Advanced Clinical Solutions Research Articles

B - 131 Validation of the California Verbal Learning Test-II-Short Form Forced Choice Paradigm as an Indicator of Performance Validity

Abstract 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.

Exploring cultural contributions to the neuropsychology of social cognition: the advanced clinical solutions

ABSTRACT Introduction Culture and social cognition are deeply intertwined, yet how this rich intersectionality is expressed neuropsychologically remains an important question. Method In a convenience sample of 128 young adults (mean age = 24.9 years) recruited from a majority-minority urban university, we examined performance-based neuropsychological measures of social cognition, the Advanced Clinical Solutions-Social Perception (ACS-SP), in relation to both cultural orientation, as assessed by the Individualism-Collectivism Scale (ICS) and spoken English language, as assessed by the oral word pronunciation measure of the Wide Range Achievement Test-4 (WRAT4). Results Results indicated higher WRAT4 scores correlated with better performance across all ACS-SP measures of social cognition. Controlling for these associations in spoken English, partial correlations linked lower scores across both prosody interpretation and affect naming ACS-SP tasks with a propensity to view social relationships vertically, irrespective of individualistic or collectivistic orientations. Hierarchical regression results showed that cultural orientation and English-language familiarity each specifically and uniquely contributed to ACS-SP performance for matching prosody with facial expressions. Conclusions These findings underscore the importance of incorporating and prioritizing both language and cultural factors in neuropsychological studies of social cognition. They may be viewed as offering strong support for expanding the boundaries of the construct of social cognition beyond its current theoretical framework of one that privileges Western, educated, industralized, rich and democratic (WEIRD) values, customs, and epistemologies.

Assessing multimodal emotion recognition in multiple sclerosis with a clinically accessible measure

BackgroundMultiple sclerosis (MS) negatively impacts cognition and has been associated with deficits in social cognition, including emotion recognition. There is a lack of research examining emotion recognition from multiple modalities in MS. The present study aimed to employ a clinically available measure to assess multimodal emotion recognition abilities among individuals with MS. MethodThirty-one people with MS and 21 control participants completed the Advanced Clinical Solutions Social Perceptions Subtest (ACS-SP), BICAMS, and measures of premorbid functioning, mood, and fatigue. ANCOVAs examined group differences in all outcomes while controlling for education. Correlational analyses examined potential correlates of emotion recognition in both groups. ResultsThe MS group performed significantly worse on the ACS-SP than the control group, F(1, 49) = 5.32, p = .025. Significant relationships between emotion recognition and cognitive functions were found only in the MS group, namely for information processing speed (r = 0.59, p < .001), verbal learning (r = 0.52, p = .003) and memory (r = 0.65, p < 0.001), and visuospatial learning (r = 0.62, p < 0.001) and memory (r = 0.52, p = .003). Emotion recognition did not correlate with premorbid functioning, mood, or fatigue in either group. ConclusionsThis study was the first to employ the ACS-SP to assess emotion recognition in MS. The results suggest that emotion recognition is impacted in MS and is related to other cognitive processes, such as information processing speed. The results provide information for clinicians amidst calls to include social cognition measures in standard MS assessments.

1 Race, Ethnicity, Education, Sex and Gender Effects on Neuropsychological Test Scores: Limitations of Current Evidence and Impact on Clinical Trials and Clinical Practice

Objective:Interpretation of neuropsychological (NP) tests depends on the quality of the normative standards available for the tests. Co-norming across tests is necessary when interpreting differences between scores on different tests. The relevance of specific norms for an individual examinee further depends on multiple design features of the standardization studies, including: when the studies were conducted, sampling strategy, inclusion/exclusion criteria, age, sex/gender, education, race and ethnicity, socioeconomic status, and region. This paper examines the standardization studies of the most widely used NP tests, identifies their strengths and weaknesses, and makes recommendations for interpretive caveats based on these analyses.Participants and Methods:We reviewed the standardization strategies and coded information about the sampling frames, inclusion/exclusion criteria, stratification methods, demographic characteristics, and sample sizes overall and within each stratum where relevant. These methods were applied to the WAIS-IV, WMS-IV, CVLT3, D-KEFS, Pearson Advanced Clinical Solutions (ACS), Rey Complex Figure Test, WCST, Symbol Digit Modalities Test, RBANS, BVMT-R, HVLT, Halstead-Reitan (“Heaton et al”) Norms for Boston Naming, Finger Tapping, Grooved Pegboard), MOANS, and MOAANS (Boston Naming, Trail Making Test, Judgement of Line Orientation). We calculated multiple indexes for each test, including standard errors and confidence intervals for scaled scores.Results:Most tests used age only as a stratification factor, providing “age corrected” scores for selected age bands. The sample sizes for the age strata range from 1 to ∼200 but were usually less than 100 participants/stratum. Sex differences were rarely reported and some studies had markedly uneven distributions of sex. Education was not used as a stratification factor in any study, and few norms attempted corrections for education. The possible interactions of age and education on test scores are seldom reported and cell sizes for combinations of age and education may be too small to enable robust estimates of scores, especially at lower levels of education and older ages. The possible impact of race and ethnicity are rarely interrogated except in ACS, Heaton and MOAANS norms, which all focus on “African American” participants. Discrepancies in scores across ACS, Heaton and MOAANS suggest marked sampling differences.Conclusions:Existing norms have major limitations which may impact the clinical assessment of individuals and result in inappropriate treatment recommendations as well as lead to inappropriate classification in clinical trials, which may include score “cutoffs” based on widely used normative standards. Most norms use only age as a stratification factor, despite robust impacts of education on scores. Race and ethnicity are poorly represented, fail to reflect current demographic characteristics of the United States, and existing norms present major conflicts for African American groups, with the same raw scores differing by a full standard deviation depending only on the source of normative data. Sex differences are examined infrequently and it remains unclear to what extent sex or gender differences may affect some scores. There is an urgent need for new, preferably “dynamic” normative standards, that include sampling by socially and demographically meaningful metrics, to provide greater precision in assessment of neuropsychological scores and score discrepancies, and for evaluating the inclusion/exclusion criteria, and criteria for efficacy in clinical trials that use neurocognitive endpoints.

A-230 A Story Told in Four Parts: Embedded Validity Indicators’ Effectiveness in Predicting Word Choice Test Validity Classification

Abstract Objective: Many individual embedded performance validity tests (PVTs) have been independently cross-validated as validity indices among various clinical populations; however, research examining the additional predictive value from combining multiple embedded PVTs is more limited. The study's purpose was to examine the accuracy of eight embedded PVTs for predicting pass/failure performance on a well-validated freestanding PVT, the Advanced Clinical Solutions: Word Choice Test (WCT). Method: The study consisted of 225 adults referred for outpatient neuropsychological evaluation that included the following embedded PVTs: Rey Auditory Verbal Learning Test (RAVLT) Forced Choice (FC), RAVLT Effort Score, Brief Visual Memory Test-Revised Recognition Discrimination (BVMT-RD), Digit Span Age Corrected Scaled Score, Reliable Digit Span, Stroop Color and Word Test Word Reading T-Score, Letter Fluency T-Score, and Trail Making Test Part A T-Score. The sample was 56% female and racially diverse (40% Black, 35% White, 17% Hispanic, 5% Asian, and 2% other ethnicities) with a mean age of 45.96 (SD=16.12) and mean education of 13.96 (SD=2.73) years. Results: A forward stepwise logistic regression was performed to predict WCT pass/fail using the embedded PVTs as predictors. The model was achieved in three steps (p95% accuracy in correctly classifying WCT pass group. Conclusion: RAVLT-FC, BVMT-RD, and TMT-A combined reliably predict WCT pass/fail group. Verbal and attention based embedded PVTs were found to have the most robust predictive capacity of WCT validity status.

A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Advanced Clinical Solutions Word Choice Test as a Performance Validity Test.

Thorough assessment of performance validity has become an established standard of practice in neuropsychological assessment. While there has been a large focus on the development and cross-validation of embedded performance validity tests (PVTs) in recent years, new freestanding PVTs have also been developed, including the Word Choice Test (WCT) as part of the Advanced Clinical Solutions Effort System. And, while the WCT's general utility for identifying invalid performance has been demonstrated in the ensuing decade since its initial publication, optimal cut-scores and associated psychometric properties have varied widely across studies. This study sought to synthesize the existing diagnostic accuracy literature regarding the WCT via a systematic review and to conduct a meta-analysis to determine the performance validity cut-score that best maximizes sensitivity while maintaining acceptable specificity. A systematic search of the literature resulted in 14 studies for synthesis, with eight of those available for meta-analysis. Meta-analytic results revealed an optimal cut-score of ≤ 42 with 54% sensitivity and 93% specificity for identifying invalid neuropsychological test performance. Collectively, the WCT demonstrated adequate diagnostic accuracy as a PVT across a variety of populations. Recommendations for future studies are also provided.

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)

Abstract 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 &amp; 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&amp;37; and 86%, respectively), with equivalent sensitivity (90%), when effort was determined by WCST (Suhr &amp; 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.

Performance Validity Testing in Justice-Involved Adults with Fetal Alcohol Spectrum Disorder.

A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits. The sample comprised 80 justice-involved adults (ages 19-40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale - Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding - Symbol Search, Vocabulary - Digit Span), and the Wechsler Memory Scale - Fourth Edition (Logical Memory II Recognition). Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35-76%). Across both groups, substantially more participants with IQ <70 failed two or more PVTs (90%), compared to those with an IQ ≥70 (44%). Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD.

Developing A Cross-Cultural Conceptual Framework for the Validation of the Advanced Clinical Solutions (ACS)-SP: Assessing Social Perception in Latinx Populations

Abstract Objective Develop a cross-cultural conceptual framework for the validation of the Advanced Clinical Solutions (ACS) Social Perception subtest to effectively assess Latinx populations. Method The framework serves to examine and evaluate the composition of the normative sample of the ACS-SP using eight key variables taken from the ECLECTIC framework, specifically education (e.g., literacy), acculturation levels (e.g., race, ethnicity), language (e.g., proficiency), economics (e.g., SES), communication styles, testing comfort, intelligence conceptualization, and context of immigration (Fujii, 2018). In addition, the model assesses the normative sample in reference to the intersectionality of identities (Cole, 2009; Wadsworth et al., 2016) across cultural and demographic variables that may influence the expression of emotion, and consequently, the interpretation of ACS-SP results. The model applies an Etic-Emic approach to address the question of cross-cultural validity of the ACS-SP (Cheung, van de Vijver &amp; Leong, 2011). Finally, the model can be applied to examine the ACS-SP in relation to cultural intelligence (CQ), a more recently established construct defined as an individual’s ability to function effectively inter-culturally (Ang, Rockstuhl, &amp; Tan, 2015). Discussion A large body of research has shown that the expression and measurement of social cognitive abilities are greatly influenced by cultural factors (Elfenbein &amp; Ambady, 2002). For example, studies have shown that the expression of these abilities may be greatly influenced by cultural differences in display rules. Likewise, it is equally important to consider key cultural variables such as those related to socioeconomic status (SES), demographics, and identity in the neuropsychological assessment of social perception in Latinx populations. Therefore, the model conducts a cross-cultural analysis of the ACS-SP. References Ang, S., Rockstuhl, T., &amp; Tan, M. L. (2015). Cultural intelligence and competencies. International Encyclopedia of Social and Behavioral Sciences, 2, 433-439. Cheung, F. M., Leung, K., Fan, R. M., Song, W. Z., Zhang, J. X., &amp; Zhang, J. P. (1996). Development of the Chinese personality assessment inventory. Journal of Cross-Cultural Psychology, 27(2), 181-199. Cole, E. R. (2009). Intersectionality and research in psychology. American psychologist, 64(3), 170. Elfenbein, H. A., &amp; Ambady, N. (2002). On the universality and cultural specificity of emotion recognition: a meta-analysis. Psychological Bulletin, 128(2), 203. Fujii, D. E. M. (2018) Developing a cultural context for conducting a neuropsychological evaluation with a culturally diverse client: The ECLECTIC framework. The Clinical Neuropsychologist, 32(8), 1356-1392, DOI: 10.1080/13854046.2018.1435826. Wadsworth, L. P., Morgan, L. P., Hayes-Skelton, S. A., Roemer, L., &amp; Suyemoto, K. L. (2016). Ways to boost your research rigor through increasing your cultural competence (part 1 of 2). The Behavior Therapist.

Cross-validation of three Advanced Clinical Solutions performance validity tests: Examining combinations of measures to maximize classification of invalid performance

Use of multiple performance validity tests (PVTs) may best identify invalid performance, though few studies have examined the utility and accuracy of combining PVTs. This study examined the following PVTs in the Advanced Clinical Solutions (ACS) package to determine their utility alone and in concert: Word Choice Test (WCT), Reliable Digit Span (RDS), and Logical Memory Recognition (LMR). Ninety-three veterans participated in clinical neuropsychological evaluations to determine presence of cognitive impairment; 25% of the performances were deemed invalid via criterion PVTs. Classification accuracy of the ACS measures was assessed via receiver operating characteristic curves, while logistic regressions determined utility of combining these PVTs. The WCT demonstrated superior classification accuracy compared to the two embedded measures of the ACS, even in veterans with cognitive impairment. The two embedded measures (even when used in concert) exhibited inadequate classification accuracy. A combined model with all three ACS PVTs similarly demonstrated little benefit of the embedded indicators over the WCT alone. Results suggest the ACS WCT has utility for detecting invalid performance in a clinical sample with likely cognitive impairment, though the embedded ACS measures (RDS and LMR) may have limited incremental utility, particularly in individuals with cognitive impairment.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary utility in adult neuro-oncology

Neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools may be insensitive to cognitive changes caused by medical treatments. Research supports the clinical value and psychometric properties of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in various medical populations; however, there is minimal evidence for its use in neuro-oncology. The purpose of the current study was to further explore the cognitive profile of patients with primary brain tumor (PBT) using the RBANS and to assess rates of below-expectation performance compared to normative data and estimated intellectual functioning. Data were collected on 82 PBT patients (54% male; age range, 19-81 years). All patients were administered the RBANS-Update and the Advanced Clinical Solutions-Test of Premorbid Functioning (TOPF) according to standardized instructions. Cognitive strengths and weaknesses were identified for PBT patients. Descriptive analyses, t tests, and chi-squared tests were utilized to identify and compare cognitive profiles. Overall, cognitive performance was low average for PBT patients. When compared to standardization data, PBT patients performed significantly worse across all 5 RBANS indexes, with Attention and Memory showing the largest discrepancies. Estimated intelligence analyses reflected greater deficits in cognitive functioning than when compared to a normal distribution. Preliminary research demonstrates the RBANS is an efficient screening tool to assess cognitive deficits in PBT patients. Data also support the importance of comparison to self, rather than normative distribution in ensuring proper identification and classification of patients.

Evaluating the accuracy of the Wechsler Memory Scale-Fourth Edition (WMS-IV) logical memory embedded validity index for detecting invalid test performance

ABSTRACTEmbedded performance validity tests (PVTs) allow for continuous assessment of invalid performance throughout neuropsychological test batteries. This study evaluated the utility of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LM) Recognition score as an embedded PVT using the Advanced Clinical Solutions (ACS) for WAIS-IV/WMS-IV Effort System. This mixed clinical sample was comprised of 97 total participants, 71 of whom were classified as valid and 26 as invalid based on three well-validated, freestanding criterion PVTs. Overall, the LM embedded PVT demonstrated poor concordance with the criterion PVTs and unacceptable psychometric properties using ACS validity base rates (42% sensitivity/79% specificity). Moreover, 15–39% of participants obtained an invalid ACS base rate despite having a normatively-intact age-corrected LM Recognition total score. Receiving operating characteristic curve analysis revealed a Recognition total score cutoff of < 61% correct improved specificity (92%) while sensitivity remained weak (31%). Thus, results indicated the LM Recognition embedded PVT is not appropriate for use from an evidence-based perspective, and that clinicians may be faced with reconciling how a normatively intact cognitive performance on the Recognition subtest could simultaneously reflect invalid performance validity.

Neuropsychological outcomes following stereotactic laser amygdalohippocampectomy

ObjectiveThe objective was to analyze neuropsychological testing data from 15 patients before and after stereotactic laser ablation surgery for temporal lobe epilepsy and to describe the seizure outcomes after stereotactic laser ablation surgery. MethodsA retrospective review of 15 patients who underwent stereotactic laser ablation and who also underwent neuropsychological testing before and after surgery was performed. Verbal and visual memory was assessed in all 15 patients using California Verbal Learning Test and Wechsler Memory Scale IV. Naming was assessed in 9 of 15 patients using the Boston Naming Test. Statistical analysis was performed to determine clinically significant changes using previously validated reliable change indices and proprietary Advanced Clinical Solutions software. Seizure outcome data were evaluated using Engel classification. ResultsPostsurgery neuropsychological evaluation demonstrated that all 15 patients experienced at least 1 clinically significant decline in either verbal or visual memory. Ten patients in this series, including five with dominant-hemisphere surgery, demonstrated decline in delayed memory for narrative information (Logical Memory II). By contrast, the Boston Naming Test demonstrated more favorable results after surgery. Two of nine patients demonstrated a clinically significant increase in naming ability, and only one of nine patients demonstrated a clinically significant decline in naming ability. With at least 6months of follow-up after surgery, 33% reported seizure freedom. ConclusionStereotactic laser ablation can result in clinically significant and meaningful decline in verbal and visual memory when comparing patients to their own presurgical baseline. Naming ability, conversely, is much less likely to be impacted by stereotactic laser ablation and may improve after the procedure.

Validation of the Advanced Clinical Solutions Word Choice Test (WCT) in a Mixed Clinical Sample: Establishing Classification Accuracy, Sensitivity/Specificity, and Cutoff Scores.

This study examined the Word Choice Test's (WCT) utility as a performance validity test in a mixed clinical sample of veterans referred for neuropsychological evaluation. Participants completed Green's Word Memory Test (WMT), WCT, and Test of Memory Malingering (TOMM) Trial 1. Using the WMT as the criterion for valid performance, logistic regressions examined the WCT and TOMM's classification accuracy for those with and without cognitive impairment (CI). Receiver operating characteristic curves were used to establish cut scores which maximized the sensitivity/specificity of each measure. In those without CI, both tests showed good classification accuracy (86.7% and 85.0%, respectively). Among those with CI, the TOMM retained good classification accuracy (82.3%), while the WCT's decreased considerably (69.4%). Optimal WCT cut scores differed based on impairment status, with a higher sensitivity/specificity trade-off among those with CI. Successful performance on the WCT appeared to rely more heavily on cognitive processes unrelated to performance validity.

Spared emotional perception in patients with Alzheimer's disease is associated with negative caregiver outcomes

ABSTRACTObjectives: Caregivers (CGs) for patients with Alzheimer's disease (AD) often experience negative mental health and relationship outcomes. Additionally, emotional perception abilities are often compromised in early AD; the relationships between these deficits and CG outcomes are unclear. The present study investigated the relationship between emotional perception abilities in AD participants and CG well-being.Methods: Participants included 28 individuals with AD, their spousal CGs, and 30 older controls (OCs). Patients and controls completed the Montreal Cognitive Assessment and Advanced Clinical Solutions: Social Perception subtest. CGs completed questionnaires related to relationship satisfaction, burden, depression, and patient neuropsychiatric symptoms and activities of daily living.Results: The patient group performed significantly worse than OCs on measures of cognition and emotional perception. Several significant relationships emerged between AD participant emotional perception and CG outcomes. Higher CG depression was associated with greater overall emotional perception abilities (r = .39, p = .041). Caregiver burden was positively correlated with AD participants' ability to label the emotional tones of voices (r = .47, p = .015). Relationship satisfaction was not significantly correlated with emotional perception.Discussion: This study replicated earlier findings of impaired emotional perception abilities in AD participants. However, preserved abilities in emotional perception were associated greater CG depression and burden. Interestingly, the CGs satisfaction with the marital relationship did not appear to be influenced by changes in emotional perception. Higher emotional engagement among couples in which one spouse has cognitive impairment may contribute to increased negative interactions and in turn a greater sense of burden and depression, while leaving the marital relationship preserved.

Spontaneous recovery of memory functions in an untreated case of anti NMDAR encephalitis – a reason to maintain hope

Objective: Anti N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder that was only fully discovered recently and neuropsychological outcome data remains sparse. We present the case of BA, a 19-year-old male, which illustrates the cognitive outcome in an untreated case over a time period of over 2½ years.Method: We conducted three cognitive assessments, including tests of memory and executive functioning, over this time period and considered the evidence for reliable change in memory function using the Wechsler Advanced Clinical Solutions (ACS) serial assessment package.Results: Our findings revealed mild memory problems 6 months post-discharge with, at best, static and potentially declining memory functioning at follow-up assessment 12 months post-discharge. However, the results of testing at 30 months post-discharge revealed significant improvements in immediate and delayed memory index performances.Conclusions: Our report of a case of anti-NMDAR encephalitis provides evidence for spontaneous improvements in memory functioning occurring more than 2 years after initial assessment and also demonstrates both the utility and potential limitations of the ACS serial assessment software when used in a relatively typical clinical assessment situation.

Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder.

The aim of the present study was to investigate the social cognitive functioning of participants with depression when compared with healthy controls, and to assess the impact of symptom severity. One hundred and eight patients with depression (66 remitted and 42 current) and 52 healthy controls were assessed using the Wechsler Advanced Clinical Solutions: Social Perception Subtest, measuring facial affect recognition in isolation and in combination with prosody and body language interpretation. When healthy controls, remitted depression and currently depressed groups were compared, no associations were found on any of the social cognition subscales. Severity of depressive and anxious symptoms predicted performance on all social cognition subscales in currently depressed participants, controlling for age, gender, education and psychotropic medication. Affective depressive symptoms were inversely related to ACS Pairs and Prosody subscales, while somatic symptoms were inversely related to the ACS Affect Recognition and Total scores. There was no association between severity and the WAIS ACS in remitted depression participants. People with MDD exhibiting more severe depressive and anxious symptoms and a cluster of affective symptoms have greater difficulty undertaking complex social cognitive tasks. Given the state like nature to these deficits, these impairments may cause problems with day to day functioning and have implications in targeted therapeutic interventions.

Social cognition deficits and associations with drinking history in alcoholic men and women.

Previous studies have demonstrated the presence of a social cognition factor as an element of general cognition in healthy control and clinical populations. Recently developed measures of social cognition include the social perception and faces subtests of the Wechsler Advanced Clinical Solutions (ACS) Social Cognition module. While these measures have been validated on various clinical samples, they have not been studied in alcoholics. Alcoholism has been associated with emotional abnormalities and diminished social cognitive functioning as well as neuropathology of brain areas underlying social processing abilities. We used the ACS Social Perception and Faces subtests to assess alcoholism-related impairments in social cognition. Social cognitive functioning was assessed in 77 abstinent alcoholic individuals (37 women) and 59 nonalcoholic control participants (29 women), using measures of the ACS Social Cognition module and subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) that contain a social cognition component (Picture Completion and Comprehension). Group and gender differences in ACS and WAIS-IV performance were assessed, as well as relationships between measures of alcoholism severity and social cognitive functioning. Alcoholics performed significantly worse than nonalcoholics on the ACS measures of Affect Naming and Faces Content. Alcoholic men were impaired relative to alcoholic women on Prosody Face Matching and Faces Content scores. Among alcoholics, longer durations of heavy drinking were associated with poorer performance on Affect Naming, and a greater number of daily drinks were associated with lower Prosody Face Matching performance. For alcoholic women, a longer duration of abstinence was associated with better performance on Affect Naming. Alcoholic men and women showed different patterns of associations between alcoholism indices and clinically validated social cognition assessments. These findings extend into the social cognition domain, previous literature demonstrating the presence of cognitive deficits in alcoholism, their association with alcoholism severity, and variability by gender. Moreover, because impairments in social cognition can persist despite extended abstinence, they have important implications for relapse prevention.

Further Consideration of Advanced Clinical Solutions Word Choice: Comparison to the Recognition Memory Test-Words and Classification Accuracy in a Clinical Sample

Word Choice (WC), a test in the Advanced Clinical Solutions package for Wechsler measures, was examined in two studies. The first study compared WC to the Recognition Memory Test-Words (RMT-W) in a clinical sample (N = 46). WC scores were significantly higher than RMT-W scores overall and in sample subsets grouped by separate validity indicators. In item-level analyses, WC items demonstrated lower frequency, greater imageability, and higher concreteness than RMT-W items. The second study explored WC classification accuracy in a different clinical sample grouped by separate validity indicators into Pass (n = 54), Fail-1 (n = 17), and Fail-2 (n = 8) groups. WC scores were significantly higher in the Pass group (M = 49.1, SD = 1.9) than in the Fail-1 (M = 46.0, SD = 5.3) and Fail-2 (M = 44.1, SD = 4.8) groups. WC demonstrated area under the curve of .81 in classifying Pass and Fail-2 participants. Using the test manual cutoff associated with a 10% false positive rate, sensitivity was 38% and specificity was 96% in Pass and Fail-2 groups with 24% of Fail-1 participants scoring below cutoff. WC may be optimally used in combination with other measures given observed sensitivity.

A Comparison of the Degree of Effort Involved in the TOMM and the ACS Word Choice Test Using a Dual-Task Paradigm

The aims of the current study were to: (a) examine the predictive validity and efficacy of the Advanced Clinical Solutions Word Choice Test (WCT) as a measure of effort relative to the Test of Memory Malingering (TOMM); (b) investigate whether performing a dual (distraction) task would undermine performance on either test; (c) assess the effect of coaching on the diagnostic accuracy of both the WCT and the TOMM; and (d) establish an optimal cut score for the WCT. The current study used a simulation design based on an analogue design in which normal participants were instructed to either apply full effort or simulate a brain injury on the tasks without being detected. Participants included 93 undergraduate university students who were randomly assigned to 1 of 4 conditions: (a) distraction, (b) uncoached traumatic brain injury (TBI) simulators, (c) coached TBI simulators, or (d) full effort. The results demonstrated that the WCT and the TOMM were effective in detecting simulated cognitive impairment. Both tests were resistant to the effects of distraction and were equally effective in detecting coached and uncoached simulators. A cut score of 42 on the WCT was found to provide optimal specificity and sensitivity on the test.