Minimal Practice Effects Research Articles

The Fuld Object-Memory Evaluation: Development and Validation of an Alternate Form

The Fuld Object-Memory Evaluation (FOME) uses multisensory (tactile, visual, and verbal) encoding of objects for assessing memory, with particular clinical and research application in older adults. This preliminary study reports the first known psychometric data on the development of an alternate form of the FOME. Data were drawn from 102 independent-living older adults participating in a larger clinical trial. Seventy participants completed three versions of the shortened administration of the FOME, and comparability of forms was established by significant, moderate intraclass correlation coefficients for immediate and delayed recall scores. Reliable change indexes indicate the new alternate form performs well, with minimal practice or learning effects. Evidence of convergent and discriminant validity was documented using the Rey Auditory Verbal Learning Test, category fluency task, and North American Adult Reading Test. Normative data are provided stratified by age for participants completing at least one of three time points (n = 96). Results of this preliminary study provide evidence for the comparability and construct validity of a new alternate form of the FOME with prior forms. An additional well-validated form of the FOME has practical implications for serial testing often required in clinical practice and research design.

Reliability and validity of the Virtual Reality Lateralized Attention Test in assessing hemispatial neglect in right-hemisphere stroke.

Many tests of hemispatial neglect are insensitive to subtle (but clinically relevant) forms of the disorder. This study provides additional reliability and validity data on the Virtual Reality Lateralized Attention Test (VRLAT), an easy-to-administer computerized measure of hemispatial neglect that mimics the attentional demands of real-world tasks, and has previously shown strong validity and sensitivity (Dawson, Buxbaum, & Rizzo, 2008). The present study assessed a large sample of patients with the aim of developing a clinically useful version of the test, and established the concurrent criterion validity of the VRLAT as measured by its association with performance in a real-world task. Seventy consecutively recruited right-hemisphere stroke patients were assessed with the VRLAT, which requires participants to name objects as they navigate (or are navigated) along a winding virtual path. They also performed a real-world navigation task, tests of sensory and motor function, and paper-and-pencil neglect tests. The VRLAT demonstrated strong sensitivity and specificity, minimal practice effects, and strong validity, and outperformed traditional paper-and-pencil tests in the prediction of real-world collisions. The VRLAT is a sensitive, valid, and reliable measure of hemispatial neglect that requires no specialized equipment, is easy to administer, and is useful for both clinical and research purposes. Moreover, a shortened version with a 5-min administration time has many of the desirable psychometric properties of the original full-length task.

Practice Effects Predict Cognitive Outcome in Amnestic Mild Cognitive Impairment

Practice effects on cognitive tests have been shown to further characterize patients with amnestic mild cognitive impairment (aMCI) and may provide predictive information about cognitive change across time. We tested the hypothesis that a loss of practice effects would portend a worse prognosis in aMCI. Longitudinal, observational design following participants across 1 year. Community-based cohort. Three groups of older adults: 1) cognitively intact (n = 57), 2) aMCI with large practice effects across 1 week (MCI + PE, n = 25), and 3) aMCI with minimal practice effects across 1 week (MCI - PE, n = 26). Neuropsychological tests. After controlling for age and baseline cognitive differences, the MCI - PE group performed significantly worse than the other groups after 1 year on measures of immediate memory, delayed memory, language, and overall cognition. Although these results need to be replicated in larger samples, the loss of short-term practice effects portends a worse prognosis in patients with aMCI.

Reliability of Repeated Cognitive Assessment of Dementia Using a Brief Computerized Battery

The aim of this study was to evaluate the short-term stability and reliability of a brief computerized cognitive battery in established dementia types. Patients were administered the computerized battery twice with administrations approximately 2 hours apart, with intervening conventional neuropsychological tests. Patients were classified clinically, via consensus conference, as healthy controls (n = 23), mild cognitive impairment (n = 20), Alzheimer's disease (n = 52), dementia with Lewy Bodies ([DLB], n = 10), or frontotemporal dementia (n = 9). Minimal practice effects were evident across Cog-State test administrations. Small magnitude improvements were seen across all groups on a working memory task, and healthy controls showed a mild practice effect on the accuracy of associative learning. In established dementia, administration of the CogState tasks appears sensitive to cognitive impairment in dementia. Repeat administration also provided acceptable stability and test-retest reliability with minimal practice effects at short test-retest intervals despite intervening cognitive challenges.

Reliability, minimal detectable changes, practice effects and correlates of the 6-min walk test in patients with schizophrenia

We examined the reproducibility of the 6-min walk test (6MWT) in patients with schizophrenia. Secondary aims were to assess minimal detectable changes and practice effects of the 6MWT and the presence of clinical conditions that might interfere. From 71 patients with schizophrenia two trials of the 6MWT, administered within 3 days, were analysed. The intraclass correlation coefficient between the two tests was 0.96. The minimal detectable change was 56.2 m for men and 50.2 m for women. Body mass index, daily antipsychotic dose, negative and depressive symptoms, resting heart rate, age, smoking behavior and different musculoskeletal complaints were all significantly associated with the distance walked. The 6MWT can be recommended for evaluating the functional exercise capacity in patients with schizophrenia. Some practice effect could however not be excluded.

Characteristics of the MATRICS Consensus Cognitive Battery in a 29-site antipsychotic schizophrenia clinical trial

Objective The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Project produced a battery of tests, the MATRICS Consensus Cognitive Battery (MCCB), designed to assess cognitive treatment effects in clinical trials of patients with schizophrenia. In validation studies, the MCCB demonstrated excellent reliability, minimal practice effects and significant correlations with measures of functional capacity. This study addresses whether the MCCB demonstrates these favorable characteristics when administered in the context of the type of large multi-site industry trial for which it was designed. Methods In a clinical trial comparing risperidone and lurasidone, 323 clinically-stable outpatients with schizophrenia at 29 sites were assessed with MCCB at screening and a median of 15 days later at baseline. A measure of functional capacity, the UCSD Performance-based Skills Assessment – Brief (UPSA-B) was administered at baseline. Results All 323 (100%) patients had sufficient data for computing a composite score according to the MCCB criteria. The test–retest reliability of the MCCB composite score was excellent (ICC = 0.88). The severity of cognitive impairment was T = 24.7 (SD = 12.1) at screening and T = 26.7 (SD = 12.4) at baseline. The MCCB composite score demonstrated a large correlation with the UPSA-B composite score ( r = .60, df = 304, p < .001). The practice effect on the composite score was small ( z = 0.18). Discussion In the context of a 29-site antipsychotic trial in stable outpatients with schizophrenia, the MCCB is sensitive to cognitive deficits in all domains, demonstrates excellent test–retest reliability and small practice effects, and is strongly correlated with a leading measure of functional capacity.

Repeated assessment of neuropsychological deficits in multiple sclerosis using the Symbol Digit Modalities Test and the MS Neuropsychological Screening Questionnaire

Background Brief cognitive performance tests and self-report measures of neuropsychological symptoms have been proposed for screening purposes in multiple sclerosis (MS) clinics. To better understand the reliability of screening methods, two tests, the Symbol Digit Modalities Test (SDMT) and the MS Neuropsychological Screening Questionnaire (MSNQ), were administered to 76 patients with MS and 25 healthy controls, matched on demographic characteristics. Methods Tests were administered at monthly intervals, over 6 months. In addition, the Beck Depression Inventory Fast Screen for medical patients (BDIFS) was administered to monitor for changes in depression. Our objectives were to determine the reliability of these measures and the relative contribution of cognitive impairment and depression in predicting self-report MSNQ scores. Results Results showed that both the SDMT and MSNQ have good to excellent reproducibility over repeated testing. In MS, there are minimal practice effects over successive tests, in the order of 0.2 SD for SDMT and minimal change in the MSNQ. Regression analyses modeled to predict MSNQ based on SDMT and BDIFS showed significant contribution for both, but with the majority of variance being accounted for depression. Conclusions We conclude that these brief screening tests provide some independent information about the mental status of patients with MS and are reliable, even when used in monthly, successive examinations.

The Effects of Practice on Speed of Information Processing Using the Adjusting-Paced Serial Addition Test (Adjusting-PSAT) and the Computerized Tests of Information Processing (CTIP)

Three experiments were conducted to determine the effects of practice on the Adjusting-Paced Serial Addition Task (Adjusting-PSAT) (Tombaugh, 1999) and the Computerized Tests of Information Processing (CTIP) (Tombaugh & Rees, 2000). The Adjusting-PSAT is a computerized modification of the Paced Auditory Serial Addition Test (PASAT) (Gronwall, 1977) that makes the interval between digits contingent on the correctness of the response. This titration procedure permits a threshold value to be derived that represents the shortest presentation interval in which a person can process the digits to produce the correct sum. The CTIP consists of three reaction time tests that are progressively more difficult. Results showed that robust practice effects occurred with the Adjusting-PSAT, with the greatest increase in performance occurring on the first retest trial. Practice effects were equally prominent regardless of whether the first retest trial occurred 20 min, 1 week, or 3 months after the first administration. These gains were maintained for periods up to 6 months and were independent of modality of presentation (visual or auditory) and type of number list (easy or hard). In contrast to the findings with the Adjusting-PSAT, only minimal practice effects were observed with the CTIP. The major clinical implication of the study is that the high reliability coefficients for the CTIP, the lack of anxiety associated with its administration, and its insensitivity to variables such as numerical and verbal ability make the CTIP ideally suited for the serial evaluation of cognitive status. These characteristics also make the CTIP a viable alternative to the Adjusting-PSAT or PASAT for measuring speed of information processing. If the Adjusting-PSAT is administered repeatedly in clinical evaluations, a “dual baseline” or “run in” procedure should be used, with the second administration serving as the baseline measurement.

Practice Effects Associated with the Repeated Assessment of Cognitive Function Using the CogState Battery at 10-minute, One Week and One Month Test-retest Intervals

There are many situations in which cognitive tests need to be administered on more than two occasions and at very brief test-retest intervals to detect change in group performance. However, previous literature has not specifically addressed these important issues. The main aim of the current study was to examine these two factors by using a computerized cognitive battery designed specifically for the repeated assessment of cognition (i.e., CogState) in healthy young adult individuals. A further aim of the study was to examine how many times the battery needed to be completed before performance, as measured by the battery, stabilized. Forty-five adults (age range: 18–40 years) completed the battery four times at 10-minute test-retest intervals, and a fifth time at an interval of one week. The results illustrated that when brief test-retest intervals were used (i.e., 10 minutes), performance stabilized after the second assessment, as significant practice effects were generally observed between the first and the second assessments. Practice effects were also observed on some of the tasks at a one-week test-retest interval. Due to these findings, 55 adults (age range: 18–40 years) completed the battery twice at 10-minute test-retest intervals (i.e., to eliminate the initial practice effect), and a third time at an interval of one month. No practice effects were observed. The implications of the results are discussed in terms of methods that can be adopted in order to minimize practice effects when this particular cognitive battery is used.

The Effect of Response Mode on Finger Localization Errors

Four different administrations of a finger localization test were given to each of 18 non-defective first-grade school children; the order of administration was varied over subjects in a manner designed to minimize practice effects. In all administrations the subject's hand was hidden from view, but a two-dimensional model of the hand was in view just above his hand. In two administrations (one with a model that bore numbers on the fingers and one with a model that had no numbers) the subject responded verbally by saying the number of the finger touched; in the other two administrations (again, one with numbered model and one with unnumbered model) the subject responded nonverbally by pointing to the corresponding finger on the model. It was found that subjects made significantly lower error scores when responding verbally than when pointing. Type of model, whether numbered or not, had no discernible process.