Demographic Corrections Research Articles

Accuracy of Two Cognitive Screening Tools to Detect Mild Cognitive Impairment in Parkinson's Disease.

Patients with Parkinson's disease (PD) who have mild cognitive impairment (PD-MCI) are at increased risk of developing PD dementia (PDD). Therefore, it is important to identify PD-MCI in a reliable way. We evaluated the accuracy of the Parkinson's Disease-Cognitive Rating Scale (PD-CRS) and the Mattis Dementia Rating Scale-2 (MDRS-2) for detecting PD-MCI. Data from healthy subjects were used to correct for demographic influences. We compared the accuracy of the two instruments using ROC analysis. The gold standard was level II diagnosis of PD-MCI according to consensus criteria of the International Parkinson and Movement Disorder Society. Seventy-five healthy subjects and 125 PD patients were included. Education level, age and sex correlated with the PD-CRS, but only age correlated with the MDRS-2. Twenty-seven percent of the patients had PD-MCI. Areas under the curve (AUCs) for raw scores of PD-CRS and MDRS-2 were 0.83 and 0.81, respectively. At the optimal cut-off for the PD-CRS (101/102), sensitivity was 88% and specificity was 64%. For the MDRS-2 (139/140) sensitivity and specificity were 68% and 79%, respectively.AUCs for demographically corrected scores of PD-CRS and for age-corrected scores of MDRS-2 were 0.80 and 0.78, respectively. At the optimal cut-off for the PD-CRS, sensitivity was 79% and specificity was 72%, while for the MDRS-2 these were 77% and 67%, respectively. Both cognitive screening tools are suitable for distinguishing PD-MCI patients from cognitively intact PD patients. Demographical correction of scores did not improve sensitivity and specificity.

A new set of tasks for the assessment of lexical disorders in Italian

A new set of tasks for the assessment of lexical disorders in Italian

Associations between self‐reported sleep quality and white matter in community‐dwelling older adults: A prospective cohort study

Both sleep disturbances and decline in white matter microstructure are commonly observed in ageing populations, as well as in age‐related psychiatric and neurological illnesses. A relationship between sleep and white matter microstructure may underlie such relationships, but few imaging studies have directly examined this hypothesis. In a study of 448 community‐dwelling members of the Whitehall II Imaging Sub‐Study aged between 60 and 82 years (90 female, mean age 69.2 ± 5.1 years), we used the magnetic resonance imaging technique diffusion tensor imaging to examine the relationship between self‐reported sleep quality and white matter microstructure. Poor sleep quality at the time of the diffusion tensor imaging scan was associated with reduced global fractional anisotropy and increased global axial diffusivity and radial diffusivity values, with small effect sizes. Voxel‐wise analysis showed that widespread frontal‐subcortical tracts, encompassing regions previously reported as altered in insomnia, were affected. Radial diffusivity findings remained significant after additional correction for demographics, general cognition, health, and lifestyle measures. No significant differences in general cognitive function, executive function, memory, or processing speed were detected between good and poor sleep quality groups. The number of times participants reported poor sleep quality over five time‐points spanning a 16‐year period was not associated with white matter measures. In conclusion, these data demonstrate that current sleep quality is linked to white matter microstructure. Small effect sizes may limit the extent to which poor sleep is a promising modifiable factor that may maintain, or even improve, white matter microstructure in ageing. Hum Brain Mapp 38:5465–5473, 2017. © 2017 Wiley Periodicals, Inc.

Distribution of lacunes in cerebral amyloid angiopathy and hypertensive small vessel disease.

To evaluate whether the burden of deep and lobar lacunes differs between patients with intracerebral hemorrhage (ICH) with definite/probable cerebral amyloid angiopathy (CAA) per the Boston criteria and hypertensive small vessel disease (HTN-SVD; ICH in basal ganglia, thalami, brainstem). We defined lobar and deep lacunes similar to the topographic distribution used for ICH and cerebral microbleeds (CMBs). We then compared their distribution between patients with CAA-ICH and those with strictly deep CMB and ICH (HTN-ICH). The independent associations of lacune location with the diagnosis of CAA-ICH and HTN-ICH were evaluated with multivariable models. The relationship between lobar lacunes and white matter hyperintensity (WMH) volume was evaluated by means of partial correlation analyses adjusted for age and a validated visual scale. In our final cohort of 316 patients with ICH, lacunes were frequent (24.7%), with similar rates in 191 patients with CAA and 125 with HTN-ICH (23% vs 27.2%, p = 0.4). Lobar lacunes were more commonly present in CAA (20.4% vs 5.7%, p < 0.001), while deep lacunes were more frequent in HTN-ICH (15.2% vs 2.1%, p < 0.001). After correction for demographics and clinical and neuroimaging markers of SVD, lobar lacunes were associated with CAA (p = 0.003) and deep lacunes with HTN-ICH (p < 0.001). Lobar lacunes in 80% of the cases were at least in contact with WMH, and after adjustment for age, they were highly correlated to WMH volume (r = 0.42, p < 0.001). Lobar lacunes are associated with CAA, whereas deep lacunes are more frequent in HTN-SVD. Lobar lacunes seem to have a close relationship with WMH, suggesting a possible common origin.

Abstract WMP100: Topographical Distribution of Lacunes in Cerebral Amyloid Angiopathy and Deep Hypertensive Intracerebral Hemorrhage

Background/Aims: To evaluate whether the burden of lacunes located at deep and lobar brain regions, would differ between intracerebral hemorrhage patients (ICH) with cerebral amyloid angiopathy (CAA) vs patients with strictly deep cerebral microbleeds (CMB) and ICH (Deep HTN-ICH). Methods: We defined lobar and deep lacunes similar to the topographic distribution used for ICH and microbleeds. We then compared their distribution between CAA and Deep HTN-ICH patients. The independent associations of lacune location (lobar vs deep) with diagnosis of CAA-ICH and Deep HTN-ICH were evaluated using multivariable models. The relationship between lobar and deep lacunes and WMH volume was evaluated using partial correlation analyses adjusting for age and by means of a validated visual scale. Results: In our cohort of 316 ICH patients, lobar lacunes were more commonly present in CAA (20.4% vs 5.7% in Deep HTN-ICH, p&lt;0.001; see figure) while deep lacunes more frequent in Deep HTN-ICH patients (15.2% vs 2.1%, p&lt;0.001; see figure). After correction for demographics, clinical and neuroimaging markers of SVD, lobar lacunes were associated with CAA diagnosis (p=0.023), while deep lacunes with Deep HTN-ICH (p&lt;0.001). Lobar lacunes in 80% of the cases were at least in contact with WMH and after adjustment for age they were highly correlated to WMH volume ( r=0.52, p&lt;0.001). Conclusions: Lobar lacunes are associated with CAA whereas deep lacunes are more frequent in patients with Strictly deep CMBs and ICH, they can thus be clinically useful in the appropriate context. Lobar lacunes seem to have a close relationship with WMH suggesting a possible common origin.

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.

Investigating Discrepancies between Predicted and Observed Wechsler Adult Intelligence Scale‐Version IV Full‐Scale Intelligence Quotient Scores in a Non‐Clinical Sample

ObjectiveIn neuropsychological assessment estimates of how a client was performing prior to an injury is achieved by using instruments that have been developed to predict premorbid abilities, such as the National Adult Reading Test (NART), the re‐standardised NART (NART‐2), the Wechsler Test of Adult Reading (WTAR), and the Test of Premorbid Functioning (TOPF), and comparing these to scores from tests of current ability, such as the Wechsler Adult Intelligence Scale‐Fourth Edition (WAIS‐IV). These instruments have been criticised, however, due to concerns regarding the accuracy of their predictions.MethodThis study evaluated the ability of the NART, NART‐2, WTAR and TOPF to accurately estimate current full scale intelligence quotient (FSIQ) as measured by the WAIS‐IV in an unimpaired Australian sample.ResultsFor the sample as a whole, the NART significantly over‐estimated FSIQ, whilst the TOPF significantly underestimated FSIQ. In the low average IQ group, scores were over‐estimated by the NART‐2 and WTAR. In the average group, the predicted FSIQ scores produced by each measure were relatively accurate. In the high average group, NART was the best predictor of FSIQ, while the other tests all significantly underestimated IQ.ConclusionsIt was concluded that reading tests may not be the most accurate method for predicting IQ, and that other approaches which include demographic correction the should be further explored.

Assessing performance of single-sample molecular genetic methods to estimate effective population size: empirical evidence from the endangered Gochu Asturcelta pig breed.

Estimating effective population size (N e) using linkage disequilibrium (LD) information (N e( LD )) has the operational advantage of using a single sample. However, N e( LD ) estimates assume discrete generations and its performance are constrained by demographic issues. However, such concerns have received little empirical attention so far. The pedigree of the endangered Gochu Asturcelta pig breed includes individuals classified into discrete filial generations and individuals with generations overlap. Up to 780 individuals were typed with a set of 17 microsatellites. Performance of N e( LD ) was compared with N e estimates obtained using genealogical information, molecular coancestry (N e(M)) and a temporal (two‐sample) method (N e( JR )). Molecular‐based estimates of N e exceeded those obtained using pedigree data. Estimates of N e( LD ) for filial generations F3 and F4 (17.0 and 17.3, respectively) were lower and steadier than those obtained using yearly or biannual samplings. N e( LD ) estimated for samples including generations overlap could only be compared with those obtained for the discrete filial generations when sampling span approached a generation interval and demographic correction for bias was applied. Single‐sample N e(M) estimates were lower than their N e( LD ) counterparts. N e(M) estimates are likely to partially reflect the number of founders rather than population size. In any case, estimates of LD and molecular coancestry tend to covary and, therefore, N e(M) and N e( LD ) can hardly be considered independent. Demographically adjusted estimates of N e( JR ) and N e( LD ) took comparable values when: (1) the two samples used for the former were separated by one equivalent to discrete generations in the pedigree and (2) sampling span used for the latter approached a generation interval. Overall, the empirical evidence given in this study suggested that the advantage of using single‐sample methods to obtain molecular‐based estimates of N e is not clear in operational terms. Estimates of N e obtained using methods based in molecular information should be interpreted with caution.

Regression-Based Normative Formulae for the Repeatable Battery for the Assessment of Neuropsychological Status for Older Adults.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has become a popular cognitive screening instrument, particularly in elderly patients. Prior studies presented lookup tables for RBANS normative data based on age, gender, education, and race using a group of 718 community-dwelling older adults. However, regression-based normative formulae that simultaneously correct for all demographic variables may be more sensitive for detecting late life cognitive decline. Using data from the prior studies, linear regression was used to generate such formulae in the Indexes and subtests of the RBANS. Results indicated that ∼11% of the variance of Index scores was accounted for by these demographic variables, and 13% of variance in subtest scores. Although some differences were present between the lookup and regression-based norms, it is expected that these current results will present more accurate demographic corrections that allow clinicians and researchers to better interpret individual performances on the RBANS.

Introducing demographic corrections for the 10/36 Spatial Recall Test

The 10/36 Spatial Recall Test is a measure of visuospatial memory and has been recommended for inclusion when administering a brief cognitive assessment to patients with multiple sclerosis by multiple groups. However, a notable limitation of the measure includes a lack of normative data with demographic corrections. Thus, the primary objective of the current study was to examine demographic influences on the 10/36 Spatial Recall Test and to introduce demographically corrected normative data for the instrument. Data were collected from 116 participants over the age of 50 years. All study participants were free of any neurologic disease or disorder and classified as cognitively intact by a consensus conference team that was comprised of neurologists and neuropsychologists. All study participants were administered a neuropsychological evaluation that included the 10/36 Spatial Recall Test Version A at the baseline visit. 10/36 Spatial Recall Test scores were affected by age, education, and race. Gender effects were not observed. Given these effects, regression equations were used to correct for the effects of demographic variables. The z-scores obtained from these corrections were not significantly influenced by demographical variables. The demographic corrections introduced in this paper offer the possibility to enhance the clinical utility of the 10/36 Spatial Recall Test.

Endothelial Activation Is Associated With Cognitive Performance in Patients With Hypertension.

Hypertension is associated with the occurrence of cognitive deficits and dementia, probably because hypertension is a major risk factor for the occurrence of brain damage as a result of cerebral small vessel disease (cSVD). Endothelial activation and inflammation have been suggested to play an important role in the pathogenesis of cSVD. We investigated if compound scores of endothelial activation or inflammation, based on several blood markers, are associated with cognitive performance 3 years later in patients with essential hypertension. At baseline, levels of blood markers of endothelial activation (soluble vascular cellular adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), sP-selectin, and sE-selectin) and markers of inflammation (neopterin, C-reactive protein, and sICAM-1) were measured and transformed into compound scores using z-scores. In addition, a brain magnetic resonance imaging (MRI) was performed to determine the presence of cSVD-related MRI markers. Three years later, patients underwent a neuropsychological assessment to determine cognitive performance. A total of 101 patients with hypertension were included in the present study. In multiple linear regression analyses with correction for demographics and MRI markers, the compound score of endothelial activation (B = -0.19, 95% confidence interval = -0.34 to -0.04, P = 0.014), but not of inflammation (B = -0.09, 95% confidence interval = -0.22 to 0.05, P = 0.198), was associated with worse cognitive performance. Our results show that an overall measure of endothelial activation is associated with cognitive performance in patients with essential hypertension. This indicates that a process involving endothelial activation might play a role in the pathogenesis of cognitive problems in patients with hypertension.

Using Twitter to Measure Public Discussion of Diseases: A Case Study.

BackgroundTwitter is increasingly used to estimate disease prevalence, but such measurements can be biased, due to both biased sampling and inherent ambiguity of natural language.ObjectiveWe characterized the extent of these biases and how they vary with disease.MethodsWe correlated self-reported prevalence rates for 22 diseases from Experian’s Simmons National Consumer Study (n=12,305) with the number of times these diseases were mentioned on Twitter during the same period (2012). We also identified and corrected for two types of bias present in Twitter data: (1) demographic variance between US Twitter users and the general US population; and (2) natural language ambiguity, which creates the possibility that mention of a disease name may not actually refer to the disease (eg, “heart attack” on Twitter often does not refer to myocardial infarction). We measured the correlation between disease prevalence and Twitter disease mentions both with and without bias correction. This allowed us to quantify each disease’s overrepresentation or underrepresentation on Twitter, relative to its prevalence.ResultsOur sample included 80,680,449 tweets. Adjusting disease prevalence to correct for Twitter demographics more than doubles the correlation between Twitter disease mentions and disease prevalence in the general population (from .113 to .258, P <.001). In addition, diseases varied widely in how often mentions of their names on Twitter actually referred to the diseases, from 14.89% (3827/25,704) of instances (for stroke) to 99.92% (5044/5048) of instances (for arthritis). Applying ambiguity correction to our Twitter corpus achieves a correlation between disease mentions and prevalence of .208 ( P <.001). Simultaneously applying correction for both demographics and ambiguity more than triples the baseline correlation to .366 ( P <.001). Compared with prevalence rates, cancer appeared most overrepresented in Twitter, whereas high cholesterol appeared most underrepresented.ConclusionsTwitter is a potentially useful tool to measure public interest in and concerns about different diseases, but when comparing diseases, improvements can be made by adjusting for population demographics and word ambiguity.

Regression-Based Norms for a Bi-factor Model for Scoring the Brief Test of Adult Cognition by Telephone (BTACT).

The current study developed regression-based normative adjustments for a bi-factor model of the The Brief Test of Adult Cognition by Telephone (BTACT). Archival data from the Midlife Development in the United States-II Cognitive Project were used to develop eight separate linear regression models that predicted bi-factor BTACT scores, accounting for age, education, gender, and occupation-alone and in various combinations. All regression models provided statistically significant fit to the data. A three-predictor regression model fit best and accounted for 32.8% of the variance in the global bi-factor BTACT score. The fit of the regression models was not improved by gender. Eight different regression models are presented to allow the user flexibility in applying demographic corrections to the bi-factor BTACT scores. Occupation corrections, while not widely used, may provide useful demographic adjustments for adult populations or for those individuals who have attained an occupational status not commensurate with expected educational attainment.

Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX).

Early administration of tranexamic acid (TXA) has been associated with a reduction in mortality and blood product requirements in severely injured adults. It has also shown significantly reduced blood loss and transfusion requirements in major elective pediatric surgery, but no published data have examined the use of TXA in pediatric trauma. This is a retrospective review of all pediatric trauma admissions to the North Atlantic Treaty Organization Role 3 hospital, Camp Bastion, Afghanistan, from 2008 to 2012. Univariate and logistic regression analyses of all patients and select subgroups were performed to identify factors associated with TXA use and mortality. Standard adult dosing of TXA was used in all patients. There were 766 injured patients 18 years or younger (mean [SD] age, 11 [5] years; 88% male; 73% penetrating injury; mean [SD], Injury Severity Score [ISS], 10 [9]; mean [SD] Glasgow Coma Scale [GCS] score, 12 [4]). Of these patients, 35% required transfusion in the first 24 hours, 10% received massive transfusion, and 76% required surgery. Overall mortality was 9%. Of the 766 patients, 66 (9%) received TXA. The only independent predictors of TXA use were severe abdominal or extremity injury (Abbreviated Injury Scale [AIS] score ≥ 3) and a base deficit of greater than 5 (all p < 0.05). Patients who received TXA had greater injury severity, hypotension, acidosis, and coagulopathy versus the patients in the no-TXA group. After correction for demographics, injury type and severity, vitals, and laboratory parameters, TXA use was independently associated with decreased mortality among all patients (odds ratio, 0.3; p = 0.03) and showed similar trends for subgroups of severely injured (ISS > 15) and transfused patients. There was no significant difference in thromboembolic complications or other cardiovascular events. Propensity analysis confirmed the TXA-associated survival advantage and suggested significant improvements in discharge neurologic status as well as decreased ventilator dependence. TXA was used in approximately 10% of pediatric combat trauma patients, typically in the setting of severe abdominal or extremity trauma and metabolic acidosis. TXA administration was independently associated with decreased mortality. There were no adverse safety- or medication-related complications identified. Therapeutic study, level IV.

The one-carbon-cycle and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in recurrent major depressive disorder; influence of antidepressant use and depressive state?

BackgroundAn important biological factor suggested in the pathophysiology of (recurrent) Major Depressive Disorder (MDD) concerns a polymorphism in a gene encoding for the MTHFR-enzyme of the one-carbon (1-C)-metabolism. Integratively investigating key 1-C-components (folate, homocysteine, vitamin B6 and B12), including the possible effects of antidepressant medication and depressive state, could provide more insight in the possible association between the MTHFR-polymorphism and recurrent MDD. MethodsWe compared the MTHFR C677T-polymorphism together with the key 1-C-components in clinically ascertained patients with recurrent MDD (n=137) to age- and gender-matched healthy controls (n=73). ResultsFirst, patients had lower folate (t=2.25; p=.025) as compared to controls; a difference that resolved after correction for demographics (t=1.22; p=.223). Second, patients that were depressed during sampling had lower vitamin B6 (t=−2.070; p=.038) and higher homocysteine (t=2.404; p=.016) compared to those in remission. Finally, current use of antidepressants had no influence on the 1-C-components. ConclusionsDespite investigation of a specific recurrently depressed patient population, we found no clear associations with the 1-C-cycle, except for higher homocysteine and lower vitamin B6 during the depressed state. This suggests that 1-C-cycle alterations in MDD are state-associated, possibly resulting from high levels of acute (psychological) stress, and may provide a treatment target to reduce cardiovascular risk in this population.

HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research

The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV-) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS ≥ 0.5) based on the local norms was best at discriminating between the two groups (HIV- = 14.3 % vs. HIV+ = 53.3 %; p < 0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV- = 4.1 % vs. HIV+ = 14.7 %; p = 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p ≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performance-based (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors.

Demographic Corrections for the Modified Telephone Interview for Cognitive Status

Despite the growing use of the modified Telephone Interview for Cognitive Status (mTICS) as a cognitive screening instrument, it does not yet have demographic corrections. Demographic data, mTICS, and a neuropsychological battery were collected from 274 community-dwelling older adults with intact cognition or mild cognitive impairments. Age, education, premorbid intellect, and depression were correlated with mTICS scores. Using regression equations, age and education significantly predicted mTICS total score, and depression and premorbid intellect further enhanced this prediction. These results were comparable when only examining the 153 cognitively intact subjects. By using these corrections, clinicians and researchers can more accurately predict an individual’s cognitive status with this telephone screening measure.

Intraindividual neuropsychological test variability in healthy individuals with high average intelligence and educational attainment

Knowledge of patterns of neuropsychological performance among normal, healthy individuals is integral to the practice of clinical neuropsychology, because clinicians may not always account for intraindividual variability (IIV) before coming to diagnostic conclusions. The IIV was assessed among a sample of 46 healthy individuals with high average intelligence and educational attainment, utilizing a battery of neuropsychological tests, including the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) and Wechsler Memory Scale, Fourth Edition (WMS-IV). The data indicated substantial variability in neurocognitive abilities. All participants were found to demonstrate scores considered impaired by at least 2 standard deviations (SDs). Despite adjusting for outliers, no participant produced a “normal” testing profile with an intraindividual maximum discrepancy (MD) of less than 1 SD in either direction. When WAIS-IV Full Scale IQ (FSIQ) was considered, participants generally demonstrated cognitive test scores ranging from 2 SDs less than to 1.5 SDs greater than their FSIQ. Furthermore, after demographic corrections, the majority (59%) of participants demonstrated at least 1 impaired cognitive test score, as defined by being 1 to 1.5 SDs below the mean. Overall, results substantiate the need for clinicians to consider FSIQ and educational attainment in interpretation of neuropsychological testing results, given the relevant commonality of “abnormal” test scores within this population. This may ultimately reduce the likelihood of making false-positive conclusions of impairment when educational attainment and intelligence are high, thus improving diagnostic accuracy.

Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery

To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant. Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals. 100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78). Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.

Parsimonious Estimation of the Wechsler Memory Scale, Fourth Edition Demographically Adjusted Index Scores: Immediate and Delayed Memory

The recent release of the Wechsler Memory Scale Fourth Edition contains many improvements from a theoretical and administration perspective, including demographic corrections using the Advanced Clinical Solutions. Although the administration time has been reduced from previous versions, a shortened version may be desirable in certain situations given practical time limitations in clinical practice. The current study evaluated two- and three-subtest estimations of demographically corrected Immediate and Delayed Memory index scores using both simple arithmetic prorating and regression models. All estimated values were significantly associated with observed index scores. Use of Lin's Concordance Correlation Coefficient as a measure of agreement showed a high degree of precision and virtually zero bias in the models, although the regression models showed a stronger association than prorated models. Regression-based models proved to be more accurate than prorated estimates with less dispersion around observed values, particularly when using three subtest regression models. Overall, the present research shows strong support for estimating demographically corrected index scores on the WMS-IV in clinical practice with an adequate performance using arithmetically prorated models and a stronger performance using regression models to predict index scores.