Archives of Clinical Neuropsychology

Ayasrah, Shahnaz M; Ahmad, Muayyad M; Abuadas, Fuad H; Abu-Snieneh, Hana M; Basheti, Iman A

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae007pmid: 38364311

PurposeTo assess levels and predictive factors of health-related quality of life (HRQOL) among stroke patients.MethodsThe study employed a cross-sectional predictive correlational design. Levels of HRQOL were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, and the Hospital Anxiety and Depression Scale was employed to assess psychological aspects among 209 Saudi stroke patients. The analysis included demographic and medical variables to comprehensively explore influencing factors.ResultsA two-step hierarchical multiple regression analysis was performed. The overall SS-QOL summary score (49 items) showed a mean score of 94.4 (SD = 8.1), indicating poor functioning. Nine predictor variables were found to significantly predict HRQOL levels, including age (β = −0.212, p ≤ .001), female (β = −5.33, p ≤ .001), unmarried (β = 2.48, p ≤ .001), low gross monthly income (GMI) (β = −9.02, p ≤ .001), medium GMI (β = −8.36, p ≤ .001), having a medical history of hypertension (β = 2.7, p ≤ .01), time since stroke (β = 3.26 p ≤ .001), and being a probable case of anxiety (β = −4.29, p ≤ .001) and/or depression (β = −2.75, p ≤ .001). These variables collectively explained ~76% of the variance in HRQOL scores (adjusted R2 = .762, F (16,192) = 42.6, p ≤ .001).ConclusionsStroke patients exhibited poor HRQOL levels influenced by various factors. Clinicians should consider these predictors and intervene early to enhance HRQOL among patients at risk, emphasizing the importance of optimizing patient outcomes.

Terry, Christian; Lecci, Len

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae020pmid: 38469927

ObjectiveTwo studies were performed to validate a brief measure of cognitive insight and compare it to an empirical model – the Cognitive Awareness Model (CAM).MethodA pilot study included 31 (52% male; Mage = 69.42) patients from an outpatient neuropsychological assessment clinic. Seven patients were diagnosed with likely Alzheimer's dementia (AD), 15 mild cognitive impairment (MCI), and 9 no diagnosis (i.e., cognitively normal; CN). The Cognitive Coding Form (CCF) and several other measures were administered. Study 2 entailed archival data extraction of 240 patients (80 CN, 80 MCI, and 80 AD; 53.3% female; Mage = 72.8) to examine whether the CCF predicts memory (Wechsler Memory Scale – IV) and executive functioning (Trail-Making Test B).ResultsThe pilot study found preliminary evidence of convergent and discriminant validity for the 8-item CCF. Study 2 confirmed that both patient-reported cognitive concerns (F(2,237) = 10.40, p < .001, ω2 = .07, power = .99) and, more strongly, CCF informant-patient discrepancy scores (F(2,237) = 24.52, p < .001, ω2 = .16, power = .99) can distinguish CNs from those with MCI and AD. A regression indicated that depression (5.5%; β = -.38, p < .001) and TMT-B (13%; β = -.43, p < .001), together accounted for 18.5% of the variance in insight (R2 = .19, F(2,219) = 26.10, p < .001), supporting the CAM.ConclusionsThese studies establish an efficient measure of insight with high clinical utility and inform the literature on the role of insight in predicting performance in those with Alzheimer’s pathology.

Thomson, Diny; Rosenich, Emily; Maruff, Paul; Lim, Yen Ying; ,

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae014pmid: 38454193

ObjectiveAllelic variation in the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism has been shown to moderate rates of cognitive decline in preclinical sporadic Alzheimer’s disease (AD; i.e., Aβ + older adults), and pre-symptomatic autosomal dominant Alzheimer’s disease (ADAD). In ADAD, Met66 was also associated with greater increases in CSF levels of total-tau (t-tau) and phosphorylated tau (p-tau181). This study sought to determine the extent to which BDNF Val66Met is associated with changes in episodic memory and CSF t-tau and p-tau181 in Aβ + older adults in early-stage sporadic AD.MethodAβ + Met66 carriers (n = 94) and Val66 homozygotes (n = 192) enrolled in the Alzheimer’s Disease Neuroimaging Initiative who did not meet criteria for AD dementia, and with at least one follow-up neuropsychological and CSF assessment, were included. A series of linear mixed models were conducted to investigate changes in each outcome over an average of 2.8 years, covarying for CSF Aβ42, APOE ε4 status, sex, age, baseline diagnosis, and years of education.ResultsAβ + Met66 carriers demonstrated significantly faster memory decline (d = 0.33) and significantly greater increases in CSF t-tau (d = 0.30) and p-tau181 (d = 0.29) compared to Val66 homozygotes, despite showing equivalent changes in CSF Aβ42.ConclusionsThese findings suggest that reduced neurotrophic support, which is associated with Met66 carriage, may increase vulnerability to Aβ-related tau hyperphosphorylation, neuronal dysfunction, and cognitive decline even prior to the emergence of dementia. Additionally, these findings highlight the need for neuropsychological and clinicopathological models of AD to account for neurotrophic factors and the genes which moderate their expression.

Gonzalez, Christopher; Finley, John-Christopher A; Khalid, Elmma; Basurto, Karen S; VanLandingham, Hannah B; Frick, Lauren A; Brooks, Julia M; Ellison, Rachael L; Ulrich, Devin M; Soble, Jason R; Resch, Zachary J

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae006pmid: 38366222

ObjectiveAdverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation.MethodThis study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs.ResultsMain effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups.ConclusionsThose with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.

Karr, Justin E; Ingram, Eric O; Pinheiro, Cristina N; Ali, Sheliza; Iverson, Grant L

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae011pmid: 38402512

ObjectiveResearchers and practitioners can detect cognitive improvement or decline within a single examinee by applying a reliable change methodology. This study examined reliable change through test–retest data from the English-language National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) normative sample.MethodParticipants included adults (n = 138; age: M ± SD = 54.8 ± 20.0, range: 18–85; 51.4% men; 68.1% White) who completed test–retest assessments about a week apart on five fluid cognition tests, providing raw scores, age-adjusted standard scores (SS), and demographic-adjusted T-scores (T).ResultsThe Fluid Cognition Composite (SS: ICC = 0.87; T-score: ICC = 0.84) and the five fluid cognition tests had good test–retest reliability (SS: ICC range = 0.66–0.85; T-score: ICC range = 0.64–0.86). The lower and upper bounds of 70%, 80%, and 90% confidence intervals (CIs) were calculated around change scores, which serve as cutoffs for determining reliable change. Using T-scores, 90% CI, and adjustment for practice effects, 32.3% declined on one or more tests, 9.7% declined on two or more tests, 36.6% improved on one or more tests, and 5.4% improved on two or more tests.ConclusionsIt was common for participants to show reliable change on at least one test score, but not two or more test scores. Per an 80% CI, test–retest difference scores beyond these cutoffs would indicate reliable change: Dimensional Change Card Sort (SS ≥ 14/T ≥ 10), Flanker (SS ≥ 12/T ≥ 8), List Sorting (SS ≥ 14/T ≥ 10), Picture Sequence Memory (SS ≥ 19/T ≥ 13), Pattern Comparison (SS ≥ 11/T ≥ 8), and Fluid Cognition Composite (SS ≥ 10/T ≥ 7). The reliable change cutoffs could be applied in research or practice to detect within-person change in fluid cognition at the individual level.

Young, Stephanie Ruth; Dworak, Elizabeth M; Kaat, Aaron J; Adam, Hubert; Novack, Miriam A; Slotkin, Jerry; Stoeger, Jordan; Nowinski, Cindy J; Hosseinian, Zahra; Amagai, Saki; Pila, Sarah; Diaz, Maria Varela; Correa, Anyelo Almonte; Alperin, Keith; Omberg, Larsson; Kellen, Michael; Camacho, Monica R; Landavazo, Bernard; Nosheny, Rachel L; Weiner, Michael W; Gershon, Richard M

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae010pmid: 38414411

ObjectiveWe describe the development of a new computer adaptive vocabulary test, Mobile Toolbox (MTB) Word Meaning, and validity evidence from 3 studies.MethodWord Meaning was designed to be a multiple-choice synonym test optimized for self-administration on a personal smartphone. The items were first calibrated online in a sample of 7,525 participants to create the computer-adaptive test algorithm for the Word Meaning measure within the MTB app. In Study 1, 92 participants self-administered Word Meaning on study-provided smartphones in the lab and were administered external measures by trained examiners. In Study 2, 1,021 participants completed the external measures in the lab and Word Meaning was self-administered remotely on their personal smartphones. In Study 3, 141 participants self-administered Word Meaning remotely twice with a 2-week delay on personal iPhones.ResultsThe final bank included 1363 items. Internal consistency was adequate to good across samples (ρxx = 0.78 to 0.81, p < .001). Test–retest reliability was good (ICC = 0.65, p < .001), and the mean theta score was not significantly different upon the second administration. Correlations were moderate to large with measures of similar constructs (ρ = 0.67–0.75, p < .001) and non-significant with measures of dissimilar constructs. Scores demonstrated small to moderate correlations with age (ρ = 0.35 to 0.45, p < .001) and education (ρ = 0.26, p < .001).ConclusionThe MTB Word Meaning measure demonstrated evidence of reliability and validity in three samples. Further validation studies in clinical samples are necessary.

Kiselica, Andrew M; Kaser, Alyssa N; Weitzner, Daniel S; Mikula, Cynthia M; Boone, Anna; Woods, Steven Paul; Wolf, Timothy J; Webber, Troy A

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae005pmid: 38364295

ObjectiveCognitive dispersion indexes intraindividual variability in performance across a battery of neuropsychological tests. Measures of dispersion show promise as markers of cognitive dyscontrol and everyday functioning difficulties; however, they have limited practical applicability due to a lack of normative data. This study aimed to develop and evaluate normed scores for cognitive dispersion among older adults.MethodWe analyzed data from 4,283 cognitively normal participants aged ≥50 years from the Uniform Data Set (UDS) 3.0. We describe methods for calculating intraindividual standard deviation (ISD) and coefficient of variation (CoV), as well as associated unadjusted scaled scores and demographically adjusted z-scores. We also examined the ability of ISD and CoV scores to differentiate between cognitively normal individuals (n = 4,283) and those with cognitive impairment due to Lewy body disease (n = 282).ResultsWe generated normative tables to map raw ISD and CoV scores onto a normal distribution of scaled scores. Cognitive dispersion indices were associated with age, education, and race/ethnicity but not sex. Regression equations were used to develop a freely accessible Excel calculator for deriving demographically adjusted normed scores for ISD and CoV. All measures of dispersion demonstrated excellent diagnostic utility when evaluated by the area under the curve produced from receiver operating characteristic curves.ConclusionsResults of this study provide evidence for the clinical utility of sample-based and demographically adjusted normative standards for cognitive dispersion on the UDS 3.0. These standards can be used to guide interpretation of intraindividual variability among older adults in clinical and research settings.

Ratcliffe, Lauren N; Hale, Andrew C; McDonald, Taylor; Hewitt, Kelsey C; Nguyen, Christopher M; Spencer, Robert J; Loring, David W

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae013pmid: 38441951

ObjectiveThe Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations.MethodData were obtained from 18,410 participants using the National Alzheimer’s Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test–retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach’s alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change.ResultsStrong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level.ConclusionsMoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores.

Garcia, Sarah; Foster, Elodie; Johnson, Peter J; Thomas, Brittany; Askew, Robert L

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae009pmid: 38402525

ObjectivePain’s impact on executive function is understood and specific cognitive abilities may contribute to coping with pain, though past work is confounded by chronic pain populations. This study aims to understand how executive functioning may predict the experience of pain among healthy adults. It was hypothesized that poorer executive functioning would predict more intense pain perception.MethodA total of 172 young adults were recruited for participation. Three aspects of executive functioning (i.e., impulsivity, cognitive flexibility, working memory) were assessed before randomizing participants to varying types and levels of stimulated pain.ResultsResults supported the hypothesis that poorer performance on tasks of working memory predicts more intense pain perception.ConclusionsFindings are counter to past work that has found inhibition may be important for coping, and future research is needed to understand the impact of specific cognitive abilities as well as how this may differ for chronic pain.

Kaufman, Jack R; Fatima, Hudaisa; Lacritz, Laura H; Cullum, C Munro

2024 Archives of Clinical Neuropsychology

doi: 10.1093/arclin/acae022pmid: 38516816

Objectiveto establish a proof-of-concept and ascertain the reliability of an abbreviated 30-second (30s) phonemic fluency measure as a cognitive screening tool in older adults.Methodsin all, 201 English-speaking individuals with normal cognition (NC; n = 119) or cognitive impairment (CI; mild CI or dementia; n = 82) were administered a standard 60s phonemic fluency task (FAS/CFL) with discrete 30s intervals denoted.Resultsfor all letters, 30s trial scores significantly predicted 60s scores for the same letter, R2 = .7–.9, F(1, 200) = 850–915, p < .001. As with 60s total scores, 30s cumulative scores (for all three trials) were significantly different between NC and CI groups (p < .001). Receiver operating characteristic analyses showed that 30s total scores distinguished NC and CI groups as effectively (AUC = .675) as 60s total scores (AUC = .658).Conclusionsthese findings support the utility and reliability of a short-form phonemic fluency paradigm, as 30s performance reliably predicted 60s/trial totals and was equally accurate in distinguishing impaired/non-impaired groups.