 0.570 p = .004, places; r = 0.619 p = .001, Visual Memory Index; r = 0.657 p = < .001). However, divergent validity was limited as ChAMP Verbal Memory Index correlated with RCFT delay (r = 0.550 p = .005) and ChAMP Visual Memory Index with CVLT-C delay (r = 0.606 p = .002). Eight percent were deemed impaired on ChAMP lists delay similar to the CVLT-C delay (13%), however, ChAMP places delay identified 21% impaired, compared to the RCFT delay (42%).

Conclusions

ChAMP scores are strongly correlated with older established measures, but identify fewer cases as clinically impaired. This may reflect the more contemporary normative data or the fact that ChAMP tasks are less multifactorial in nature than are the CVLT-C and RCFT.
A-183 A Preliminary Study of Comfort with Computers and Analog Tasks in Relation to Older Adults’ Performance in Virtual Reality
Authors: L Williams , A Coldiron , A Sandlin , E Flores , J Flair , D Lee , N Tran , M Barnett
Published: August 2020

Objective

Neuropsychologists are using virtual reality to simulate everyday activities in order to increase ecological validity in neuropsychological assessments (Kane & Parsons, 2017). However, relatively little is known about the extent to which comfort with computers and analog tasks influences older adults’ performance on virtual reality-based tasks.

Methods

Healthy older adults (N = 42) rated how comfortable they are with computers and cooking meals in daily life and completed the Virtual Kitchen Protocol, a measure of procedural learning and memory for meal preparation tasks.

Results

Both higher comfort with cooking meals in a real kitchen and higher comfort with computers were associated with better learning, immediate recall, and delayed recall of the procedural task in virtual reality. However, comfort with computers did not explain a significant amount of variance in performance beyond comfort cooking in a real kitchen.

Conclusion

While both comfort with computers and analog versions of tasks may relate to older adults’ learning and memory in virtual reality, performance may be primarily related to analog abilities.
A-186 An Enhanced Delayed Recognition Measure for the WMS-IV Logical Memory Subtest
Authors: C Gass , B Patten , A Penate , A Rhodes
Published: August 2020

Objective

We introduce a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale – IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 168 female and 105 male neurologically normal outpatient referrals to a neuropsychology clinic.

Method

Ten 5-option items were developed for each of the three LM stories (A, B, and C) reflecting the stories’ narrative content, yielding 20 items for administration to examinees under 70 (Stories B and C) and older than 69 (Stories A and B). Four distractor options for each item were designed to be “plausible” alternatives for the examinee who had little or no recollection of the narrative material. Examinees (N=360), screened for performance validity (effort), completed the LM Recognition test immediately after delayed LM free recall.

Results

Internal consistency (Cronbach alpha) was acceptable for both 20-item LM Recognition tests. Individuals’ scaled scores on LM-Recognition were compared with LM-II (free recall). Recognition was superior (> one SD) to free recall performance in 43% (age 18 to 69) and 48.2% (age 70+).

Conclusion

Delayed free recall scores often underestimate a person’s ability to encode and store new information. For clinical application, separate LM Recognition norms were derived for older (Stories A and B) and younger examinees (stories B and C). This 20-item measure assists clinicians in differentiating between storage and retrieval deficits on the Logical Memory subtest.
A-194 The Impact of Emodiversity on Mental and Physical Health
Authors: R Rivera , D Carballea , A Ardila
Published: August 2020

Objective

The purpose of this systematic review was to examine how emodiversity affects mental and physical health. Emodiversity has been described as an integral component of the human emotional ecosystem that can serve as a predictor for mental and physical health.

Data Selection

This review was conducted using the following databases: Taylor & Francis, Science Direct, Google Scholar, and ProQuest Central. Inclusion criteria consisted of peer-reviewed articles published in English between the years of 2011–2019. Keywords for the search included emodiversity, emotional diversity, emotion, neuroscience, physical health, and mental health. A total number of 20 articles were reviewed and 8 articles were retained.

Data Synthesis

Research indicated that lack of differentiated emotional experiences, specifically the continuity of negative emotional states, stimulates inflammatory responses that are associated with negative moods and traits, such as depression and anxiety. Furthermore, heightened systemic inflammation has been associated with poor health conditions, such as Type II Diabetes, insulin resistance, rheumatoid disease, and oxidative stress. On the other hand, the presence of differentiation in emotions may lead to adaptive coping and adjustment. Emodiversity is also considered a predictor of habits that may contribute positively to physical health, such as healthy diets, regular exercise, and refraining from smoking.

Conclusion

Articles reviewed suggest that emodiversity is a fundamental criterion for evaluating the human emotional ecosystem. Reviewed literature showed that the absence of emodiversity may be related to different mental health conditions and physical illnesses. Studies have shown that diverse emotional experiences are beneficial for mental and physical health.
A-201 Factor Structure of the RBANS in Patients with Huntington’s Disease
Authors: J Carvalho , B Springate
Published: August 2020

Objective

The Repeatable Battery for the Assessment of Neuropsychological Status is a commonly used screen of neuropsychological performance (RBANS). A 5-factor structure is used when scoring this measure, revealing 5 composite scores that are used in clinical diagnosis (Immediate Memory; Visuospatial/Constructional; Language; Attention; Delayed Memory). This structure has been supported in a sample of older adults with cognitive impairment. However, a 5-factor structure has not been consistently observed. Rather, in a sample of veterans, a 2-factor solution was noted, as was in a large exploration of past RBANS studies. We explored the factor structure of the RBANS in a sample of patients with Huntington’s Disease (HD).

Method

Participants were 147 patients with HD who presented to an outpatient HD clinic at UConn Health Center, Mage = 46.75, SD = 13.35; Meducation = 13.87, SD = 2.63.

Results

Exploratory principal component factor analysis with direct Oblimin rotation was conducted. A 2-component structure was found with eigenvalues > 1 (65.1% variance). Contrary to expectations from other clinical samples, we did not find the traditional 5-factor solution. Rather, results revealed a 2-factor solution. Factor loadings generally are comprised of visually-loaded (Figure Copy, Line Orientation, Picture Naming, Figure Recall) versus non-visually-loaded tasks.

Conclusions

Results revealed a 2-factor structure of the RBANS in a sample of patients with HD, contrary to the traditional 5-factor solution typically derived into composite scores with this measure. Our findings suggest that HD patients may not perform on the RBANS in a traditional manner. Thus, clinicians evaluating HD patients should exercise caution when using composite scores when considering patient performance on this measure.
A-203 Method Matters: Measures of Social Communication Ability Disagree in Women with Autistic Traits
Authors: J Beck , M South , T Gabrielsen , J Cox , R Lundwall
Published: August 2020

Objective

Increasing evidence suggests that many women with autism spectrum disorder (ASD) may be undiagnosed and thus denied access to supports and interventions. Evaluating suspected ASD involves assessing social communication abilities, and many potentially helpful tools exist. We sought to compare various social communication measures (self-report, clinician-rated, and behavioral) in a sample of women with autistic traits.

Method

Our sample includes women without intellectual impairment (N = 66; age M = 25 years; IQ M = 114; 63 White) who reported impairing symptoms associated with ASD (BAPQ total score > 3). One third (n = 22) had been diagnosed with ASD. Participants were recruited through local clinics, a university counseling center, and social media. Participants completed the SRS-2 (self-report), ADOS-2 (clinician rating of autistic traits), and TASIT-S (video-based test of social cognition).

Results

As expected, women with a previous diagnosis of ASD showed significantly more social communication difficulties on the ADOS-2, t(64) = −4.88, p < .001, and TASIT-S, t(64) = 2.23, p = .03. Observable social difficulties on the ADOS-2 were significantly associated with poor performance on the TASIT-S (rS = −.27, p = .03). However, women with an ASD diagnosis did not report more social communication problems on the SRS-2, and SRS-2 scores were not associated with ADOS-2 or TASIT-S scores.

Conclusions

These findings highlight the importance of using a multi-method approach when assessing social communication abilities in women with suspected autism, as self-report measures may not discriminate well mild from more severe impairment, and may disagree with clinician ratings and/or behavioral measures.
A-209 The Relationship Between Performance on the Test of Memory Malingering (TOMM) Trial 1 and Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population
Authors: A Smith , J Thomas , C Friedhoff , E Chin
Published: August 2020

Objective

In concussion populations, suboptimal effort on performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive complaints. This study examined if performance on TOMM Trial 1 was associated with increased cognitive deficits, post-concussive symptoms, and emotional concerns in a pediatric concussion population.

Method

This study utilized archival data from 93 patients (mean age = 14.56, SD = 2.01) with a history of concussion who were assessed at approximately 40 days post-injury. Individuals were divided into “Pass” and “Fail” groups based on their TOMM Trial 1 performance using the established cut-off. The testing battery included Auditory Consonant Trigrams, CPT-II and III, HVLT-R, WJ-III and IV, ImPACT, BASC-2, and BRIEF.

Results

The overall pass rate on Trial 1 was 70% (mean = 46.04, SD = 4.55). There were no significant correlations with Trial 1 and age, grade, gender, prior history of concussion, or mechanism of injury. The Fail group scored lower across domains of attention, memory, and processing speed when compared to the Pass group (p < .05), though their performances were largely average. On rating scales, more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group (p < .05), though their scores were below clinical levels. The Fail group reported more post-concussive complaints (p < .05) but they did not significantly differ from the Pass group in terms of depressive symptoms, anxiety, or somatization.

Conclusions

This study highlights the importance of utilizing PVTs when evaluating concussion recovery in pediatric patients.
A-211 Examination of the Personality Assessment Inventory and Performance Validity Tests: Correlation between Response Styles, Performance Effort, and Somatic Complaint
Authors: C Chan , J Roth , J Roberts , G Getz
Published: August 2020

Objective

Correlation between the performance validity measures from the Advanced Clinical Solution (ACS) package and select scales from the Personality Assessment Inventory (PAI) were examined to investigate relationships between performance effort and response styles involving negative impression (NIM), inconsistency (ICN), infrequency (INF), and somatic compliant (SOM) scales. Theoretical differences between symptom validity based on self-report questionnaires and credibility of performance on a performance validity tests (PVTs) were considered.

Method

Archival data from clinical neuropsychological evaluations between the years 2015–2018 were reviewed, and 120 consecutive adult cases involving 68 males and 52 females between the ages of 19–69 were collected. Examined measures included: ACS—Word Choice Test (WCT), Reliable Digit Span, Visual Reproduction II Recognition, Logical Memory II Recognition, and the PAI. Spearman’s rank-order correlation and point-biserial correlation analyses were conducted to examine the relationship between variables.

Results

WCT had significant negative correlations with the NIM scale (rs(118) = −.203, p = .013). Modest correlations were found between SOM and WCT when examining PVT raw score (rs (118) = −.192, p = .018) and base rate performance (rs(118) = −.222, p = .007). Point-biserial serial analysis found a weak negative correlation between performance credibility and the SOM scale, which was statistically significant (rpb = −.221, n = 120, p = .008).

Conclusions

NIM T-scores appear to be correlated with lower performance on the WCT, suggesting that an exaggerated or distorted impression of the self is associated with higher risk of poorer performance the stand-alone PVT. Correlation between embedded PVTs and PAI scales were inconsistent.
A-213 Comparing WAIS-IV Reliable Digit Span and Age Corrected Scaled Score’s Performance Validity Cutoffs when Patients’ Effort is Determined by One or More Performance Validity Tests (PVTs)
Authors: J Livingstone , C Reese
Published: August 2020

Objective

The purpose of the present study was to compare Wechsler Adult Intelligence Scale-IV (WAIS-IV) Reliable Digit Span (RDS) and Digit Span Age-Corrected Scaled Score (DS-ACSS) sensitivity and specificity, when the effort criterion was determined by between one and five performance validity test (PVT) cut scores.

Method

Data were collected from 82 adults (18–49) referred for clinical questions of multiple sclerosis, mild traumatic brain injury, and attention deficit hyperactivity disorder. Patients were administered full neuropsychological batteries,with different combinations of PVTs (including Advanced Clinical Solutions Word Choice, Animals raw score, Trails A T-score, Wisconsin Card Sorting Test [WCST; Suhr & Boyer] equation, and California Verbal Learning Test-II Forced Choice). Chi-square and receiver operating characteristic (ROC) analyses were utilized.

Results

Using established RDS (≤7) and DS-ACSS (≤6) cut scores, specificity was highest (90&37; and 86%, respectively), with equivalent sensitivity (90%), when effort was determined by WCST (Suhr & Boyer) equation failure alone. Related area under the curve for RDS was .90 (CI = .76–1.0) and for DS-ACSS was .88 (CI = .74–1.0).

Conclusions

In this clinical sample, the highest sensitivity and specificity were observed when the RDS cut score was utilized, and effort was based on the WCST criterion. However, the DS-ACSS cut score resulted in strong sensitivity/specificity combinations across more effort classification groups.
A-228 Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare?
Authors: C Cooper , E Trahan , C Muncy , J Higa , J Link , M Reid , R Seegmiller , J Kennedy , L Lu
Published: August 2020

Objective

One study reported that suboptimal effort on performance validity tests (PVTs) is associated with higher healthcare utilization within a VA setting, defined as the number of Emergency Department visits and inpatient hospitalizations. The current study sought to expand on this by examining whether PVT failure is associated with higher number of outpatient visits in a military sample with a history of mild traumatic brain injury (mTBI).

Method

The medical records of 43 participants, 13 of whom failed the PVT Green’s Word Memory Test (WMT), were reviewed for the number of encounters since the mTBI and the reason for the encounter. The two groups (passed vs. failed) did not differ significantly on demographic variables (39 males, mean age 39, 65% Caucasian).

Results

The overall number of medical encounters was not significant between the two groups after controlling for years since the mTBI (F(1, 40) = 2.67, p = .11); however, once three participants with (>2 years) missing records were excluded (final n = 40), the PVT failure group was seen significantly more often, (F(1, 37) = 8.23, p = .01). The PVT failures had a higher number of encounters with physical therapy (t(38) = −2.79, p = .01) and orthopedics (t(38) = −2.10, p = .04).

Conclusions

Preliminary results suggest that suboptimal effort is not associated with higher healthcare utilization; however, when participants with more than two years of missing records were excluded, those who failed PVTs were seen more frequently by physical therapy and orthopedic specialties. Limitations for future investigations are highlighted.
A-235 Construct validity of the National Institutes of Health Toolbox- Cognition Battery (NIHTB-CB) in children and adolescents with cerebral cavernous malformation, type 1 (CCM-1) and their non-affected relatives
Authors: C Petranovich , K Wilson , D Gill , L Morrison , B Hart , R Campbell
Published: August 2020

Objective

This study assessed the convergent validity of the NIHTB-CB in a sample of children and adolescents with CCM-1 and non-affected relatives.

Method

Twenty-two participants with CCM-1 and 7 non-affected relatives completed the NIHTB-CB and traditional neuropsychological measures. The following domains were assessed: memory (NIHTB-CB Picture Sequencing Memory and Child and Adolescent Memory Profile- Screening Index), word reading (NIHTB-CB Oral Reading and Wide Range Achievement Test-4th Word Reading [WRAT-4 WR]),processing speed (NIHTB-CB Pattern Comparison and Symbol Digit Modalities Test), and attention/working memory (NIHTB-CB List Sorting and Digit Span).

Results

The non-affected group scored higher than the CCM-1 group on WRAT-4 WR (t = 2.68, p = .02) and NIHTB-CB Oral Reading (t = 2.18, p = .05). The groups did not differ on the other measures (p > .05). Pearson’s correlations ranged from .45 for memory to .81 for word reading, demonstrating adequate construct validity for memory, processing speed, and attention/working memory and good to very good for word reading. The NIHTB-CB was more likely to identify participants as impaired for memory (17.2% vs 6.9%) and processing speed (62.1% vs. 3.4%). The traditional attention/working memory measure was more likely to identify participants as impaired (27.6% vs 3.4%). Impairment rates were similar for the word reading measures.

Conclusions

Of the domains considered, convergent validity was best established for word reading. Although correlations were adequate, rates of impairment differed for memory, processing speed, and attention/working memory, suggesting that caution is warranted when comparing the NIHTB-CB to traditional measures in these areas.
A-247 Overall Test Battery Means from ANAM4 TBI-MIL and D-KEFS: A Within-Subject Comparison of a Traumatic Brain Injury Cognition Composite Score
Authors: B Ivins , J Arrieux , W Cole , G Iverson
Published: August 2020

Objective

Several cognition composite scores have been developed for potential use in traumatic brain injury clinical trials. This analysis examined the equivalence of overall test battery mean (OTBM) from two different test batteries administered consecutively to the same subjects.

Methods

Soldiers were administered the Automated Neuropsychological Assessment Metrics (version 4) TBI-MIL (ANAM4) computerized battery and D-KEFS as part of a larger study comparing within-subject performance from different neuropsychological test batteries. Data from 121 soldiers with complete and valid data on both ANAM4 and D-KEFS and no recent TBI were used in this analysis. OTBMs were calculated for ANAM4 and the seven D-KEFS achievement scores. The OTBMs from the 121 soldiers were ranked from lowest to highest and the percentile rankings from each battery were compared. For each soldier, the differences between the percentile ranks from each battery were also calculated.

Results

Only 53.8% of soldiers who scored below the 20th percentile on ANAM4 also scored below the 20th percentile on D-KEFS. Furthermore, only 47.8% of soldiers who scored at or above the 80th percentile on ANAM4 also scored in that range on D-KEFS. Some soldiers’ performance on each battery diverged by large amounts, for example from 59.5 to 82.6 percentage points. Correlation analysis revealed that the OTBMs and percentile rankings from both batteries were modestly correlated (OTBM r = 0.515, p < 0.001, percentile rank r = 0.499, p < 0.001).

Conclusion

These results suggest that comparing similar cognition composites from different neuropsychological test batteries from different studies in a meta-analytic manner may not be feasible due to psychometric difference between batteries.
A-249 Evidence for Frontal Lobe Involvement in the Visual Processing Streams
Authors: S Leonard , T Hall
Published: August 2020

Objective

Extant literature supports the “Two-Stream Hypothesis” of visual processing including a ventral stream (connecting the occipital lobe to the temporal lobe) and a dorsal stream (connecting the occipital lobe to the parietal lobe), but is not traditionally believed to involve the frontal lobe.

Method

“Eddie”, a healthy 14-year-old male, sustained a penetrating brain injury by accidentally lodging a pool cue through his right orbital bones and piercing his right frontal lobe through to the skull. He was ambulatory, awake, and alert on arrival to the ED, with a laceration, swelling, and bleeding of the eyelid. A cranial CT revealed a complex orbital roof fracture, injury to the orbit, and right frontal contusions. Eddie underwent a right supraorbital craniotomy with repair of the orbital roof fracture and debridement of bony fragments. Post-operative MRI revealed right frontal parenchymal edema and patchy areas of contusion.

Results

Neuropsychological evaluation revealed a robust cognitive reserve including verbal skills, working memory, processing speed, and word reading skills in the high average. Eddie demonstrated significant discrepancies in visually mediated skills including relatively weaker visual–spatial skills (24 standard score (SS) points lower than verbal skills), fluid reasoning with visual problem-solving (30 SS points lower than verbal skills), low average judgment of line orientation, and a discrepancy between verbal and visual memory. He also demonstrated mild difficulties consistent with his right orbito-frontal injury including weaknesses regarding impulsivity, self-monitoring, planning, and task approach.

Conclusions

The current case demonstrates possible involvement of the frontal lobe in the visual processing pathways.
A-255 Severe Psychological Dysfunction in a Neurologically Complex Patient during a Pre-Surgical Evaluation for Normal Pressure Hydrocephalus Shunt Implantation
Authors: A Wisinger , J Fink
Published: August 2020

Objective

Psychological syndromes like depression and anxiety are common in neurological conditions and lead to poorer quality of life and disability. However, these syndromes are often under-recognized in neurologic patients and are thus under-diagnosed due to overlapping symptomatology. Here, we report on a patient with a complex neurological history as well as clinically significant affective symptoms.

Participants

The patient is a 69-year-old Caucasian female recently diagnosed with normal pressure hydrocephalus. Relevant medical history was significant for focal epilepsy with complex seizures, obstructive sleep apnea, and cerebrovascular accident. She underwent neuropsychological evaluation as part of a pre-surgical workup for shunt implantation.

Results

The patient’s neurocognitive profile was marked by significant impairments in most cognitive domains and she was not independent in activities of daily living. On self-report measures of current emotional functioning, she reported clinically severe levels of depression, anxiety, apathy, executive dysfunction, and disinhibition. During the clinical interview, she reported experiencing passive suicidal ideation as well as a significant history of traumatic experiences.

Conclusion

The psychological symptoms the patient was experiencing undoubtedly impacted her neurocognitive status and functioning abilities, though she was receiving no treatment for these symptoms. Addressing symptoms resulting from psychological syndromes in patients with neurological conditions is an important role for neuropsychologists, as accurate diagnosis of psychological syndromes can inform treatment recommendations and improve patient outcomes. This case illustrates the importance of documenting a thorough clinical history, including past psychiatric history, as well as a detailed examination of self-reported current psychological functioning as part of a comprehensive neuropsychological case formulation.
Using Nasal Self-Esteem to Predict Revision in Cosmetic Rhinoplasty
Authors: Okland Tyler S , Patel Priyesh , Liu George S , Most Sam P
Published: August 2020

Background

It would be useful if existing tools or outcomes measures could predict which patients are at greater risk of revision surgery following rhinoplasty.

Objectives

The authors sought to determine if a single question assessing nasal self-esteem could be utilized to predict which patients are at greatest risk of revision surgery following rhinoplasty.

Methods

The authors conducted a retrospective chart review of 148 patients who underwent cosmetic rhinoplasty. Results of pre- and postoperative Standardized Cosmesis and Health Nasal Outcomes Survey questionnaires and rates of revision or patient-initiated revision discussions (RD) were collected. Patients were stratified based on answers to Standardized Cosmesis and Health Nasal Outcomes Survey question 5 (SQ5), “Decreased mood and self-esteem due to my nose.”

Results

Of the 148 patients included in the analysis, 72.9% were women, and the mean age was 30.9 (15-59, standard deviation = 10.3) years. Those patients who selected 4 or 5 on SQ5 had an overall revision rate of 16.7% and 18.8%, respectively, and a RD rate of 27.8% and 31.25%, respectively. Those patients who selected 0 through 3 on SQ5 had an overall revision rate of 0% and an overall RD rate of 10.4%. Only SQ5 was predictive of revision and RD on logistic regression analysis (P = 0.0484 and P = 0.0257) after Bonferroni correction.

Conclusions

SQ5 appears to offer a useful adjunct to guide surgical management of the cosmetic rhinoplasty patient. Those patients who reported worse nasal self-esteem and associated mood preoperatively were more likely to request and undergo revision.

Level of Evidence: 4
Upfront triple oral combination therapy including selexipag in a high-risk patient with idiopathic pulmonary arterial hypertension: a case report
Authors: Rossi Serena , Pietrangelo Carla , Pierdomenico Sante Donato , Giuliani Livio
Published: August 2020

Background 

Selexipag is an oral selective prostacyclin IP receptor agonist approved in patients with low- and intermediate-risk pulmonary hypertension (PH); evidence in patients at high risk is lacking.

Case summary 

A 42-year-old woman with worsening dyspnoea (World Health Organization functional class III–IV) and suspected PH at echocardiographic examination was evaluated in our Pulmonary Hypertension Centre. Right heart catheterization showed pre-capillary PH with reduced cardiac index and increased pulmonary vascular resistance. High-resolution computed tomography excluded parenchymal lung disease and ventilation/perfusion (V/Q) lung scan was negative for mismatched perfusion defects so the conclusive diagnosis was high-risk idiopathic pulmonary arterial hypertension (PAH). The patient refused an initial combination therapy including a parenteral prostacyclin analogue (PCA) in accordance with the ESC/ERS guidelines, so an off-label triple oral combination therapy including a phosphodiesterase-5 inhibitor, an endothelin receptor antagonist, and selexipag was started. At 3- and 6-month follow-up we found a clinical and haemodynamic improvement, so the patient was reclassified as low risk. Her clinical condition is currently stable.

Discussion 

Despite the benefit of parenteral PCAs in high-risk PAH, low adherence to treatment may be explained by adverse side effects related to the intravenous route of administration. Given the potential effect seen in our patient, upfront triple oral combination therapy in PAH high-risk patients should be further evaluated in a controlled clinical trial.
May Measurement Month 2018: an analysis of blood pressure screening results from Ecuador
Authors: Peñaherrera Ernesto , Beaney Thomas , Ster Anca Chis , Poulter Neil R , Villalba Jose , Ramirez Maria Isabel , Duarte Yan , Caceres Silvia , Mora Cecilia , Peñaherrera Ruben , Avila Elisa , Arteaga Fabricio , Bravo Jesenia , Hidalgo Eric
Published: August 2020

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension (ISH) aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2018. A volunteer cross-sectional survey was carried out in May 2017 across 33 health centres. Blood pressure measurement, the definition of hypertension (HTN) (mean of the 2nd and 3rd BP measurement ≥ 140/90 mmHg or who were medicated for high BP), and statistical analysis followed the standard MMM protocol. In total, 11 922 individuals (53.7% female) were screened during MMM18. After multiple imputation, 4563 (38.3%) had HTN. Of individuals not receiving antihypertensive medication, 1302 (15.0%) were hypertensive. Of individuals receiving antihypertensive medication, 933 (28.6%) had uncontrolled BP. MMM18 was the largest BP screening campaign done in Ecuador. Hypertension was detected in 38.4% of those screened and almost 4 out of 10 were either not on treatment or were not controlled to the BP goal. These results suggest that appropriate screening can help to identify a significant number of people with high BP. These data should attract the attention of doctors and health care system in Ecuador.
May Measurement Month 2018: an analysis of blood pressure screening results from Chile
Authors: Lanas Fernando , Garcia Maria Soledad , Paccot Melanie , Peña Jimena , Torres Pamela , Beaney Thomas , Ster Anca Chis , Poulter Neil R , Xia Xin
Published: August 2020

Hypertension is highly prevalent in Chile. The National Health Survey 2016–17 reported a 27.6% prevalence, 68.7% awareness, and 33.3% of hypertensives had controlled blood pressure (BP). May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. A cross-sectional survey of volunteers aged ≥18 years old was carried out in May 2018. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Ninety-four sites participated, most of them from the Public Health System outpatient clinics distributed along the country. In addition, universities, clinical research sites, and private clinics participated. Hypertension was diagnosed as mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or receiving antihypertensive medication. Overall 9344 individuals were screened. After multiple imputation, hypertension prevalence was 29.2%, of which 64.0% were aware of their condition. Of those aware of their hypertension diagnosis, 87.7% were receiving antihypertensive medication and 56.1% of the total number of hypertensives were on antihypertensive medication. Moreover, 15.3% of the participants who were not receiving treatment were considered potential hypertensives identified in the MMM18. MMM18 was one of the largest BP screening campaigns performed in Chile. It demonstrated a high prevalence of hypertension with one-third of these individuals having controlled BP. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggests that systematic screening programmes may be a useful tool to improve hypertension control in Chile.
May Measurement Month 2018: an analysis of blood pressure screening results from Colombia
Authors: Lopez-Jaramillo Patricio , Otero Johanna , Alvernia Juliana , Ney-Salazar Daniela , Lopez-Lopez Jose , Accini Jose L , Aroca Gustavo , Urina-Triana Miguel , Sánchez-Vallejo Gregorio , Arcos Edgar , Casanova María E , García Henry , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

High blood pressure (BP) is the leading global preventable cause of death and the most common risk factor for cardiovascular disease (CVD). However, due to its asymptomatic nature, the lack of awareness of this condition causes underdiagnosis and low rates of adherence to pharmacological treatment. Looking for practical approaches to increase awareness worldwide, the International Society of Hypertension (ISH) implemented the 2nd May Measurement Month campaign in 2018 (MMM18). In order to contribute to this initiative, Colombia participated as one of the 89 countries involved in this hypertension screening programme. Blood pressure was measured in subjects from 11 departments in Colombia. Under the leadership of the Fundación Oftalmológica de Santander (FOSCAL), 400 volunteers across the country collected the data following the MMM protocol. Measurements from 35 548 participants with a mean age of 41.9 years were obtained. In total, 9475 (26.7%) of the total population studied had hypertension. Of those with hypertension, 69.9% of these subjects were aware of their condition, 65.0% were on antihypertensive medication, and 43.1% had controlled BP. Of those on medication, 66.3% had controlled BP. Hypertension screening, awareness, treatment, and control should be a priority in public health objectives due to its elevated burden of disease and direct association with increased CVD. The MMM campaign provided a positive impact in the diagnosis of hypertension across Colombia. Although efforts are being made to expand treatment capability and adherence, still more are needed to insure a broader coverage of antihypertensive medication in Colombia.
May Measurement Month 2018: an analysis of blood pressure screening from Kenya
Authors: Ogola Elijah N , Barasa Anders , Gachemba Yubrine M , Barasa Felix , Gitura Bernard M , Nalwa Wafula , Wairagu Anne , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

Hypertension (HTN) is highly prevalent and the leading cardiovascular risk factor for death globally. A large proportion of individuals with high blood pressure (BP) are unaware leading to under treatment and poor control. To address this, the International Society of Hypertension (ISH) initiated a global mass screening campaign, the May Measurement Month 2017 (MMM17), in which Kenya participated. Following the success of the campaign, its successor MMM18 was launched. Here, we present the Kenyan results for MMM18. Opportunistic screening of consenting adults was done in various sites across Kenya in May 2018, by volunteers trained using ISH material, under the co-ordination of the Kenya Cardiac Society. Blood pressure, pulse rate, weight, and height were measured by standard methods. Definitions of HTN and statistical methods all adhered to the standard MMM protocol. We screened 49 548 subjects, mean age 39.95 (15.3) years. In total, 49.4% had never had a BP measurement taken. After multiple imputation, 17.1% were hypertensive and of those who were hypertensive, 30.7% were aware, 26.6% were on antihypertensive treatment, and 13.0% had controlled BP. Alcohol use, excess weight, and treatment for HTN were associated with higher BP. The Kenyan MMM18 sites successfully screened more than three times the number screened in 2017, hence improving public awareness. Less than half the population had ever had a BP check. Less than a third of the hypertensives were aware with correspondingly poor treatment and control rates. Opportunistic mass screening is useful in raising public awareness.