bluuebunny/crossref_metadata_2025 huggingface dataset:
B - 103 Chronic Stress and Smoking Moderate the Relation between Hippocampal Volume and Long-Term Memory in Older Hispanic Adults
Authors: Gomien Kenneth , Hill Benjamin , Ikonomou Vasilios , Barnickel Jaryn , Campbell Ivan
Published: September 2024

Objective

We evaluated how self-reported chronic stress and lifetime smoking behavior moderates the relation between hippocampal volume and memory.

Method

841 Hispanic adults (mean age = 63.12 years, SD = 8.03; mean years of education = 10.01, SD = 4.65; 67% female) underwent MRI of the brain and completed the HCHS Chronic Stress measure, a lifetime nicotine use question, and the WMS-III Logical Memory Delayed Recall subtest (LM-II). Two models evaluating HCHS Chronic Stress score and lifetime smoking behavior as moderators of the relation between hippocampal volume and LM-II were run.

Results

Moderation analyses revealed the endorsement of ever smoking cigarettes was a significant moderator for the relation between hippocampal volume and LM-II performance (Smoking: Estimate = −0.012, p = 0.005). Additionally, increased chronic stress was also a significant moderator for the relation between hippocampal volume and LM-II performance (Chronic Stress: Estimate = −0.001, p = 0.021).

Conclusions

The current findings suggest that smoking and chronic stress each acted as a moderator of the relation between hippocampal volume and memory, though the effects were small. Future research should examine whether there is a dose–response relationship for cigarette smoking and how this moderates brain health and memory. Additionally, whether there is an interactive effect between stress and smoking warrants further study.
B - 105 ICANS, CAR-T, and Cognition: a Case Study
Authors: Fisher Madelyn , Zolliecoffer Chandler , Lacy Maureen
Published: September 2024

Objective

Immune effector cell-associated neurotoxicity syndrome (ICANS), an autoimmune delirious condition, affects 37.5% to 77% of individuals during or after chimeric antigen receptor T-cell (CAR-T) treatment for hematologic cancers (Grant et al., 2022). Initial clinical response varies widely but may include apraxia, aphasia, disorientation, and hallucinations (Möhn et al., 2022). Recent research indicates complete symptom resolution in most patients a month post-ICANS onset (Sales et al., 2023). However, a self-report study suggested more than 1 in 3 report persisting cognitive sequelae 1–5 years post-ICANS onset (Rurak et al., 2020). This discrepancy may be due to subtle changes missed by the Montreal Cognitive Objective Assessment (Sales et al., 2023; Möhn et al., 2022). The current case report investigates neurobehavioral outcome post-ICANS via comprehensive neuropsychological assessment.

Method

Two weeks post-CAR-T therapy, a 53-year-old male exhibited abrupt onset facial palsy and cognitive slowing prompting hospitalization. His wife reported new-onset apathy, atypical behaviors exacerbation (e.g., licking plate), and cognitive lapses (e.g., short-term memory, slowing, repeating questions) with little insight. Neuroimaging revealed supratentorial white matter hyperintensities plus calvarium and R skull base enhancing lesion regression.

Results

Neuropsychological assessment 10-months post-ICANS revealed subtle executive inefficiencies with family reports of improved yet ongoing social disinhibition and apathy.

Conclusions

This is the first comprehensive neuropsychological assessment of a patient who developed ICANS post-CAR-T therapy. Neuropsychologists should be aware of delayed cognitive sequelae possibility of this advancing treatment option. Future studies will be useful for patient/family preparation.
B - 107 Is the Flynn Effect Present in a Veteran Outpatient Clinic Sample?
Authors: Carter Kirstine , Marceaux Janice C
Published: September 2024

Objective

The Flynn Effect refers to improvement in cognitive scores over time due to advancements in education quality, nutrition, and socioenvironmental variables. Recent studies suggest cognitive scores may plateau or decline over time. Characterization of cohort effects in cognitive performance has implications for normative group selection and identification of brain illness. This study examines cognitive performances of veterans using older and newer versions of normative data to determine if a Flynn effect is present.

Method

Veterans (N = 189) who passed TOMM and completed the Trail-Making Test (TMT), Animal Naming, and California Verbal Learning Test-II (CVLT-II) were selected for inclusion. The sample was 81% male, racially diverse (49% White/Caucasian, 31% Black/African American, 16% Hispanic/Latino, 4% other), and diagnostically diverse (13% no diagnosis, 33% cognitive disorder, 54% psychiatric diagnosis). Normative scores were calculated from CVLT-II/CVLT-3 manuals for Trial 1, Trial 5, and LDFR; ADC Uniform Data Sets (UDS) were used for TMT-A/B and Animals. Wilcoxon matched-pairs signed rank tests examined differences in z-scores across older and newer normative data.

Results

Median z-scores were significantly lower using updated UDS norms for TMT-A (z = −11.60, p < 0.001), TMT-B (z = −10.41, p < 0.001), and Animals (z = −11.76, p < 0.001), while CVLT Trial 1 z-scores were significantly higher using CVLT-3 norms (z = 11.24, p < 0.001). CVLT Trial 5 and LDFR medians did not differ.

Conclusion

Findings demonstrate the need to examine cohort differences in normative reference groups to ensure accurate detection of brain illness. Furthermore, the Flynn Effect may not apply uniformly across domains within a period.
B - 108 Sleep Disordered Breathing, Cognition, and Anxiety in Young Adults
Authors: Lin Theresa , Dougher Caitlin C , Watson Malorie E , Zimmerman Molly E
Published: September 2024

Objective

Sleep disordered breathing (SDB) describes abnormal breathing during sleep due to upper airway dysfunction. SDB and anxiety are associated and independently affect cognition. The purpose of this study was to examine these associations among young adults in the domains of executive function, attention, working memory (WM), and long-term memory (LTM).

Method

Bronx students (N = 49, Mage = 19.8 years (SD = 1.30), female = 65%) were recruited via flyers. SDB risk assessment utilized the Berlin Questionnaire. Cognitive assessment included the Modified Rey Auditory Verbal Learning Test, Trail Making Test A and B, Controlled Oral Word Association Test, and the Cogstate computerized battery (Groton Maze Learning Test, Identification Test, One Back Test, Two Back Test, and Groton Maze Learning Test Recall). Anxiety was assessed with the Depression, Anxiety, and Stress Scales. Individuals in the normal/mild ranges were categorized in the low anxiety group, and individuals in the moderate/severe/extremely severe ranges were categorized in the high anxiety group.

Results

Anxiety symptoms moderated the relationship between SDB risk and WM. For high anxiety individuals, as SDB risk increased, performance on WM measures decreased (F(1,45) = 6.06, p = 0.02, η2 = 0.12). There was a trend for anxiety symptoms to moderate the relationship between SDB risk and LTM – among high anxiety individuals, as SDB risk increased, performance on LTM decreased (F(1,44) = 4.04, p = 0.05, η2 = 0.084).

Conclusion

For young adults, anxiety symptoms moderated the relationships between SDB and WM and between SDB and LTM, suggesting that mild levels of anxiety may have a beneficial effect on the relationship between SDB and cognition, while more severe anxiety may worsen that relationship.
B - 110 Exploring the Relationship between Subjective Cognitive Complaints, Psychiatric Symptom Reporting, and Neurocognitive Test Performance in a Post-SARS-CoV-2 Clinical Sample
Authors: Boulais Brooke M , Sedgwick Thomas A , Ellison Rachel L , Ulrich Devin M , Jennette Kyle J , Pliskin Neil H , Soble Jason , Phillips Matthew S
Published: September 2024

Objective

This study evaluated the relationship between subjective cognitive complaints, objective cognitive performance, and psychological outcomes among clinical patients referred for persisting cognitive concerns following SARS-CoV-2 infection.

Method

The sample consisted of 49 patients (69.4% female; 38.8% Black, 36.7% White, 18.4% Hispanic, 6.0% Other; Mage = 45.27, SD = 12.08; Meducation = 15.49; SD = 3.0) referred for neuropsychological evaluation to assess for long-term post-SARS-CoV-2 cognitive changes. All patients were administered a uniform neuropsychological test battery that included measures of working memory, processing speed, and verbal learning/memory, as well as measures of anxiety, depression, and perceived stress. Degree of subjective cognitive concerns was established using the Neurobehavioral Symptom Inventory (NSI) cognitive subscale. Linear regression models were conducted between the NSI cognitive subscale and each cognitive and psychological outcome.

Results

NSI cognitive scale predicted all psychological (depression [F = 31.37, p < 0.001(R2 = 0.41)]; anxiety [F = 6.71, p = 0.01(R2 = 0.13); perceived stress [F = 4.40, p = 0.04(R2 = 0.10)]) variables. The NSI cognitive scale also significantly predicted working memory [F = 4.624, p = 0.04(R2 = 0.09)]; however, no individual scores fell below the low average range upon further analysis. Cognitive complaints did not significantly predict any other cognitive (processing speed [F = 0.002, p = 0.97(R2 = 0.00)], total learning [F = 0.14, p = 0.71(R2 = 0.00)], and delayed recall [F = 1.03, p = 0.32(R2 = 0.02)]) variable.

Conclusions

Subjective cognitive complaints significantly predicted self-reported psychological symptoms including depression, anxiety, and perceived stress, while working memory was the only cognitive performance with a similarly meaningful relationship. These preliminary findings suggest that the psychological effects of persistent symptoms following SARS-CoV-2 infection, rather than objective cognitive changes, may better explain subjective cognitive concerns reported by this population.
B - 111 Community Resource Access and Neuropsychological Outcomes in a Post-SARS-CoV-2 Clinical Sample
Authors: Boulais Brooke M , Sedgwick Thomas A , Ellison Rachel L , Phillips Matthew S , Jennette Kyle J , Pliskin Neil H , Soble Jason , Ulrich Devin M
Published: September 2024

Objective

Lower access to resources, income, education, and housing quality has been linked with poorer neuropsychological outcomes. This study evaluated the relationship between community resource access and several cognitive and psychological outcomes among clinical patients with persisting cognitive concerns following SARS-CoV-2 infection.

Method

The sample consisted of 49 patients (30.6% male; 35.3% White; Mage = 45.3, SD = 12.1; Meducation = 15.5, SD = 3.0) referred for neuropsychological evaluation to assess for long-term cognitive changes following SARS-CoV-2 infection. All patients were administered a uniform neuropsychological test battery that included measures of working memory, processing speed, and verbal learning/memory, as well as measures of depression, anxiety, and perceived stress. Area deprivation index (ADI) was determined using the national decile of the 2021 Neighborhood Atlas. Linear regression models were conducted between ADI and each cognitive and psychological outcome.

Results

No significant associations were identified between ADI and cognitive (working memory [F = 3.16, p = 0.08]; processing speed [F = 0.89, p = 0.32]; total learning [F = 0.41, p = 0.52]; delayed recall [F = 0.08, p = 0.78]) nor psychological (depressive symptoms [F = 0.09, p = 0.77]; anxiety symptoms [F = 0.05, p = 0.82]; perceived stress [F = 0.49, p = 0.49]) variables.

Conclusions

In this preliminary study, community access to resources did not significantly predict long-term cognitive or psychological symptoms following SARS-CoV-2 infection. This unexpected result suggests that neighborhood deprivation may be one particular social determinant of health that is less impactful for post-SARS-CoV-2 neuropsychological outcomes in similar populations. Generalizability is limited by sample characteristics (highly educated; uncomplicated disease course) and small sample size. Thus, replication in a larger database and further research involving other social determinants is indicated.
B - 112 Challenges and Opportunities for Training in a New Era in Neuropsychology: a Survey Study
Authors: Fox-Fuller Joshua , Wisinger Amanda , Koudys Jacob W , DesRuisseaux Libby A , Cerny Brian , Schmitt Taylor , Towns Stephanie , Rahman-Filipiak Annalise , Votruba Kristen
Published: September 2024

Objective

The field of neuropsychology is undergoing significant changes, especially as the Minnesota Update Conference (MUC) drafts are developed. In late 2023, a group of neuropsychology trainee-leaders, united through the Clinical Neuropsychology Trainee Forum (CNTF), surveyed trainees in the United States and Canada to better understand their needs and perception of the neuropsychology training climate.

Method

Survey items were written by a CNTF task force consisting of trainee-leaders from major neuropsychology organizations before being refined by four independent neuropsychologists, including two current neuropsychology postdoctoral fellowship training directors. The survey was distributed via listservs and social media.

Results

220 respondents completed a majority of the survey, and they were primarily female (86%), White (71%), and training in the United States (92%). More than 75% of respondents reported satisfaction with their doctoral program, internship, and/or fellowship. Similarly, 90% and 73% of respondents, respectively, felt their opinions on the future of the field are listened to and/or valued in discussions with peers and supervisors/mentors. However, only 57% of respondents felt their opinions are valued by neuropsychology organizational leadership, and nearly 70% were uncertain or disagreed that trainees’ opinions were valued during the MUC draft development and review period.

Conclusions

Most neuropsychology trainees are satisfied with their training programs yet expressed concern about their opinions on the future of the field being heard by neuropsychology leadership. Trainee stakeholder engagement will be key to the vitality of neuropsychology in light of anticipated MUC Guidelines. Recommendations for supervisors, training directors, and neuropsychology organizational leadership will be discussed.
B - 113 Assessing the Neuropsychology Information Base of Large Language Models
Authors: Kronenberger Oscar , Bullinger Leah , Kaser Alyssa N , Cullum Munro C , Schaffert Jeffrey , Harder Lana , Lacritz Laura
Published: September 2024

Objective

Research has demonstrated that Large Language Models (LLMs) can obtain passing scores on medical board-certification examinations and have made substantial improvements in recent years (e.g., ChatGPT-4 and ChatGPT-3.5 demonstrating an accuracy of 83.4% and 73.4%, respectively, on neurosurgical practice written board-certification questions). To date, the extent of LLMs’ neuropsychology domain information has not been investigated. This study is an initial exploration of ChatGPT-3.5, ChatGPT-4, and Gemini’s performance on mock clinical neuropsychology written board-certification examination questions.

Methods

Six hundred practice examination questions were obtained from the BRAIN American Academy of Clinical Neuropsychology (AACN) website. Data for specific question domains and pediatric subclassification were available for 300 items. Using an a priori prompting strategy, the questions were input into ChatGPT-3.5, ChatGPT-4, and Gemini. Responses were scored based on BRAIN AACN answer keys. Chi-squared tests assessed LLMs’ performance overall and within domains, and significance was set at p = 0.002 using Bonferroni correction.

Results

Across all six hundred items, ChatGPT-4 had superior accuracy (74%) to ChatGPT-3.5 (62.5%) and Gemini (52.7%; p’s < 0.001). The LLMs had lower performance on items with domain information (ChatGPT-4 = 66%, ChatGPT-3.5 = 56%, Gemini = 42%; see Table 1). Generally, ChatGPT-4 performed better across domains (range = 59.5%–74%) than ChatGPT-3 (range = 48.4%–65.6%) and Gemini (range = 38.1%–50%). The same trend was observed for pediatric questions (ChatGPT-4 = 65%, ChatGPT-3.5 = 51.7%, Gemini = 46.7%).

Conclusions

Consistent with reports in other medical subspecialties, these findings reflect LLMs’ rapidly expanding neuropsychology information base. With additional neuropsychology-specific training, LLMs may have utility in educational and clinical training settings. It is incumbent upon neuropsychologists to explore the various applications of this technology.
B - 114 Evaluation of the Montreal Cognitive Assessment Memory Index Score for Predicting Amnestic Mild Cognitive Impairment to Alzheimer’s Clinical Syndrome Progression
Authors: Kronenberger Oscar , Lacritz Laura H , Nguyen Trung P , Kaser Alyssa , Longoria Anthony , Lee Diamond , Schaffert Jeffrey
Published: September 2024

Objective

The Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) is derived from the MoCA as a supplementary memory measure, with research suggesting the MoCA-MIS can identify those at higher risk of progression from mild cognitive impairment (MCI) to Alzheimer’s Clinical Syndrome (ACS). This study evaluated the sensitivity and specificity of the MoCA total score (TS), delayed free recall score (DFRS), and MIS in classifying amnestic MCI (aMCI) to ACS converters and replicated an algorithm recommended by Julayanont et al. (2014).

Methods

National Alzheimer’s Coordinating Center data were examined in individuals with aMCI, ≥50 years of age (Myears = 75.35[7.92]) who had 3–6 annual follow-up visits. Participants (n = 353) were mostly male (58%), White (88%), and well-educated (Myears = 16.37[5.21]). Receiver operating characteristic (ROC) analyses utilized baseline MoCA scores to examine optimal cutoffs using Youden’s index. Sensitivity and specificity of Julayanont’s algorithm (TScutoff<20 + MIScutoff<7) were also examined.

Results

Over follow-up (Myears = 4.52[1.02]), 53.3% converted to ACS. ROC analyses to predict longitudinal conversion from aMCI to ACS revealed similar sensitivity and specificity across MoCA scores (TScutoff<24, AUC = 0.67, Sensitivity = 0.78, Specificity = 0.49; DFRScutoff<2, AUC = 0.67, Sensitivity = 0.75, Specificity = 0.54; MIScutoff<8, AUC = 0.69, Sensitivity = 0.66, Specificity = 0.64). The Julayanont algorithm displayed low sensitivity (0.18) but high specificity (0.93) in this sample.

Conclusion

In predicting aMCI to ACS conversion over a 3–6 year period, baseline MoCA-TS, DFRS, and MIS cutoffs failed to demonstrate high sensitivity with adequate specificity. The Julayanont combination approach had unacceptable sensitivity in this sample. These findings suggest MoCA cutoffs are poor predictors of future cognitive progression in those with aMCI and highlight the importance of comprehensive longitudinal follow-up.
B - 116 What Factors Predict Clinician Ratings of the Alliance in Neuropsychological Settings?
Authors: Madnick Alison , Zweig Richard
Published: September 2024

Objective

The study aimed to identify variables associated with clinician ratings of the working alliance in neuropsychological assessment settings.

Method

The study utilized a cross-sectional design and survey method to evaluate hypotheses. Participants (n = 224) recruited from neuropsychology listservs were clinicians who saw an adult patient in the context of a neuropsychological evaluation within the past month. Clinician demographics, patient demographics, evaluation variables (e.g., time spent in evaluation, referral question, evaluation setting) and ratings of the salience of the alliance were collected via participant self-report. The Working Alliance Inventory – Neuropsychology Revised (WAI-NP-R) (α = 0.93) created for this study served as the primary outcome.

Results

Between-subjects ANOVA revealed that clinician-patient match on gender demographics was associated with higher clinician ratings of the working alliance (F(1, 218) = 6.73, p = 0.010, ηp2 = 0.03). Post hoc tests revealed that ratings of the working alliance were significantly higher for male clinicians with female patients (M = 104.26, SE = 2.54) than for female clinicians with female patients (M = 92.97, SE = 1.89), mean difference = 11.288, 95% CI [2.65, 19.92], p = 0.004. In a hierarchical regression analysis both examiner age (β = 0.297, p < 0.001) and examiner rating of importance of the alliance (β = 0.164, p = 0.010) were independent predictors of alliance ratings.

Conclusions

The study found that clinician ratings of the working alliance were associated with clinician age, gender, and investment in the alliance. Findings add to a limited but growing body of literature on the alliance within neuropsychology.
B - 118 Exploration of Supplemental Recognition Measures for the RBANS
Authors: Golla Megan , Golla Lauren
Published: September 2024

Objective

RBANS is a widely used cognitive screener that lacks memory recognition measures for 2 recall tasks. Performance on verbal and visual recognition measures, relative to recall, may help inform clinical decision-making and treatment planning. Our pilot project aims to understand how individuals with valid cognitive data and normal memory functioning perform on newly developed RBANS story and figure memory recognition tests.

Method

Of those referred for outpatient neuropsychological assessment at a veterans hospital between 2017–2024, 89 received the newly established recognition measures as part of their clinical evaluation. Our analysis included veterans that displayed valid profiles (TOMM trial 1 ≥ 45, n = 53). Assessment occurred 30% face-to-face and 70% telehealth. In addition to key demographic factors listed in table 1, race/ethnicity breakdown included: 92% White, 4% Black, 2% Asian, 2% Hispanic. These veterans were subdivided into 3 intact memory groups: list recall (≥ 25%ile, n = 31), story recall (≥ 25%ile, n = 37), figure recall (≥ 25%ile, n = 42) to determine average recognition performances across domains.

Results

The individuals with valid cognitive data and normal memory recall performed as listed in table 1. Although our novel story and figure recognition measures differ from those published in Duff et al. (2021), our pilot project data largely overlapped with their reported findings despite demographic differences.

Conclusion(s)

These novel recognition scores can help establish normal story and figure recognition performance to assist with clinical diagnosis and treatment planning. With greater and more diverse samples, we may be able to establish relative cut points for expected recognition memory performances across intact, amnestic/cortical, and vascular/subcortical.
B - 120 Participant Satisfaction with Tele-Neuropsychology: the Framingham Heart Study
Authors: Muller Emma V , Walsh Lindsey K , Devine Sherral , Gifford Katherine , Sunderaraman Preeti , Liu Yulin , Ang Ting Fang Alvin , Mez Jesse , Au Rhoda , Gurnani Ashita
Published: September 2024

Objective

Tele-neuropsychological assessments (tele-np) have grown in importance since the COVID-19 pandemic, allowing for ongoing surveillance of underserved remote participant populations when traditional in-person evaluations are not practical, convenient, or possible. However, literature addressing satisfaction and acceptance with tele-np is scarce. This study examines participants’ satisfaction with a unique tele-np protocol in a cohort-based epidemiological study, the Framingham Heart Study (FHS).

Methods

FHS participants who have completed a tele-np evaluation via HIPAA-compliant Zoom since 2021 were included. Tele-np participants completed the same protocol as in-person evaluations. Record forms and a digital pen to capture drawing tasks and Boston Process Approach variables are mailed with a return label to participants. Participants provided feedback on their experience on four, five-point Likert scale questions (1 = strongly negative, 5 = strongly positive).

Results

Sixty-three largely college-educated (87.30%) participants, with average age of 74.28 years (SD = 7.82), 47.62% female, representing 21 US states completed a tele-np visit. Average completion time was 78.74 minutes (SD = 10.78). 94.83% reported a positive overall experience (M = 4.47, SD = 0.71) with tele-np protocol. Participants reported positive experiences with the use of video conferencing (M = 4.33, SD = 0.73), shipping and test-related materials (M = 4.52, SD = 0.60), and clarity of instructions (M = 4.53, SD = 0.54).

Conclusions

Older adults positively relate to a tele-np protocol that allows for robust remote assessment of cognition. Tele-np is a feasible and acceptable mode for large scale neuropsychological data collection in older adults and can minimize attrition due to travel limitations. Continued study of participant feedback is imperative as tele-np is expanded to improve accessibility for underserved and diverse populations.
B - 123 Examining the Utility of a Short-Form Letter Fluency Task: a Lifespan Analysis Using the D-KEFS Verbal Fluency Test
Authors: Kheradbin Nusha , Bunner Melissa R , Eisenstat Lauren N
Published: September 2024

Objective

The D-KEFS Verbal Fluency Test (VF) is a commonly used measure of a variety of executive functions with three separate components: Letter Fluency (FAS), Category Fluency and Category Switching. This study will solely explore the FAS, a measure of phonemic fluency and lexical access. Prior research in cognitively impaired adults suggested a potential for a short-form version of the test. This project seeks to validate these findings across different age groups. The hypothesis predicts a positive correlation between words produced in the 1–15 second interval for the letter F and the total FAS score, which includes three 60-second intervals for each letter.

Method

The study involved 99 patients aged 10 to 88 (X ̅: 38.77; males = 50) referred for outpatient neuropsychological evaluation. Pearson’s correlation coefficient assessed the relationship between the initial 15-second FAS interval and the total raw score.

Results

The Pearson correlation coefficient shows a moderate positive correlation between the 15 second interval for the letter F and FAS total score (r = 0.435). Further, this correlation is significant, (p < 0.001).

Conclusions

The study suggests that the initial 15-second FAS interval effectively predicts overall performance across pediatric and adult populations. This underscores the potential for a short-form Letter Fluency component as a valuable addition to clinical assessments. Short forms could alleviate patient frustration and maintain motivation during testing, enhancing the utility of cognitive measures like the D-KEFS FAS in clinical settings.
B - 124 Neuropsychological Evaluation of Chinese Speaking Patients with Parkinson’s Disease for Deep Brain Stimulation Surgery
Authors: Jiang Yirou , Zhang Belinda , DeVaughn Saskia , Rengifo Johanna , Peery Shelley
Published: September 2024

Objective

Neuropsychological evaluation is a critical part of standardized workup of candidates with Parkinson’s disease (PD) for deep brain stimulation (DBS), identifying patients with cognitive dysfunction (Okun et al., 2006). Existing literature has primarily involved native English speakers with dementia and mild cognitive impairment (MCI), informing treatment planning (Troster et al., 2018). This case series aims to address the gap for Chinese-speaking patients, by describing Chinese neuropsychological measures and norms sensitive to MCI.

Method

Six cases of first-generation Chinese immigrants diagnosed with PD considering DBS were included in this study. They identified Chinese as their primary language and English as their second language. Duration of residency in the U.S. ranged from 11 to 44 years. The battery included Chinese version of the MOCA; Chinese WAIS-IV; Boston Naming Test (Cheung et al. 2004); semantic verbal fluency, Auditory Verbal Learning Test, Symbol Digit Modalities Test, and Color Trail Test (Lee and Wang, 2010); and Brief Visuospatial Memory Test, Revised Edition (BVMT-R) or RBANS: Figure Recall.

Results

Consistent with studies for native English speakers (Foley et al., 2018), cognitive declines were found in attention, memory, and executive function domains. Two of the six cases were diagnosed with MCI, which warrants caution before DBS.

Conclusions

This case series explores measures for Chinese speakers with PD undergoing evaluation for DBS surgery, highlighting cultural considerations, including Chinese measures and norms. This battery can help to differentiate cognitive impairments before proceeding with DBS. Given the diversity within this population and the scarcity of Chinese tools, more research is urgently needed.
B - 126 Posttraumatic Stress Disorder Symptoms as a Predictor of Invalid Attention-Deficit/Hyperactivity Disorder and General Psychiatric Symptom Reporting among Adult Neuropsychology Referrals
Authors: Piszczor Justyna , Shoemaker Bonnie E , Jones Mackenze , Soble Jason R
Published: September 2024

Objective

Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is complicated by the nonspecific nature of attention complaints, which overlap with most forms of internalizing psychopathology as well as elevated rates of invalid symptom overreporting. This study assessed the relationship between posttraumatic stress disorder (PTSD) symptoms and overreporting of both ADHD and general psychological symptoms.

Method

Data from 308 consecutive adults (mean age = 29.0; mean education = 16.09; 57.5% female, 42.5% male; 35% White, 27% Hispanic, 18% Black, 13% Asian, 7% Other) referred for neuropsychological evaluation of possible ADHD were administered the PTSD Checklist for DSM-5 (PCL-5) and embedded symptom validity tests (SVTs) on the Clinical Assessment of Attention Deficit-Adult (CAT-A) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Patients were classified as overreporting/no overreporting ADHD and general psychiatric symptoms based on elevations on the CAT-A and MMPI-2-RF overreporting SVTs, respectively.

Results

Logistic regressions showed that higher PCL-5 scores significantly predicted overreporting of both ADHD symptoms on CAT-A (X2 = 7.47, p = 0.006; Classification Accuracy = 85.1%; Nagelkerke R2 = 0.04; B.025; p = 0.007) and psychiatric symptoms on MMPI-2-RF (X2 = 58.76, p < 0.001; Classification Accuracy = 71.4%; Nagelkerke R2 = 0.35; B = -1.92; p < 0.001), with significantly greater variance predicted for overreporting of psychiatric symptoms.

Conclusions

Higher PTSD symptoms predicted overreporting of ADHD symptoms (CAT-A) and, more significantly, broad psychopathology (MMPI-2-RF). Findings reinforce the necessity of SVTs when evaluating ADHD among adults, particularly in the context of elevated PTSD symptoms, and also indicate that neuropsychologists should consider routinely assessing patients’ trauma history/symptomatology during ADHD evaluations to improve diagnostic accuracy.
B - 127 Equivalence of In-Person and Remotely Administered Performance Validity Tests: Evidence from a Forensic Sample
Authors: Bart Thomas A , Nghiem Duyen M , Carlew Anne R , Wisdom Nick , Collins Robert L , Sullivan-Baca Erin
Published: September 2024

Objective

While neuropsychologists are increasingly recognizing the importance of tele-neuropsychology (teleNP), existing research has not comprehensively explored equivalency of commonly used performance validity tests (PVTs) and symptom validity tests (SVTs) across in-person and remote administration. This is despite the fact that such measures are a crucial component of any neuropsychological assessment battery and are, as such, considered medically necessary. Furthermore, the existing teleNP research base is primarily limited to clinical and other non-forensic samples, with limited applicability to forensic teleNP evaluations. The current study examined the equivalency of in-person and remote administration of widely used PVTs and SVTs in a forensic sample.

Method

Archival data between July 2021 and December 2023 were collected from a private practice setting in which board-certified neuropsychologists (ABPP/ABCN) conducted independent medical evaluations (IMEs) in controlled settings with utilization of an on-site proctor. Mean PVT and SVT scores across in-person and remote evaluations were compared.

Results

All included PVTs and SVTs (TOMM, DCT, WAIS-IV RDS, Word Choice, WMT, MENT, MSVT, IOP-29, SIMS, MMPI-2-RF scales) showed mean equivalency across in-person and remote administration (p > 0.05).

Conclusions

Findings provide preliminary support for the adaptation of both PVTs and SVTs for teleNP. Implications are present for forensic and clinical practice, although future research should continue to establish preliminary trends.
B - 128 Examining Word Choice (WC) and Test of Memory Malingering Trial 1 (T1) Cutoffs by Ethnicity, Language, and Education
Authors: Hausman Hanna , Roop Samantha , Hromas Gabrielle , Rolin Summer , Davis Jeremy
Published: September 2024

Objective

Optimal cutoffs on performance validity tests can vary by examinee characteristics including ethnicity, language, and education. We examined WC and T1 cutoffs in Hispanic/Latino (H/L) and non-H/L participants with consideration of language and education.

Method

Local clinical data were retrospectively examined. Cases with WC and T1 data were included if there was no diagnosis of dementia, intellectual disability or psychosis yielding a sample (N = 580) in which 41% of participants identified as H/L and 26% of participants with language data (n = 530) reported bilingualism. Outcome measures included WC and T1 scores and dichotomous cutoffs.

Results

Education showed significant associations with WC and T1 (r = 0.12–0.20) and varied by ethnicity and bilingualism (pH/L) with a small effect (d = 0.21). No language differences were observed on WC or T1. Logistic regression models predicting dichotomous WC and T1 with education, ethnicity, and language as predictors were significant overall, but ethnicity and language were not significant. Grouping with independent validity indicators, WC false positives (5–6%) did not vary significantly by ethnicity or language; T1 false positives were not significantly different but were slightly higher in H/L and bilingual (14–15%) participants compared to non-H/L and monolingual (9–10%) participants.

Conclusions

WC and T1 cutoffs from prior research in mixed clinical and forensic samples appear appropriate for use with H/L and bilingual examinees. Lower educational levels remain an area in need of further validity measure research.
B - 129 Examining the Influence of Age and Other Demographics on Word Choice (WC)
Authors: Roop Samantha , Hausman Hanna , Hromas Gabrielle , Rolin Summer , Davis Jeremy J
Published: September 2024

Objective

Performance validity tests (PVTs) often vary by examinee characteristics including age and education among other demographics. Normative data on WC are limited to adults in the 16–69 age range. We examined relationships among demographic variables and WC in a mixed clinical sample.

Method

Local clinical data were retrospectively examined. Cases with WC and four independent PVTs were included; cases with dementia, intellectual disability or psychosis were excluded yielding a sample (N = 362) in which 61% of participants were female and 44% identified as Hispanic/Latino. Average age and education were 48 and 13 years, respectively. Outcome measures included WC and PVT scores and dichotomous cutoffs.

Results

WC was associated with age (r = −0.27) but not education. WC scores were significantly different by gender with a small effect (d = 0.39) but not by ethnicity. Using logistic regression with WC as outcome, age, education, and gender were significant predictors. Significantly more males (11%) scored below the WC cutoff than females (5%) in the valid group. Among participants 70 and older, 17% scored below the standard WC cutoff, but only 7% scored below expectation on two or more criterion PVTs. Lowering the WC cutoff resulted in improved specificity in the 70 and older subset: 15% with WC ≤ 40, and 11% with WC ≤ 36.

Conclusions

WC scores varied by age and gender. The standard WC cutoff showed an elevated false positive rate among adults 70 and older. Consideration might be given to adjusting the cutoff if subsequent research supports these preliminary findings. Further research might also examine relationships among gender, education, and WC.
B - 130 Application of Item Response Theory to the MMPI-2-RF Response Bias Scale-19 (RBS-19)
Authors: Childers Luke , Herring Tristan , Albertorio Arianna , Ingram Paul
Published: September 2024

Objective

RBS is a cognitive overreporting scale on the MMPI-family of instruments. Recent efforts to refine the scale removed nine items lacking conceptual and empirical relationships to cognitive dysfunction (Ingram et al., 2024; Ratcliffe et al., 2022). This revised scale version (RBS-19) demonstrated improved utility and classification accuracy, although the improvements were small. Albertorio et al (2024) found that the RBS could be reduced to 14 items and identified potential “critical items”. This study uses IRT in a database of Active-Duty personnel to explore reduced item RBS forms.

Method

Using a 2-parameter IRT model, we examined cognitive overreporting across the 19-item MMPI-2-RF RBS-19 Scale. Participants (n = 326; 96% male) were divided into pass-all vs fail 2+ standalone PVTs for criterion-based comparisons (e.g., ROC analysis and mean difference), with indetermined profiles removed.

Results

Results indicate good theta coverage. Two items (24 and 26) were removed due to low α (2). RBS-14/17/19 all had similar AUC (0.72 vs 0.71 vs 0.72) and similar effect sizes between groups.

Conclusions

IRT analyses supported a 17-item RBS scale rather than the 14 or 19 item versions in this sample. However, no “critical items” emerged in this sample. Such differences may reflect changes in factor structure based on referral reason (Boress et al., 2023).
B - 131 Validation of the California Verbal Learning Test-II-Short Form Forced Choice Paradigm as an Indicator of Performance Validity
Authors: Do Cardinal , Milam Alicia L , Soble Jason R , Webber Troy A
Published: September 2024

Objective

Although the Forced Choice (FC) paradigm of the standard California Verbal Learning Test-Second Edition (CVLT-II) has been extensively validated as an embedded performance validity test (PVT), no studies have validated the CVLT-II Short Form (SF) against a standard battery of external PVTs.

Method

Participants included 98 veterans (Mage = 69.7 ± 9.0; 86.7% cisgender-male) who completed the CVLT-II-SF FC and the following independent criterion freestanding/embedded PVTS as part of comprehensive outpatient neuropsychological evaluations: the Advanced Clinical Solutions Word Choice Test, Test of Memory Malingering-Trial 1, and Reliable Digit Span from the Wechsler Adult Intelligence Test-Fourth Edition Digit Span subtest. Invalid performance was identified using two different criteria: (1) failing ≥2 PVTs in addition to other clinical indicators of poor engagement, or (2) failing one PVT. Receiver Operator Characteristic (ROC) curves tested the classification accuracy of identifying participants in the invalid group versus those with valid presentations and with or without cognitive impairment.

Results

Using both criteria, ROC analyses accurately identified invalidity (AUCs = 0.708–0.807) in the total sample, with cut-scores of ≤7 or ≤ 8 on the CVLT-II-SF FC exhibiting adequate specificities (0.900–0.986) and sensitivities of 0.407–0.500. Classification accuracy was acceptable for differentiating the invalid and cognitively intact groups (AUCs = 0.734–0.829) at a cut score of ≤8 (specificities = 0.923–0.958, sensitivities = 0.500–0.704), but was variably acceptable for differentiating the invalid and cognitively impaired groups (AUCs = 0.684–0.794; cut-score of ≤7 with specificities = 0.962–0.978 and sensitivities = 0.229–0.407).

Conclusions

Our findings support the CVLT-II-SF FC trial as an embedded PVT, particularly when differentiating cognitively intact examinees from those with noncredible presentations.
B - 135 Wisconsin Card Sorting Test 64-Card Computer Version (WCST-64-CV) Failure to Maintain Set (FMS) as an Embedded Performance Validity Indicator in a Mixed Clinical Sample
Authors: Cation Bailey , Schoenberg Michael
Published: September 2024

Objective

The current objective was to determine the sensitivity and specificity of the Wisconsin Card Sorting Test 64-card Computer Version (WCST-64-CV) Failure to Maintain Set (FMS) as an embedded validity indicator.

Methods

Data were from an archival database of an academic medical center neuropsychology service. Three hundred sixty-eight adult participants completed the WCST-64-CV and Word Memory Test (WMT). Participants were defined as noncredible if all three of their WMT Immediate Recall (IR), Delayed Recall (DR), and Consistency (CNS) scores were 82.5% or below. Participants were defined as credible if all three of IR, DR, and CNS scores were above 82.5%. Forty-seven participants with scores both above and at/below 82.5% were excluded (N = 321). The sample was mean age 45 years (standard deviation [SD] = 17), mean education 13 years (SD = 2), 50% female, and 77% Caucasian. Primary diagnoses were 56.8% epilepsy and 18.1% mild cognitive impairment. No participants had dementia or an acute stroke.

Results

Twenty-eight participants were noncredible (8.7%) and 293 were credible (91.3%). One hundred sixty-five participants got 0 FMS (51.4%), 95 participants got 1 (29.6%), 41 participants got 2 (12.8%), and 20 participants got 3 or more (6.2%). The lowest cut-off that achieved at least 90% specificity was failure defined as ≥3. The specificity was 93.5% and the sensitivity was 3.5%. A cut-off of ≥2 achieved 80.8% specificity and 17.8% sensitivity. A cut-off of ≥1 achieved 50.8% specificity and 42.8% sensitivity.

Conclusions

There is no cut-off of WCST-64-CV FMS that achieves adequate specificity and sensitivity as an embedded validity indicator in this mixed clinical sample.
B - 136 A Validity Study of an Embedded Performance Validity Measure of Wide Range Assessment of Memory and Learning, Third Edition
Authors: Franke Michelle L , Adams Wayne , Black Jacy , Cantley Jessica , Gordon Taryn
Published: September 2024

Objective

This study investigated chance levels of responding on the Recognition Memory component of the performance validity test 2 (PVT2) measure embedded within the Wide Range Assessment of Memory and Learning, Third Edition (WRAML3; Adams & Sheslow, 2021). While standardized norms are provided, the WRAML3 has yet to examine PVT2 scores obtained through random responding. Given the impact of suboptimal effort and performance on test scores, providing scores obtained through guesstimation can help differentiate low scores due to impairment from chance responding.

Methods

Participants included 50 volunteer undergraduates and graduate students. To assess levels of random responding on PVT2 items, participants responded to the four Recognition memory subtests of the WRAML3 without the usual prior exposure to immediate and delayed subtest content. One-sample t-tests were conducted to compare participant performance scores to statistical chance levels of responding and the established PVT2 cut-off scores.

Results

Analyses revealed that the mean total PVT2 score was significantly lower than the established WRAML3 PVT2 cut-off score of 17 (t(49) = −26.88, p < 0.001). Regarding chance levels of responding, participants’ random responses were significantly different from the hypothesized chance mean of 5 (t(49) = 6.24, p < 0.001).

Conclusions

Findings support the overall utility of the available WRAML-3 embedded PVT2 cutoff scores while indicating individuals who rely on guesstimation techniques may be able to answer better than chance. These results establish a new standard of random response on the WRAML3, which may be utilized to determine whether scores below the PVT2 cutoff are invalid or may warrant further investigation.
B - 137 Analyzing Completion Time on a Created Forced Choice Trial of the Hopkins Verbal Learning Test – Revised (HVLT-R) to Measure Engagement in a Mixed Clinical Sample
Authors: Kapoor Arunima , Conrad Alexis , Thomas Aaron , Kristinsson Hayley , Lopez Michael , Chen Patrick , Lopez Alex
Published: September 2024

Objective

We created a forced choice recognition trial (FCR) for the HVLT-R, including recording completion time (FCompT), to evaluate the utility of combining completion time with accuracy scores when using performance validity tests (PVTs).

Method

Participants included 29 clinically referred patients at a large medical center who completed the HVLT-R in addition to multiple free-standing and embedded PVTs including the TOMM, Word Choice Test (WCT), Reliable Digit Span (RDS), and the Dot Counting Test (DCT) as part of a larger battery of neuropsychological tests in an outpatient setting. Data from the sample (M age = 64.79, SD = 13.86; M education = 15.65, SD = 2.47; 62.1% females) were analyzed using correlation and linear regression.

Results

The HVLT-R FCR trial correlated with the TOMM-10, r(19) = 0.75, p = <0.001, TOMM trial 1, r(17) = 0.75, p = <0.01, the DCT r(12) = −0.71, p = <0.01, and the FCompT, r(29) = −0.72, p = <0.001. The FCompT was correlated with RDS, r(28) = −0.46, p = 0.03, TOMM-10, r(19) = −0.64, p = <0.01, and TOMM trial 1, r(17) = −0.61, p = <0.01. FCompT significantly predicted FCR accuracy b = −0.72, t(29) = −5.41, p < 0.001.

Conclusions

The HVLT-R FC and FCompT strongly correlated with free-standing and embedded PVTs. Data demonstrates that a longer completion time predicts poorer performance on FCR. Results demonstrate the value of measuring completion time for specific PVTs, in addition to providing support for the addition of a FCR trial to the HVLT-R.
B - 139 A Bayesian Approach to Performance Validity in Neuropsychological Testing
Authors: Serrano-Salcedo Juan A , Wang Yishi , Forde Jessica , Zambrana-Bonaparte Hjalmar M , Carlson Kate E , Puente Antonio E
Published: September 2024

Objective

Using the Test of Memory Malingering (TOMM), this study seeks to explore the feasibility of a continuous approach to performance validity by simulating experiments using a Bayesian statistical algorithm.

Methodology

A literature review was carried out to conduct statistical analyses from data of two known groups (those putting forth credible effort and those not). TOMM scores were modeled using various statistical distributions, with the inflated Conway-Maxwell-Poisson (ICMP) distribution providing the best fit. Simulation experiments were conducted to test the Bayesian statistics model. This involved generating artificial data from known distributions and then seeing how well the algorithm could recover the probability of a score belonging to the credible effort group. We tested the algorithm’s robustness by intentionally starting with incorrect assumptions and seeing if it could still converge on the correct probabilities. Finally, the Bayesian model was applied to real TOMM data to estimate the probability of credible effort for each possible score.

Results

The simulation studies showed that the Bayesian approach was generally robust, even when starting with incorrect assumptions. When applied to real data, TOMM scores of 40, 45, and 50 were essential, with approximately 5% change occurring with each score. A score of 40 covers approximately 50% of scores, 45 covers approximately 75%, and, finally, 50 covers 95% of scores. A perfect score of 50 encompassed ~95% of credible performances but not 100%.

Conclusion

This study provides initial statistically derived evidence for the feasibility and potential value of a continuous, probabilistic approach to performance validity.