Neuropsychological Test Data Research Articles

National Adult Reading Test performance in established dementia

Demographic and neuropsychological test data from patients with dementia of Alzheimer or multi-infarct type were analysed in an examination of the validity of the National Adult Reading Test (NART) as an index of premorbid ability in established dementia. The discrepancy between premorbid IQ predicted firstly using the NART and secondly using demographic variables entered in a recognised regression equation was calculated. This discrepancy correlated strongly with measures of current level of functioning, even after exclusion of patients with apparent dysphasia or dyslexia. The results indicate that NART performance is clearly influenced by severity of dementia, and that use of the NART as a comparator in estimating the severity of established dementia will lead to systematic underestimation of severity as a function of that severity. Estimates of premorbid function based on demographic variables may be preferable in this context.

Visuoconstructional Drawing Ability in the Differential Diagnosis of Neurologic Compromise Versus Depression

Neuropsychologists are often called upon to assist in making differential diagnoses between neurologic compromise and depression. However, the literature has been inconsistent about the impact of depression on neurocognitive functioning. This makes interpretation of neuropsychological test data among depressed individuals difficult. In a retrospective cross-sectional study of 200 patients, the relationship between depression (Beck Depression Inventory or Geriatric Depression Scale) and visuoconstructional drawing ability/praxis (Rey-Osterrieth Copy [RO]) was evaluated. Age and education both correlated significantly with RO performance (p < .001 and .005, respectively). There were no significant relationships found between copy performance and depression, even when controlling for the significant effects of age and education. A prospective longitudinal study of 20 psychiatric inpatients with depression tested on admission and again at discharge matched with 20 nondepressed normal controls yielded similar results in that the two groups did not differ in their initial RO performance. Moreover, an improvement in depression as measured by a decrease in Beck Depression Inventory scores did not coincide with any improvement in RO scores. By comparison, a matched positive control group of 20 neurologically compromised patients was significantly worse than both the normal control and the depressed groups on the RO (p < .05). These data suggest that poor performance on the RO should not be interpreted simply as a consequence of depression. Age and education, though, should be considered when interpreting the RO.

Visuoconstructional Drawing Ability in the Differential Diagnosis of Neurologic Compromise Versus Depression

Neuropsychologists are often called upon to assist in making differential diagnoses between neurologic compromise and depression. However, the literature has been inconsistent about the impact of depression on neurocognitive functioning. This makes interpretation of neuropsychological test data among depressed individuals difficult. In a retrospective cross-sectional study of 200 patients, the relationship between depression (Beck Depression Inventory or Geriatric Depression Scale) and visuoconstructional drawing ability/praxis (Rey-Osterrieth Copy [RO]) was evaluated. Age and education both correlated significantly with RO performance ( p < .001 and .005, respectively). There were no significant relationships found between copy performance and depression, even when controlling for the significant effects of age and education. A prospective longitudinal study of 20 psychiatric inpatients with depression tested on admission and again at discharge matched with 20 nondepressed normal controls yielded similar results in that the two groups did not differ in their initial RO performance. Moreover, an improvement in depression as measured by a decrease in Beck Depression Inventory scores did not coincide with any improvement in RO scores. By comparison, a matched positive control group of 20 neurologically compromised patients was significantly worse than both the normal control and the depressed groups on the RO ( p < .05). These data suggest that poor performance on the RO should not be interpreted simply as a consequence of depression. Age and education, though, should be considered when interpreting the RO.

Statistical interpretive methods for difficult neuropsychological test data

Statistical interpretive methods for difficult neuropsychological test data

Neuropsychological outcomes in randomized controlled trials of antiepileptic drugs: a systematic review of methodology and reporting standards.

To systematically review the methodology and use of neuropsychological tests in randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) in patients with epilepsy. Trial reports were found by searching Medline 1966-1996 and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and neuropsychological test data was extracted by using a proforma. 43 reports met our inclusion criteria, representing 40 RCTs. as three RCTs had generated two reports. Twenty-two were actively controlled, and 18 were placebo-controlled studies. Reporting of basic methods such as randomization method was poor. There has been no uniform approach to the use of neuropsychological tests, and a total of 87 has been used. The Stroop Colour Word Test and the Finger Tapping Test were most commonly used, at 13 times each, but were not used or reported in a uniform manner. Poor reporting of methods and the use of a plethora of neuropsychological tests create great difficulties for anyone wishing to make sense of currently available data. If we are better to understand the neuropsychological effects of AEDs, a more rational approach is needed, for which recommendations are made.

Neuropsychological predictors of adaptive kitchen behavior in geriatric psychiatry inpatients.

This study examined the degree to which demographic variables, psychiatric diagnosis, depression rating, and neuropsychological test performance predict adaptive kitchen behavior in geriatric psychiatry patients and normal elderly volunteers. Amixed group of 27 participants including 8 normal volunteers and 19 geriatric psychiatry inpatients underwent psychiatric evaluation, neuropsychological testing, and a kitchen skills assessment conducted in a natural setting. Both depression and dementia were prevalent among patients. The kitchen skills assessment was abnormal in 69% of patients, compared to none of the normal volunteers. Estimated premorbid IQs, psychiatric diagnosis, and neuropsychological test scores significantly predicted the pass/fail status on the kitchen skills assessment, but there was no effect for age, education, gender, or depression. The discriminant function analysis classified 92% of cases, and the canonical correlation coefficient was .84. Of the neuropsychological tests employed in the study, two tests involving visuospatial processing and attention were retained in the discriminant function analysis. The results are consistent with previous studies that suggest that visuospatial tasks are more predictive of instrumental activities of daily living than are cognitive tasks emphasizing verbal and memory abilities. In addition, we conclude that neuropsychological test data are useful and valid for the purpose of guiding clinical judgments regarding activities of daily living in geriatric psychiatry patients.

Sleep-disordered breathing and neuropsychological deficits. A population-based study.

The relationship of sleep-disordered breathing (SOB) to neuropsychological deficits was investigated with cross-sectional data from the Wisconsin Sleep Cohort Study, a population-based study of the natural history of SDB. A sample of 841 employed men and women ages 30 to 60 yr was studied by overnight polysomnography to assess the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). Prior to overnight polysomnography, the participants were given a battery of neuropsychological tests for functionally important capacities including motor skills, attention, concentration, information processing, and memory. Principal factor analysis of all the neuro-psychological test data revealed a psychomotor efficiency and a memory factor. Multiple regression analysis showed a significant negative association between logarithmically transformed AHI (LogAHI) and psychomotor efficiency score independent of age, gender, and educational status (p = 0.017). The relationship was not explained by self-reported sleepiness. No significant relationship was seen between LogAHI and memory score. In assessing the clinical significance of mild SDB, we estimate that an AHI of 15 is equivalent to the decrement in psychomotor efficiency associated with 5 additional yr of age, or to 50% of the decrement associated with hypnosedative use.

Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome

Objectives: To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport.Design: Retrospective identification of convulsions associated with concussive brain injury from...

Psychologists' accuracy in identifying neuropsychological test protocols of clinical malingerers

Neuropsychology practitioners' accuracy in detecting malingering (based on neuropsychological test data alone) was investigated. Four test protocols had been produced by clinical malingerers who were identified by below-chance forced-choice test (FCT) results. For two of the cases observation/ surveillance data also indicated malingering. Two test protocols had been produced by severely head-injured individuals. Sixty psychologists reviewed a malingered test protocol and 26 reviewed data of a head-injured patient. Error rates (diagnosis of cerebral dysfunction without identifying malingering) ranged from zero to 25% and averaged 10% across the four malingered cases. Eight percent of the psychologists diagnosed malingering in the severely head-injured cases. Psychologists who received FCT data were significantly more confident in their diagnoses than were psychologists who did not receive FCT results, but they were not more accurate. The results suggest that neuropsychologists are capable of accurately detecting malingering, at least for obvious cases.

Psychologists' accuracy in identifying neuropsychological test protocols of clinical malingerers

Neuropsychology practitioners' accuracy in detecting malingering (based on neuropsychological test data alone) was investigated. Four test protocols had been produced by clinical malingerers who were identified by below-chance forced-choice test (FCT) results. For two of the cases observation/ surveillance data also indicated malingering. Two test protocols had been produced by severely head-injured individuals. Sixty psychologists reviewed a malingered test protocol and 26 reviewed data of a head-injured patient. Error rates (diagnosis of cerebral dysfunction without identifying malingering) ranged from zero to 25% and averaged 10% across the four malingered cases. Eight percent of the psychologists diagnosed malingering in the severely head-injured cases. Psychologists who received FCT data were significantly more confident in their diagnoses than were psychologists who did not receive FCT results, but they were not more accurate. The results suggest that neuropsychologists are capable of accurately detecting malingering, at least for obvious cases.

The effects of clozapine on symptom reduction, neurocognitive function, and clinical management in treatment-refractory state hospital schizophrenic inpatients

Thirty chronically hospitalized, refractory schizophrenic patients were evaluated while on typical neuroleptics and again after 12 weeks of clozapine treatment. Patients demonstrated small but statistically significant reductions in total Brief Psychiatric Rating Scale (BPRS) symptoms, need for seclusion and restraint, and PRN medications, and they frequently were transferred to a less restrictive treatment environment. Neuropsychological test data from a subset of patients suggested improvement on measures of verbal fluency and graphomotor speed, but deterioration on measures of visual memory and executive/frontal ability. Clozapine's different effects on multiple neurotransmitter systems may be responsible for its mixed effects on cognitive abilities. No significant relationships were found between symptom reduction, cognitive improvement, and transfer to a less restrictive environment.

Hazards of blind analysis of neuropsychological test data in assessing cognitive disability: the role of confounding factors

Neuropsychological testing has frequently been perceived by many health care and rehabilitation professionals as simply the administration and scoring of standardized neuropsychological tests followed by a comparison of the patient's scores to normative standards for the purposes of determining the patient's cognitive strengths and deficits, and whether or not the patient has sustained brain damage. Unfortunately, this simplistic model often results in inaccurate and misleading assessments of the patient's cognitive and behavioral functioning, erroneous diagnoses, and improper treatment. The issue of whether or not a patient has actually sustained a traumatic brain injury, or what specific cognitive and behavioral functions are impaired and to what degree, particularly in reference to a specific accident or event, cannot be determined solely by examining the patient's test data. Such data are frequently confounded by numerous factors which necessitate that the neuropsychologist proceed with caution and avoid arriving at any diagnostic impressions without a full appreciation of the impact of these factors, which may contribute significantly to the patient's neuropsychological test performance. This paper examines numerous potential confounds to test performance and discusses how the neuropsychologist can utilize a vector analysis approach to address the issue of the ecological validity of the neuropsychological test data.

Hazards of blind analysis of neuropsychological test data in assessing cognitive disability: the role of confounding factors

Hazards of blind analysis of neuropsychological test data in assessing cognitive disability: the role of confounding factors

The relationship of neuropsychological status and productive outcomes following traumatic brain injury.

Neuropsychological assessment is a standard component of traumatic brain injury rehabilitation programmes; however, the relationship between neuropsychological test scores and functional abilities is not clear. The current study compared serial neuropsychological test data with functional outcomes for 152 subjects. Outcome was operationally defined for three activity settings (home, school, work) with six levels of productivity for each. Productivity was defined as one's ability to function at increasing levels of independence. Demographic and caseload variables were analysed utilizing correlation and stepwise multiple regression analyses. Significant relationships to outcome were found between certain neuropsychological test scores, and certain demographic variables. Positive outcomes were related in part to patient's speed of information processing, memory skills, and simultaneous processing abilities. Also related to positive outcomes were mechanism of injury, level of insurance funding, premorbid educational level, and negative history of substance abuse. The activity setting influenced outcome such that it appeared to be most difficult to return to work, suggesting the necessity of adequate vocational assistance. However, cognitive and demographic variables accounted for less than 30% of the total variance in outcome. Therefore, brain injury rehabilitation must be multifaceted.

La lobectomie temporale: indications et rôle dans la chirurgie de l'épilepsie

When a focal epilepsy proves refractory to medical therapy, surgical treatment is increasingly used. Most interventions consist in cortical resections, and by far the most common operation is a temporal lobectomy. The presurgical evaluation is a multi-disciplinary one, and includes history and examination, neuropsychological testing, neuro-imaging techniques, functional studies (functional imaging and intracarotid amobarbital procedure), and neurophysiologic data (EEG-video monitoring). When non-invasive EEG does not succeed in localizing the epileptogenic zone with sufficient accuracy, several invasive techniques are available. Each has its own advantages and disadvantages. In appropriately selected cases, postoperative outcome is excellent, especially in temporal lobe epilepsy. In general, outcome is slightly less successful in extra-temporal cases.

Color- and picture-word Stroop tests: performance changes in old age.

The Stroop test comes in different variations, but all of them index performance on a basic task, like color or picture naming, when it is carried out by itself versus when it is performed in the presence of conflicting or incongruent stimuli. The present study examined the hypothesis that Stroop interference--the cost of performing one task in the presence of another--is a general as opposed to a test-specific index of cognitive flexibility. A second goal was to examine changes in Stroop test performance in old age. A group of 129 healthy older adults (> or = 65 years of age) were assessed on the color- and picture-word Stroop test, as well as on a battery of neuropsychological tests. Subjects' performance on each card of both Stroop tests, and various derived (differences and ratios) scores, were used to prepare age-group norms. The use of the norms is illustrated with findings from previous studies. Regression analyses showed age-changes in several aspects of Stroop test performance. Hierarchical multiple regression analyses, and causal modeling showed an age effect on Stroop interference only on the picture-word test but not on the color-word test. Exploratory factor analysis of the Stroop data and the neuropsychological test data revealed different factor loadings for the color- and picture-word test. The combined findings suggest that the color- and picture-word Stroop test measure different cognitive functions, at least in old age.

Patterns of Cognitive Impairment among Alcoholics: Are There Subtypes?

The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive processes has gained support from a number of studies in which detoxified alcoholics have a lower mean performance level than peer controls on a variety of neuropsychological tests. This approach might obscure consistent but different patterns of preserved and impaired cognitive performance among subgroups of alcoholics, suggestive of alternative hypotheses. To test this possibility, neuropsychological test data from two large, independent samples of alcoholics (sample 1, n = 143; sample 2, n = 130) and controls (sample 1, n = 97; sample 2, n = 83) were subjected to separate centroid hierarchical cluster analyses. For both samples, the majority of alcoholics (94% and 94%) exhibited a pattern of impaired verbal and nonverbal performance and deficits in memory and perceptual motor skill, with normal motor skill. The alcoholics who did not fit this pattern showed more severe or wide-ranging impairments. These findings indicate that empirical support for the mild generalized dysfunction hypothesis of alcoholics' cognitive deficits is not an artifact of averaging.

The contribution of neuropsychology to psychiatry.

Neuropsychological test data are applied with increasing frequency in research studies and clinical practice in psychiatry. This article addresses three popular assumptions about neuropsychological test data and describes the limitations and contributions of neuropsychological assessment of patients with psychiatric disorders. All research articles from major journals in psychiatry and clinical psychology since 1991 that focused on neuropsychological assessment of psychiatric patients were reviewed. Other journals and earlier studies were reviewed selectively. Neuropsychological test data have made significant contributions to the development of hypotheses about abnormal brain structure and function in patients with psychiatric disorders, yet many findings from neuropsychological assessments of psychiatric patients are misinterpreted. The extent to which neuropsychological test data in psychiatric populations can be interpreted to reflect abnormalities in brain structure and function is frequently exaggerated, as is the ability of neuropsychological measures to serve as specific cognitive probes in imaging studies of physiological activation. On the other hand, the utility of neuropsychological test batteries as measures of the patterns of cognitive strength and deficit in individuals with specific psychiatric disorders is frequently underestimated. In addition to testing models of regional brain dysfunction in psychiatric disorders, neuropsychological tests can provide researchers in psychiatry with an improved understanding of the relation between central cognitive impairments and symptoms and serve to identify cognitive predictors of course of illness, and they may provide a method for discriminating among heterogeneous forms of some psychiatric disorders. Clinically, neuropsychological test data can be used to develop treatment strategies tailored for an individual's specific cognitive strengths and deficits.

MRI hippocampal volume and neuropsychology in epilepsy surgery

A review is provided of recent findings on relationships between neurocognitive test data and magnetic resonance imaging (MRI)-determined hippocampal volumes in nonlesional temporal lobectomy patients. The difference between the right and left hippocampal volumes is correlated with postoperative verbal memory in left temporal lobectomy patients who do not have lesional pathology. MRI hippocampal volume data are not associated with measures of executive functioning or naming. Sex differences have been found for verbal memory outcome as women have better verbal memory following left temporal lobectomy. Sex differences have also been found in the relationships between verbal and visual memory, and hippocampal volume data. The systematic combination of MRI-acquired morphological data and neuropsychological test data may further our understanding of neurocognitive function, and provide clinically useful data for counseling epilepsy surgery patients. The current data are promising with regard to prediction of memory outcome following temporal lobectomy, but they do not yet allow for prediction of specific individual patient outcomes. Rather, the currently available data support counseling patients based on the memory outcome of others with similar characteristics.

Event-related brain potential evidence for a verbal working memory deficit in multiple sclerosis.

Memory deficits are frequently identified in patients with multiple sclerosis. Both working (short-term) and long-term memory appear affected, particularly on free-recall tasks. The focus of our study was to examine neurophysiological correlates of working memory processes and to identify the specific components responsible for the working memory deficits reported in multiple sclerosis. Event-related brain potentials (ERPs) were recorded from the scalp of mildly afflicted multiple sclerosis patients and their matched normal controls during the performance of phonological and visuo-spatial working memory tasks. Neuropsychological test, behavioural performance and ERP data all indicated that verbal working memory is especially susceptible to impairment by multiple sclerosis, while visuospatial working memory is less susceptible. The pattern of results further indicated that the verbal working memory dysfunction in multiple sclerosis is at least partially due to impairment in the phonological loop, a rehearsal mechanism for retaining verbal information in working memory.