Neuropsychological Assessment Measures Research Articles

Executive function and cortical thickness in biomarker aMCI

Introduction Memory deficits are the primary symptom in amnestic Mild Cognitive Impairment (aMCI); however, executive function (EF) deficits are common. The current study examined EF in aMCI based upon amyloid status (A+/A−) and regional atrophy in signature areas of Alzheimer’s disease (AD). Method Participants included 110 individuals with aMCI (A+ = 66; A− = 44) and 33 cognitively healthy participants (HP). EF was assessed using four neuropsychological assessment measures. The cortical thickness of the AD signature areas was calculated using structural MRI data. Results A + had greater EF deficits and cortical atrophy relative to A − in the supramarginal gyrus and superior parietal lobule. A − had greater EF deficits relative to HP, but no difference in signature area cortical thickness. Discussion The current study found that the degree of EF deficits in aMCI are a function of amyloid status and cortical thinning in the parietal cortex.

9 Four-Year Practice Effects on the RBANS in a Longitudinal Study of Older Adults

Objective:The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is one of the most widely used measures in neuropsychological assessment. Studies of practice effects on the RBANS have largely been limited to studies assessing one or two repeated assessments. The aim of the current study is to examine practice effects across four years after baseline in a longitudinal study of cognitively healthy older adults. Practice effects were estimated using a pseudo-replacement participants approach which has been previously applied in other aging studies.Participants and Methods:453 Participants from the Louisiana Aging Brain Study (LABrainS) completed the RBANS Form A on up to four annual assessments after a baseline evaluation. Practice effects were calculated using a modified participants-replacement method where scores of individuals who were administered RBANS Form A multiple times are compared to the baseline scores of matched participants with additional adjustment for attrition effects.Results:Practice effects were observed primarily in the immediate memory, delayed memory, and total score indices. For example, an increase of nearly half a standard deviation was observed for delayed memory.Conclusions:These findings extend past work on the RBANS and other neuropsychological batteries more broadly in showing the susceptibility of memory measures to practice effects. Given that memory and total score indices of the RBANS have the most robust relationships with diagnostic status and biomarkers for pathological cognitive decline, these findings raise concerns about the ability to recruit those at risk for decline from longitudinal studies using the same form of the RBANS for multiple years.

What are the most important prognosticators of Alzheimer's disease progression? – Answers from machine learning

AbstractBackgroundNumerous variables that influence the risk of decline in Alzheimer’s disease (AD) have been identified. Previous studies have only examined a relatively small number of these variables. To our knowledge, no study has compared all variables in a large dataset to determine which are the most important.We hypothesised that the most important variables are neuropsychological assessment (NPA) scores and neuroimaging findings; moreover, the prognostic value of all variables will vary with disease stage: normal control (NC), mild cognitive impairment (MCI) or dementia. Secondly, we hypothesised that non‐NPA variables, such as imaging, cerebrospinal fluid (CSF) and genetics, will add prognostic value to that provided by NPA variables alone.MethodWe analysed all relevant variables in the Alzheimer’s Disease Neuroimaging Initiative database – the largest open‐access dataset of subjects with or at risk of AD. With machine learning, we identified those variables which are the strongest predictors of the annual rate of change in up to the first 10 years of Alzheimer’s Disease Assessment Scale – Cognitive Subscale, 13‐item version (ADAS‐Cog13) and Clinical Dementia Rating, Sum of Boxes (CDR‐SB) scores. We repeated this analysis for each disease stage subgroup. Secondly, we compared models that only used NPA‐related variables (NPA‐only) with those that used up to 2 non‐NPA modalities (NPA‐plus) and contrasted the findings between the same subgroups.ResultAcross all subjects, the strongest predictors of the rate of change of both ADAS‐Cog13 and CDR‐SB scores are CSF total tau and amyloid levels, fluorodeoxyglucose (FDG) positron emission tomography (PET) findings, and certain NPA measures. At the NC and MCI stages, CSF and imaging variables are strong predictors, but only NPA variables remained useful at the dementia stage. Secondly, NPA‐plus models consistently outperformed NPA‐only models. The non‐NPA modalities which added the most predictive power varied based on a subject’s disease stage in a manner similar to the previous findings.ConclusionWe identified a multi‐modal set of variables that have the strongest impact on predicting decline during different stages of AD. Our findings are clinically relevant as they recommend the investigations that are of most prognostic yield for clinicians to undertake at each stage of AD progression.

A-182 Depression Symptoms Predict Neurocognitive Functioning Following Pediatric Traumatic Brain Injury in the Acute Recovery Phase

Abstract Objective: Pediatric Intensive Care Unit (PICU) survivors are at elevated risk for developing neurocognitive concerns. Lower premorbid abilities, pediatric traumatic brain injury (pTBI) severity, and post-injury depression symptoms have been shown to predict greater neurocognitive deficits. However, limited extant research has focused on the acute recovery phase or used objective neuropsychological assessment measures. We examined the impact of pTBI severity and post-injury depression symptoms on neurocognitive functioning in the acute recovery phase. Method: Seventy-four trauma patients (8 to 19 years) were assessed 1-3 months after PICU discharge. Demographic and clinical data were extracted from the electronic medical record. Caregivers completed questionnaires about their children’s physical, cognitive and emotional functioning. The direct assessment included measures of WRAT5 word-reading; CMS/WISC-V/WAIS-IV digit span; WISC-V/WAIS-IV coding and symbol search; and DKEFS Trails-4, verbal phonemic and semantic fluencies. Given the high intercorrelations between aspects of executive function, principal components analysis (PCA) was conducted to create a cumulative neurocognitive index (NCI). A simple linear regression was used to test if moderate-severe Glasgow Coma scores and clinically elevated Promis Depression scores predicted NCI, controlling for reading ability. Results: Combining all participant data in the PCA yielded a single component solution accounting for 52.79% of total explained variance. The overall regression was significant (R2=.40), F(df=3,70) =15.23, p<.001. Elevated depression predicted NCI (p=.03) whereas greater pTBI severity was not predictive above the impact of premorbid factors. Conclusions: Neurocognitive functioning in PICU survivors within the acute recovery phase may be more related to concurrent depression symptoms than injury severity markers when premorbid factors are considered.

Incipient chronic traumatic encephalopathy in active American football players: neuropsychological assessment and brain perfusion measures

Background and aimsChronic traumatic encephalopathy (CTE) is a degenerative disease caused by repetitive traumatic brain injury (TBI). Because CTE can be definitely diagnosed only post-mortem, it would be important to explore clinical and radiological correlates of CTE and TBI. The aims of this study were to assess (1) the relationship between the neuropsychological profile of active American football players and the traumatic load; (2) whether traumatic brain injury associated with American football activity has a specific cerebral perfusion pattern; and (3) whether this perfusion pattern correlates with neuropsychological performances.MethodsIn 20 American football players [median age [25th–75th percentile] 25.0 [21.6–31.2] years, all males], we evaluated history, traumatic load and symptoms using the TraQ (Trauma Questionnaire), and cognitive performances on neuropsychological tests. Brain perfusion was estimated using arterial spin labeling MRI and compared to a group of 19 male age-matched (28.0 [24.8–32.3] years) healthy subjects.ResultsWe found different cognitive performances between American football players stratified according to field position and career length. Linemen had poorer executive, verbal, and visual performances; a career > 7 years was associated with poorer verbal fluency performances. American football players had statistically significant reduced cerebral blood flow values in sensory-motor areas in comparison with healthy controls. Poorer neuropsychological performances correlated with lower perfusion in specific brain areas.ConclusionsOur study seems to confirm that CTE in American football players is influenced by the field position and the career length, and correlates with lower cognitive performances linked to lower perfusion in specific brain areas.

Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: afeasibility study.

BackgroundCognitive Remediation Therapy (CRT) is an adjunct treatment targeting set-shifting (SS) and weak central coherence (CC) thought to play a role in maintaining anorexia nervosa (AN). This study aimed to test the feasibility of brief group CRT for young people with AN in a day-patient setting using neuropsychological assessment of SS and CC. It also explored the benefit for young people with Autism Spectrum Disorder (ASD) features.MethodsTwenty female day-patients (12–18 years) with AN or Atypical AN completed neuropsychological assessment of SS (using the Wisconsin Card Sorting Task and the Brixton Spatial Anticipation Test) and of CC (using the Rey Osterrieth Complex Figures Task) pre and post 4 sessions of group CRT. Baseline ASD features and weight change pre and post were measured. Feasibility was assessed regarding the recruitment process, intervention feedback, suitability of neuropsychological assessment measures, and effect sizes.ResultsStudy uptake was 95%, intervention retention was 91%, and group CRT was rated as acceptable. Medium to large effect size improvements were found across measures of SS (dz = 0.44 to dz = 0.90) and medium size improvements found in CC (dz = 0.59). Young people with ASD features showed smaller to similar size improvements in SS and larger improvements in CC. There was a moderate (not significant) correlation with level of weight restoration.ConclusionsImportant study parameters have been estimated in order to plan a future definitive trial of brief group CRT in a day-patient setting using neuropsychological assessment. These findings also have implications for the use of brief group CRT in young people with ASD features.

Common neuropsychological assessment measures as performance indicators in neuropsychological rehabilitation: An exploratory correlational study

This study aims to identify neuropsychological assessment measures that can better guide the selection and difficulty level adjustment of neuropsychological rehabilitation tasks for patients with acquired brain injury. Eight patients with acquired brain injury were recruited from one rehabilitation institution. The neuropsychological protocol included standard neuropsychological tests targeting attention, memory, and executive functions. After the assessment, the patients enrolled in an intensive online cognitive neuropsychological rehabilitation training program (80 sessions of 49 cognitive training and 31 affective and psychosocial intervention sessions). The association between the assessment results and the training outcomes was measured to explore which measures were better associated with specific training outcomes. This study suggests that the results of specific conventionally administered neuropsychological tests can be good indicators of the patients’ performance in the cognitive training of attention and working memory. On the other hand, none of the tests provided valuable data regarding the patients’ ability to perform the executive functioning training tasks, perhaps because those appeal to everyday situations, which are not adequately represented in the administered tests. More research is needed, especially regarding the executive function.

Brain structure in subjective cognitive decline: A replication study

AbstractBackgroundAlzheimer’s disease (AD) is an incurable neurodegenerative disorder, which disproportionately affects women (Erol et al., 2015). Given that the current treatments for AD aim to prevent symptom progression, the primary objective of emerging research is to identify pre‐clinical biological markers. Investigating such biomarkers would be appropriate in those experiencing subjective cognitive decline (SCD). Individuals with SCD are thought to be the earliest along the cognitive continuum between healthy aging and AD, as their reported change in cognition is not yet measurable using standard neuropsychological assessment measures. Previous research has found differences to exist in brain function, but not structure between healthy controls and those with SCD (Parker et al., 2020). The current study represents a preliminary analysis of structural brain images in healthy women compared to women with SCD; no structural differences between groups were hypothesized.MethodThe 3T T1 anatomical magnetic resonance images (MRI) used in this analysis was a subset of participants obtained from the Women’s Healthy Ageing Project collected in 2012 (N = 170). This subset included 30 healthy women (mean age = 71.4; SD = 3.12) and 30 women with SCD (mean age = 70.5; SD = 2.23). Voxel‐based morphometry (VBM) analyses were conducted using FMRIB’s Software Library to examine cross sectional differences between healthy women and women with SCD.ResultWhole brain VBM analyses did not reveal any significant differences in grey matter tissue density between healthy women and women with SCD at p < 0.05 level with threshold free cluster enhancement (corrected for multiple comparisons).ConclusionAlthough the current findings did not reveal differences in grey matter between healthy women and women with SCD, this result replicates our previous findings and other reports in the literature that structural differences may not be detectable between healthy individuals and those with SCD. Follow‐up work will include investigation of differences in functional connectivity between these two groups using resting‐state functional MRI with the total sample collected in 2012 (N = 170). Identifying changes in brain function prior to structural atrophy and measurable decline on neuropsychological measures would represent a major advance in AD biomarker research.

A-197 Trail Making Test Normative Data from the National Alzheimer’s Coordinating Center: A Comparison of Regression and Non-Regression Methods

Abstract Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research Centers, yet little research exists comparing these norms to similar regression/non-regression-based norms. Normative data for the widely-used Trail Making Test (TMTA&B) was compared between two regression-based normative data methods (Mitrushina and NACC) and traditional normative methods (i.e., Mayo’s Older Americans Normative Studies [MOANS]). Method TMTA&B data were obtained from 14,873 cognitively normal NACC participants (ages: 50–89; education: M = 15.81, SD = 2.90). T-scores for TMTA&B scores based on Mitrushina, NACC, and MOANS norms were computed. T-scores for regression norms were bounded from 20 to 80. Cohen’s d effect sizes were used to compare differences in scores. Results MOANS and Mitrushina norms produced similar normative scores in the overall sample (TMTA T-score difference = 1.06, d = 0.112, TMTB T-score difference = 1.4, d = 0.144). NACC-derived scores were ~ 0.5 SD below MOANS (TMTA T-score difference = −5.3, d = 0.553, TMTB T-score difference = −4.1, d = 0.427) and Mitrushina scores (TMTA T-score difference = −6.3, d = 0.736, TMTB T-score difference = −5.6, d = 0.615). NACC data produced the lowest average TMTA&B T-scores across all 5-year age band groups. Conclusions Significantly lower TMT scores were obtained using NACC’s regression-based norms compared to both MOANS norms and Mitrushina regression norms. These results underscore that the choice of norms may under and/or overestimate cognitive functioning, and comparison norms must be chosen carefully when making decisions about patients’ cognitive status. Future research applying NACC’s regression-based norms to other commonly used neuropsychological measures is warranted.

76644 Cognitive and Behavioral Outcomes in Adolescents with Sickle Cell Disease Before and After a Telehealth Cognitive Remediation Program to Prepare for Transition of Care

ABSTRACT IMPACT: This study is providing a telehealth intervention for the first time in patients with sickle cell disease with the goal of improving cognitive functioning and preparing adolescents for successful transition of care to adult healthcare providers. OBJECTIVES/GOALS: There is a high prevalence of cognitive impairment in adolescents with sickle cell disease (SCD). The purpose of this study is to test the efficacy of an individualized cognitive remediation program designed to promote not just cognitive function, but also adaptive and self-management skills necessary for successful transition to independence. METHODS/STUDY POPULATION: 12 participants with SCD (5 males, ages 10-16) participated in an individualized program, Cognitive-Remediation of Executive and Adaptive Deficits in Youth [C-READY], consisting of three main components: individual goal-based therapy, parent training sessions, and home skill practice. C-READY sessions occur one-on-one with a trained therapist for 8 sessions conducted over 4 weeks. Weekly parent training sessions are also conducted as part of the C-READY program. All of these sessions occurred via telehealth video-calling between the therapist and the adolescent/parent. Participants were evaluated before and after the C-READY program using neuropsychological assessment measures and transition readiness questionnaires. Parents also completed ratings on telehealth delivery, content, and timing. RESULTS/ANTICIPATED RESULTS: Repeated measures ANOVA indicated significant improvement in transition readiness behaviors as rated by parents, including improved independence in medication management (p = 0.029) and in talking with their healthcare providers (p = 0.019). Significant improvement was also demonstrated on a neuropsychological measure related to executive function skills, specifically inhibition and switching (p = 0.012). Results from telehealth surveys (rated on a 5-point Likert scale) indicated overall satisfaction with services (4.2/5), including visual (4/5) and voice quality (4.3/5) of telehealth equipment. Ratings also indicated feeling that their privacy was respected (4/5) and that their interactions with their therapist were appropriate and sensitive (4.5/5). DISCUSSION/SIGNIFICANCE OF FINDINGS: These results provide support for interventions that focus on cognitive skills to improve behaviors necessary for successful transition of care in youth with SCD. Results are also promising for delivery via telehealth in order to address barriers related to access to care. Future results will continue to be reported, as this study is currently ongoing.

C-08 Hippocampal Volume in a Cognitively Healthy Population Scoring Within Normal Limits on Cognitive Tasks

Abstract Objective Our aim was to investigate hippocampal volume in a cognitively healthy aging population that scored within normal limits on neuropsychological testing. Decreased hippocampal volume was expected to predict decreased memory performance, and not expected to predict executive function. Method A cross-sectional design was conducted from archival data at Huntington Medical Research Institutes. The sample consisted of 35 older adults (63-89 years) with college degrees or higher. Hippocampal volume and intracranial volume were obtained via MRI, and neuropsychological assessment measures included Wechsler Memory Scale, 3rd edition (WMS-III), California Verbal Learning Test, 2nd edition (CVLT-II), and the Stroop Color and Word Test. Results Total hippocampal volume was a good predictor of Logical Memory delayed (LM-II) scores (Figure 1), such that a larger hippocampus was associated with poorer LM-II performance (p < .01). Consistent with the above, both left hemisphere (LH) (p = .03), and right hemisphere (RH) hippocampal volume (p < .01), were found to be good predictors of LM-II scores, and a larger RH or LH hippocampus was associated with poorer performance. Neither CVLT-II nor Stroop C Interference sores were significantly related to total hippocampal volume. Conclusion(s) Unexpectedly, participants with a larger hippocampus performed more poorly on the LM-II task. These results might be explained by the effects of neuroinflammation in early Alzheimer’s disease pathology. However, given that the MRI volumes did not account for atrophy or damaged cortical tissue, inference is limited. Future research investigating the early pathology of brain aging in the hippocampus in cognitively healthy individuals is recommended.

The relationship between adiposity and cognitive function in a large community-dwelling population: data from the Trinity Ulster Department of Agriculture (TUDA) ageing cohort study

Previous reports investigating adiposity and cognitive function in the population allude to a negative association, although the relationship in older adults is unclear. The aim of this study was to investigate the association of adiposity (BMI and waist:hip ratio (WHR)) with cognitive function in community-dwelling older adults (≥60 years). Participants included 5186 adults from the Trinity Ulster Department of Agriculture ageing cohort study. Neuropsychological assessment measures included the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multi-variable linear regression models were used to assess the association between adiposity and cognitive function adjusting for insulin resistance, inflammation and cerebrovascular disease. The mean ages were 80·3 (sd 6·7), 71·0 (sd 7·3) and 70·2 (sd 6·3) years on the cognitive, bone and hypertensive cohorts, respectively. In the cognitive cohort, BMI was positively associated with immediate and delay memory, visuospatial/constructional ability, language and MMSE, and negatively with FAB (log-transformed), whereas WHR was negatively associated with attention. In the bone cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with visuospatial/constructional ability, attention and MMSE. In the hypertensive cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with immediate and delayed memory, visuospatial/constructional ability, language and MMSE and positively with FAB (log-transformed). In the cognitive and bone cohorts, the association of WHR and attention disappeared by further controlling for C-reactive protein and HbA1C. In this study of older adults, central adiposity was a stronger predictor of poor cognitive performance than BMI. Older adults could benefit from targeted public health strategies aimed at reducing obesity and obeseogenic risk factors to avoid/prevent/slow cognitive dysfunction.

Self-reported inhibition predicts history of suicide attempts in bipolar disorder and major depression

BackgroundStudies have reliably identified an association between suicide attempts and executive functions such as decision making (DM) and inhibitory control (IC) in patients with mood disorders. As such, the present study aimed to investigate the association between inhibition, DM, impulsivity and the history of suicide attempts in individuals with bipolar (BD) or major depressive disorder (MDD), identifying which assessment instruments may be most strongly associated with suicide in clinical samples. MethodsThe sample included 80 control subjects and two groups of patients with BD and MDD, matched by age and education (26 with a history of suicide attempts [MD+], and 26 with no such history [MD−]). Participants completed behavioral and self-report measures of DM and IC, which were compared between groups using ANCOVA, followed by logistic regression for patients with mood disorders only, and the presence or absence of a history of suicide as the outcome. ResultsCognitive performance did not differ between groups. The MD+ group showed significantly higher motor and attentional impulsivity on the BIS-11 than the MD− and control groups. A regression analysis containing these scores showed that motor impulsivity was the only significant predictor of a history of suicide (OR = 1.14; 95%CI 1.00–1.30). ConclusionsSelf-reported motor impulsivity was a significant predictor of suicide. These findings underscore the importance of self-report measures in neuropsychological assessment, and their contributions to the management and prognosis of patients with mood disorders. Lastly, they point to the role of impulsivity as a target for interventions and public policy on suicide prevention.

Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study

Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test – Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area.

Association Between Traumatic Brain Injury-Related Brain Lesions and Long-term Caregiver Burden.

To investigate the association between traumatic brain injury (TBI)-related brain lesions and long-term caregiver burden in relation to dysexecutive syndrome. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. A total of 256 participants: 105 combat veterans with TBI, 23 healthy control combat veterans (HCv), and 128 caregivers. Caregiver burden assessed by the Zarit Burden Interview at 40 years postinjury. Participants with penetrating TBI were compared with HCv on perceived caregiver burden and neuropsychological assessment measures. Data of computed tomographic scans (overlay lesion maps of participants with a penetrating TBI whose caregivers have a significantly high burden) and behavioral statistical analyses were combined to identify brain lesions associated with caregiver burden. Burden was greater in caregivers of veterans with TBI than in caregivers of HCv. Caregivers of participants with lesions affecting cognitive and behavioral indicators of dysexecutive syndrome (ie, left dorsolateral prefrontal cortex and dorsal anterior cingulate cortex) showed greater long-term burden than caregivers of participants with lesions elsewhere in the brain. The TBI-related brain lesions have a lasting effect on long-term caregiver burden due to cognitive and behavioral factors associated with dysexecutive syndrome.

The Use of Virtual Reality in the Military's Assessment of Service Members With Traumatic Brain Injury: Recent Developments and Emerging Opportunities

Traumatic brain injury (TBI) is a common event in the current extended conflicts by American service members, with estimates that as many as 300,000 have sustained combat-related concussions during Operation Iraqi Freedom and Operation Enduring Freedom. The limited ecological validity of traditional neuropsychological assessment measures presents a challenge to effective postconcussion evaluation of service members in relation to fitness-for-duty decisions or rehabilitation needs. Virtual reality (VR) technology offers a promising opportunity to advance the field of functional assessment for TBI. This article reviews the current professional literature on VR applications for TBI assessment, with special emphasis on those that are particularly relevant to U.S. service members. VR affords several advantages for clinical use. These include assessment of complex sets of cognitive and behavioral functions rather than the isolated components assessed by traditional measures; more precise control over the standardized presentation of task stimuli and the recording of response data; and enhanced ecological validity that can lead to more useful assessment data in the applied contexts faced by the U.S. military.

Doors and People: An exploration of validity in older people

The Doors and People battery was designed to be a sensitive memory assessment battery across a spectrum of memory functioning, including dementia. The validity of the battery was explored in routine clinical practice with older adults with subjective memory complaints. Participants’ standard scores were compared with standard scores on other memory tests. Standard scores on Doors and People recall tests were lower than the same people’s standard scores on comparison recall memory tests. Recognition test scores did not show this effect. Although the results raise doubts about the validity of the Doors and People for assessing memory recall with older adults, the reliability of the results is questionable given the limitations in the methods used. However, it is hoped that this paper will serve to promote discussion and further investigation of neuropsychological assessment measures within services.

Theory of mind function, motor empathy, emotional empathy and schizophrenia: A single case study

It has been proposed that theory of mind dysfunction contributes to the development of paranoid schizophrenia. The inability to represent others' thoughts and feelings has implications for the type of behaviour expressed by people with delusional beliefs. Evidence has shown that a diagnosis of paranoid schizophrenia is associated with an increased risk of violence. This case study explores the role of theory of mind and emotional processing in the violent index offence of a 33-year-old man (SB) with a diagnosis of paranoid schizophrenia. Neuropsychological and theory of mind assessment measures were administered during SB's admission to medium secure services. SB was found to be within the average range on standardised neuropsychological assessment measures but was found to be significantly impaired on measures examining theory of mind and various aspects of emotional functioning. The implications of SB's emotional deficits within the context of his index offence are discussed.

Performance-based measures of functional skills: usefulness in clinical treatment studies.

Recently, attention to the assessment and treatment of functional disability has increased notably. It is widely understood that impairments in everyday living skills, including independent living skills, social functions, vocational functioning, and self-care, are present in people with schizophrenia. It has also become clear recently that assessment of these skills can pose substantial challenges. These challenges include selection of meaningful short-term outcome measures and avoiding bias and reduced validity in the data. Self-report, direct observation, and informant reports of everyday disability all have certain advantages but appear to be inferior to direct assessment of skills with performance-based measures. This review outlines the issues associated with the assessment of functional skills and everyday functioning and provides a description of the strengths and weaknesses of these approaches. We conclude that direct assessment of functional capacity has substantial advantages over other measures and may actually provide a more direct and valid estimate of functional disability than performance on the more distal neuropsychological assessment measures.

Understanding reported cognitive dysfunction in older adults with cardiovascular disease.

Older adults with cardiovascular disease (CVD) often report experiencing significant cognitive dysfunction in everyday life and exhibit deficits on neuropsychological testing. However, the relationship between subjective and objective cognitive dysfunction is inconsistent across studies and requires closer examination. Participants included 84 older adults with documented CVD and no history of neurological or severe psychiatric disorder. All participants underwent echocardiogram and neuropsychological assessment and completed self-report measures of perceived cognitive dysfunction, depression, and health-related quality of life. Results showed that concerns regarding distractibility and sustained attention were most common. Level of reported cognitive dysfunction was significantly related to depressive symptoms, quality of life, and performance on multiple cognitive tests. Exploratory regression analyses showed that depressive symptoms, physical health-related quality of life, and speeded sustained attention predicted reports of cognitive dysfunction, whereas demographic variables, cardiac output, and other cognitive tests did not. Should they be replicated, these findings suggest that reports of cognitive dysfunction in older adults with CVD largely reflect depressive symptoms and reduced quality of life.