Computerized Assessment Package Research Articles

Safety Evaluation of Employing Temporal Interference Transcranial Alternating Current Stimulation in Human Studies.

Temporal interference transcranial alternating current stimulation (TI-tACS) is a new technique of noninvasive brain stimulation. Previous studies have shown the effectiveness of TI-tACS in stimulating brain areas in a selective manner. However, its safety in modulating human brain neurons is still untested. In this study, 38 healthy adults were recruited to undergo a series of neurological and neuropsychological measurements regarding safety concerns before and after active (2 mA, 20/70 Hz, 30 min) or sham (0 mA, 0 Hz, 30 min) TI-tACS. The neurological and neuropsychological measurements included electroencephalography (EEG), serum neuron-specific enolase (NSE), the Montreal Cognitive Assessment (MoCA), the Purdue Pegboard Test (PPT), an abbreviated version of the California Computerized Assessment Package (A-CalCAP), a revised version of the Visual Analog Mood Scale (VAMS-R), a self-assessment scale (SAS), and a questionnaire about adverse effects (AEs). We found no significant difference between the measurements of the active and sham TI-tACS groups. Meanwhile, no serious or intolerable adverse effects were reported or observed in the active stimulation group of 19 participants. These results support that TI-tACS is safe and tolerable in terms of neurological and neuropsychological functions and adverse effects for use in human brain stimulation studies under typical transcranial electric stimulation (TES) conditions (2 mA, 20/70 Hz, 30 min).

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Objectives: According to one hypothesis, the popularity of levothyroxine (L-T₄)/liothyronine (L-T₃) combination therapy relates to weight loss. The purpose of this study was to detect a possible correlation between thyroid-related quality of life (QoL) and weight loss in hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy. Methods: In an open-label cohort study, all hypothyroid patients referred to the University Hospital endocrine clinic due to persistent symptoms despite adequate L-T₄ monotherapy (without other explanations for the symptoms) were switched from L-T₄ monotherapy to L-T₄/ L-T₃ combination therapy at a ratio of approximately 17/1. At baseline and after 3 months of treatment we measured: QoL by the Thyroid Patient-Reported Outcome (ThyPRO-39) questionnaire, thyroid hormones, body weight, body composition by a DEXA-scan, and cognitive function by evaluating participants’ reaction time as well as working memory by the California Computerized Assessment Package (CalCAP®). QoL was re-evaluated after 12 months. Results: Twenty-three patients participated (91% women, median age 47 years). The ThyPRO-39 composite score decreased from a median of 54 (quartiles: 34, 74) to 15 (11, 28) after 3 months (p < 0.0001), and 20 (14, 26) after 12 months, indicating a better QoL. There was no change in body weight, and no correlations between QoL and weight. There was a slight improvement in cognitive function, whereas body composition, heart rate, and serum TSH did not change. Conclusion: Our study on hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy showed a substantial improvement in QoL measured by the ThyPRO-39. This improvement could not be explained by weight loss.

The role of executive function and the dorsolateral prefrontal cortex in the expression of neuroticism and conscientiousness

The current study examined how specific neurological systems contribute to the expression of multiple personality dimensions. We used individuals with traumatic brain injuries to examine the contribution of the dorsolateral prefrontal cortex (DLPFC)—a region important for executive function and attention—to the expression of neuroticism and conscientiousness factors and facets. Results from Voxel-Based Lesion-Symptom Mapping analyses revealed that focal damage to the left DLPFC (Brodmann’s area 9) was associated with high neuroticism and low conscientious factor and facet scores (anxiety and self-discipline, respectively). Compared with lesioned and normal controls, veterans with damage in left DLPFC also reported higher neuroticism and lower conscientiousness facet scores, slower reaction times on the California Computerized Assessment Package assessment, and lower scores on the Delis–Kaplan executive function battery. Findings suggest that while neuroticism and conscientiousness remain psychometrically independent personality dimensions, their component facets may rely on a common neurocognitive infrastructure and executive function resources in general.

Neuropsychological deficits in adolescent methamphetamine abusers

Methamphetamine (METH) is a widely abused psychostimulant that is associated with neurotoxicity and neurocognitive impairments in adults. However, the effects of METH use on neurocognitive performance of adolescents are unclear. Fifty-four adolescent METH users and 74 age-matched comparison subjects (ages 12 to 23 years) were evaluated with a battery of neuropsychological tests. The cognitive domains evaluated include psychomotor (Symbol Digit, Trail Making), executive function (Stroop Interference task, Wisconsin Card Sort task), fine-motor speed (Grooved Pegboard), memory (Digit span and Auditory Verbal Learning Task), as well as attention and working memory (California Computerized Assessment package). METH users were slower on the Stroop Interference task than the comparison subjects (F(1,114) = 4.33, p = 0.03). METH subjects also performed worse than controls on the Wechsler Adult Intelligence Scale III/Wechsler Intelligence Scale for Children IV (WAIS/WISC) Matrices task (F(1,114) = 4.37, p = 0.04) and performed significantly worse on the Peg Board task than the comparison subjects for both the dominant (F(1,114) = 7.56, p = 0.01) and non-dominant (F(1,114) = 6.75, p = 0.01). Lastly, length of abstinence was associated with improved performance on the Peg Board test with the dominant had (r = -0.34), as well as the WAIS/WISC Forward Digit Span task (r = 0.38) METH use is associated with impaired executive functions in adolescent users.

A Comparison of Psychosocial and Cognitive Functioning Between Depressed and Non-Depressed Patients with Cannabis Dependence

ABSTRACT Cannabis use and depressive disorders are thought to impair cognitive performance and psychosocial functioning. Both disorders co-occurring may compound the negative effects of these diagnoses. In this study, the authors used the California Computerized Assessment Package as the cognitive performance measure and the Addiction Severity Index as the psychosocial functioning measure to compare individuals who were cannabis dependent and either depressed or not depressed (N= 108: 54 cannabis dependent only, 54 cannabis dependent and depressed or dysthymic). As predicted, cannabis dependent individuals with comorbid depression showed more psychosocial impairment than individuals with cannabis dependence alone. However, contrary to the authors’ hypothesis, individuals who were cannabis dependent with comorbid depression showed less cognitive impairment in some California Computerized Assessment Package modules than individuals with cannabis dependence alone. Based on the authors’ results, they concluded that the additive effects of cannabis dependency and depression may only be limited to psychosocial domains and may not extend to cognitive functioning.

Demographic and biological influences on cognitive reserve

High levels of education have been linked to reduced risk of dementia, whereas magnetic resonance imaging (MRI) white matter hyperintensities (WMH) have been shown to correspond to deficits in executive functioning and psychomotor speed. We studied education, WMH, age, and gender as predictors of better cognitive performance, or cognitive reserve, in the normal elderly. The Repeatable Battery for the Assessment of Neuropsychological Status, supplemented by the Trail Making Test, the Stroop Test, and the California Computerized Assessment Package, were administered to 95 volunteers, aged 75–90 years. Quantitative MRI was used to determine the extent and location of WMH. Using factor analysis, the cognitive measures were reduced to three factors: verbal memory, information-processing speed/executive functioning, and visuospatial skills. When entered into a hierarchical regression, age and gender were the primary predictors of verbal memory, accounting for 34.8% of the variance, with education and WMH adding only 9%. WMH, education, and age contributed independently to predicting speed of information processing/executive functioning, explaining 22.5% of the variance. Only education and age were predictors of visuospatial skills, explaining 14.8% of the variance. These data suggest that cognitive reserve represents a combination of factors that independently determine the threshold for competence within specific cognitive domains.

Prediction of driving ability after inconclusive neuropsychological investigation

Objective: The aim of the present study was to investigate the predictive value of neuropsychological tests for on-road evaluation outcome after inconclusive assessment.Methods and procedures: Thirty-five patients were assessed neurologically, neuropsychologically by traditional clinical tests and by on-road evaluation. Simple univariate tests, logistic regression and ROC-curve analysis were used to investigate the predictive power of different neuropsychological tests.Main outcomes and results: Six measures from the California Computerized Assessment Package (CalCAP) and the Digit-Symbol test from Wechsler Adult Intelligence Scale predicted the outcome of the on-road evaluation. A logistic regression analysis showed that a model with two variables from CalCAP and the Digit Symbol test predicted the results of the on-road driving evaluation with an overall accuracy of 84.8%.Conclusions: The findings indicate that the outcome of on-road assessment is most related to cognitive skills such as attention and processing speed in combination with cognitive flexibility.

Antiepileptic monotherapy significantly impairs normative scores on common tests of executive functions

Understanding how antiepileptic (AED) monotherapy influences normative test scores is of importance in the clinic for correct interpretation of neuropsychological profiles. Previous studies have primarily reported minor influence on neuropsychological raw scores, and the clinical relevance of these findings is unclear. To obtain a clinical valid answer to this question, we analysed changes in T-scores after AED withdrawal in a large group of well-controlled epilepsy patients, for tests previously shown to be sensitive to AED withdrawal. We report outcomes on measures of choice reaction time from the California Computerized Assessment Package, on the Controlled Oral Word Association Test and on the Stroop Color-Word Interference Test. Significantly improved T-scores were revealed after AED withdrawal on five of the six tests of executive functions with mean improvement of 5 T-scores. Comparable results were achieved in the subgroup taking carbamazepine, with a mean improvement of 6.2 T-scores. The present results suggest that T-scores for computerized tests of choice reaction time and tests of verbal fluency and response inhibition may be significantly impaired as a consequence of AED monotherapy, and that careful interpretation of these scores is required in diagnostic assessment of patients receiving AED monotherapy.

Improvement in Speeded Cognitive Processing After Anti-epileptic Drug Withdrawal – A Controlled Study in Mono-therapy Patients

Background: Anti-epileptic drugs (AEDs) are associated with cognitive side effects. Doubt exists regarding the degree of cognitive effects primarily related to problems with design and methodology in many studies. The aim of the reported study was to assess the effect of AED withdrawal in patients on monotherapy using computerised measures of attention, reaction time and speed of information processing. Methods: One hundred and fifty patients seizure free &gt;2 years on drug monotherapy went through a randomised, double blind, placebo controlled study. All patients were included for 12 months or until seizure relapse. Cognitive function was assessed with the California Computerized Assessment Package at baseline and 7 months after withdrawal. Results: The major finding was that discontinuation of major AEDs significantly improved performance on tests that require complex cognitive processing under time pressure. The difference in speed of cognitive processing between the withdrawal and non-withdrawal groups was between 24 and 43 ms. No significant difference emerged between the groups on simple tasks of attention and reaction time. Most of the patients in the study were treated with carbamazepine and valproate. The outcome of carbamazepine withdrawal was similar to the outcome for the total study population while discontinuation of valproate only revealed a non-significant tendency in the same direction. Interpretation: The results suggest that seizure-free epilepsy patients on monotherapy can obtain improvement in speeded cognitive processing if they withdraw anti-epileptic treatment.

Facets of Psychopathy, Heart Rate Variability and Cognitive Function

The aim of the present study was to investigate whether the four facets of Hare's Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Bolt, Hare, Vitale, & Newman, 2004) were related to physiological and cognitive mechanisms. Fifty-three male prisoners participated in this study. Physiological responses were measured as heart rate variability (HRV) and heart rate (HR). Cognitive functions were measured using a continuous performance test (CPT; California Computerized Assessment Package, Abbreviated version) and a working memory test (WMT); based on Baddeley & Hitch (1974). The regression analysis of the HRV revealed that the interpersonal facet explained most of the variance during baseline (28%), CPT (16%), and WMT (12%). This was also true for the HR data during baseline (28%), CPT (20%), WMT (10%), and recovery (13%). The antisocial facet explained 10% of the variance only during baseline. Subjects scoring high compared to low on the interpersonal facet also showed better cognitive functioning. The study suggests that the different facets were differently associated with both physiological and cognitive functions.

Influence of major antiepileptic drugs on neuropsychological function: Results from a randomized, double-blind, placebo-controlled withdrawal study of seizure-free epilepsy patients on monotherapy

The aim of this study was to assess cognitive effects of anticonvulsants in a way that would yield results that are most directly applicable to epilepsy populations. This was done with a placebo-controlled, prospective, randomized, double-blind, parallel group study of anticonvulsant withdrawal in a population of subjects taking a single anticonvulsant with completely controlled seizures. Outcomes of this study on cognitive measures from the California Computerized Assessment Package have recently been reported. To aid comparison with results of prior studies, we report outcomes here on several more standard measures of neuropsychological function. The major findings were that, in subjects with therapeutic drug levels at baseline, drug withdrawal was associated with significant improvement in performance on the Controlled Oral Word Association Test and the Stroop Color-Word Interference Test. Comparable results were achieved in the subgroup taking carbamazepine.

Assessment of Cognitive Functioning of Methadone-Maintenance Patients

The purpose of this study was to determine if methadone-maintained patients (MMP) with cocaine dependence (CD) and/or adult Attention Deficit Hyperactivity Disorder (ADHD) exhibited compounded cognitive dysfunction associated with their poly-substance use and/or co-morbid psychiatric diagnoses. The sample consisted of 79 MMP (59% male, 51% Caucasian), maintained on methadone doses ranging from 40-130 mg/day, who were placed into one of four diagnostic categories: (1) a control group (no ADHD, no CD) (n = 24), (2) CD alone (n = 18), (3) ADHD alone (n = 18), and (4) ADHD + CD (n = 19). The California Computerized Assessment Package (CalCAP®) was administered to assess cognitive functioning requiring focused and sustained attention in a standardized fashion. There were no group differences on Simple Reaction tasks. Compared to the control group, the ADHD + CD group was slower and less accurate on 33% of the Choice Reaction (CR) tasks. Specifically, individuals in the ADHD + CD group and the ADHD alone group performed significantly worse on tasks measuring attention and psychomotor responding. These tasks are associated with broader cognitive skills in working memory, language discrimination and flexibility of cognitive sets that may have implications for treatment outcome. Diagnostic services capable of identifying cognitive deficits among MMP with ADHD and/or CD are needed to maximize the likelihood of treatment success and to serve as an indicator for the efficacy of therapeutic approaches.

Influence of Major Antiepileptic Drugs on Attention, Reaction Time, and Speed of Information Processing: Results from a Randomized, Double‐blind, Placebo‐controlled Withdrawal Study of Seizure‐free Epilepsy Patients Receiving Monotherapy

All major antiepileptic drugs (AEDs) have been reported to be associated with cognitive side effects. Uncertainty exists regarding the degree of cognitive effects, primarily because many studies do not adhere to basic standards of methodology and design. The aim of this study was to assess the effect of discontinuation of AEDs in patients receiving monotherapy on measures of attention, reaction time, and speed of information processing. The 150 subjects who had been seizure free>2 years on drug monotherapy went through a randomized, double-blind, placebo-controlled study. Each patient was included for 12 months or until seizure relapse. Cognitive function was assessed with the California Computerized Assessment Package at baseline and 7 months after discontinuation. The major finding in this study is that discontinuation of major AEDs significantly improved performance on tests that require complex cognitive processing under time pressure. The difference in speed of cognitive processing between the two groups on these tasks was between 24 to 43 ms. Simple tasks of attention and reaction time revealed no significant differences between the discontinuation group and the nondiscontinuation group. Most of the subjects in the study were medicated with carbamazepine (CBZ) and valproate (VPA). The outcome of discontinuation of CBZ was similar to the outcome for the total study population, whereas withdrawal of VPA revealed only a nonsignificant tendency in the same direction. The results suggest that seizure-free epilepsy patients receiving monotherapy can obtain improvement in cognitive function if they discontinue AED treatment.

Computerized reaction time battery versus a traditional neuropsychological battery: detecting HIV-related impairments.

In recent years, interest in the use of computerized neuropsychological (NP) assessment measures has increased. However, there are limited data regarding how performance on these measures relates to performance on more traditional, clinical instruments. In the present study, 82 HIV+ men, who were all believed on clinical grounds to have neurobehavioral impairment, completed a traditional NP battery (TNB) and the California Computerized Assessment Package (CalCAP, a collection of computerized reaction time tests). Summary scores based on a TNB, as well as those based on the CalCAP, demonstrated significant associations with both degree of immunosuppression (CD4 count) and detectable viral load in cerebrospinal fluid, but not with detectable viral load in plasma. Established norms on the TNB and CalCAP batteries resulted in classifying 57% and 49% of the HIV+ sample as impaired, respectively. When using the TNB as the "gold standard," impairment classifications based on CalCAP summary scores exhibited a sensitivity of 68% and a specificity of 77%. Overall agreement on impairment classifications between batteries was low (kappa = .44). Data from this study suggest that traditional NP batteries and computerized reaction time tests do not measure the same thing, and are not interchangeable in examining HIV-related NP impairments.

Perfusion MRI and computerized cognitive test abnormalities in abstinent methamphetamine users

This study aims to determine possible persistent abnormalities in regional cerebral blood flow (relative rCBF) and cognitive function in abstinent methamphetamine (METH) users. Twenty METH-dependent subjects (abstinent for 8±2 months) and 20 age- and gender-matched controls were evaluated with perfusion magnetic resonance imaging (pMRI) and neuropsychological tests. METH users showed decreased relative rCBF bilaterally in putamen/insular cortices (right: −12%; left: −10%) and the right lateral parietal brain region (−11%), but increased relative rCBF bilaterally in the left temporoparietal white matter (+13%), the left occipital brain region: (+10%) and the right posterior parietal region (+24%). Interaction effects were observed between METH and gender in the right occipital cortex and a midline brain region; female METH users showed increased relative rCBF (+15% both regions) whereas the male METH users had decreased relative rCBF (−10% and −18%, respectively). METH users performed within normal ranges on standard neuropsychological tests; however, they were slower on several tasks on the California Computerized Assessment Package (CalCAP), especially tasks that required working memory. These findings suggest that METH abuse is associated with persistent physiologic changes in the brain, and these changes are accompanied by slower reaction times on computerized measures of cognitive function.

Factors in Acceptance of Advanced Information Technology Among Social Workers

Summary Advanced information technology such as diagnostic programs, decision support systems or therapeutic computer games are likely to have far-reaching effects on the nature of social work practice, on the condition that they can be accepted by rank and file workers in human services organizations. This exploratory study was designed to develop a valid instrument that can test the extent to which social workers are willing to use the three most common types of advanced information technology: (1) computerized assessment package (CA), (2) decision support system (DSS), and (3) therapeutic computer games (TG). The instrument was field-tested with 74 Israeli social workers. Social workers clearly differentiated between the types of information technology with preference for therapeutic computer games (TG, DDS, CA, mean acceptance = 4.14, 3.91, 3.47, respectively). The differences between TG and CA, and between DDS and CA were statistically significant in paired t-tests (p = .000 and .003 respectively).