Test Of Premorbid Functioning Research Articles

A Potential Measure of Premorbid Functioning: Evaluating the Construct Validity of the Author and Magazine Recognition Tests.

To establish convergent and discriminant validity for a combined measure of print exposure (i.e., Author Recognition Test and Magazine Recognition Test [ART/MRT]) and assess its potential utility for estimating premorbid cognitive functioning. Community-dwelling older adults (N = 84; 95% non-Hispanic White) completed the ART/MRT, Test of Premorbid Functioning (ToPF), Dementia Rating Scale - 2nd Edition (DRS-2), Hopkins Verbal Learning Test - Revised (HVLT-R-DR), and select subtests from the Delis-Kaplan Executive Functioning System (D-KEFS) as measures of executive functioning (i.e., D-KEFS-EF) and processing speed (i.e., D-KEFS-PS). Pearson correlations and linear regressions were used to examine the relationships between the ART/MRT, cognition, and demographics. Cognitive scores, with the exception of HVLT-R-DR, were positively correlated with ART/MRT score such that better cognitive performance was associated with greater print exposure (range r = 0.39-0.49). ART/MRT score was positively correlated with years of education and negatively correlated with age. ToPF and DRS-2 differentially and uniquely predicted ART/MRT score beyond the other cognitive and demographic variables and beyond each other. Findings indicate that measures of print exposure reflect crystallized knowledge but may also capture fluid abilities that may be more vulnerable to age-related decline or neurodegeneration. Assessment of print exposure may offer an alternative to word reading measures that may be inappropriate for translation into other languages and for use with individuals with certain language difficulties.

Adverse childhood experiences, cognitive functioning, depression, and anxiety in adulthood.

Evidence suggests that adverse childhood experiences (ACEs) predict cognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding of how ACEs affect cognitive health in midadulthood. This study compared psychiatric and cognitive differences between adults at high- and low-risk of adverse health outcomes based on the ACE risk classification scheme. Adult patients (N = 211; 46.9% female; Mage = 44.1, SD = 17.1; Meducation = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. Patients were divided into high and low ACE groups based on the number of ACEs endorsed. Subsequently, a series of one-way analyses of variances were conducted to compare high versus low ACE groups on the Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-Fourth Edition Digit Span Test, Trail Making Test-Parts A and B, Rey Auditory Verbal Learning Test, Beck Depression Inventory-II, and Beck Anxiety Inventory scores. Significant group differences were detected for anxiety and depression with the high ACE group endorsing significantly greater depression and anxiety symptoms relative to the low ACE group. High and low ACE groups did not significantly differ on any cognitive measures. Results indicate that an individual's psychological health, but not cognitive functioning, is impacted by the level of ACE exposure. Study findings highlight the importance of including ACE measures in neuropsychological evaluations, as it will aid in case conceptualization and tailoring treatment recommendations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

63 Examining TOPF Performance in a Neurodegenerative Population

Objective:Cognitive tests on which performance is unrelated to brain pathology are considered “hold” tests and are often used to estimate cognitive abilities prior to injury or disease. Amongst the most commonly used “hold” tests are measures of irregular word reading, such as the Test of Premorbid Functioning (TOPF). Measures of irregular word reading assess ability to accurately pronounce phonetic irregularities based on prior experience and word knowledge, and tend to be insensitive to most forms of brain pathology (Lezak, 2012). However, research examining whether a relationship exists between neurodegenerative diseases and decline in irregular word reading is limited. The few studies completed have demonstrated a decline in irregular word reading in neurodegenerative disease in general (Berg, Durant, Banks, & Miller, 2016) and Alzheimer’s dementia specifically (McFarlane, Welch, & Rodgers, 2006). However, no known research has been published examining whether irregular word reading and TOPF scores differ depending on cognitive classifications commensurate with DSM-V diagnoses (i.e., mild or major neurocognitive disorder, etc.), or presumed neurological etiology.Participants and Methods:Patients were enrolled from the University of Colorado Hospital Neuropsychology Clinic. This study was a retrospective review of consecutive referrals over the age of 65 to the University of Colorado Hospital Neuropsychology Clinic from 2019 to present. The TOPF was administered along with a full neuropsychological battery and patients were clinically classified by severity of cognitive impairment (e.g., Normal, Mild Neurocognitive Disorder, Major Neurocognitive Disorder) and presumed neurologic etiology (e.g., Alzheimer’s disease (AD), Parkinson’s disease (PD), vascular cognitive impairment (VCI), and mixed dementia (AD and VCI). TOPF Raw scores were used for all analyses. Correlation analysis was conducted to determine significant relationships between various demographic variables and TOPF performance. ANCOVA analyses were conducted to examine differences on TOPF performance by diagnostic classification and differences on TOPF performance by presumed neurologic etiology.Results:Correlation determined a significant relationship between TOPF performance and education (r = .51, p < .001), but not age (p = .092) or gender (p = .680). ANCOVA revealed a significant effect of TOPF performance on diagnostic group classification after controlling for education, F(2, 504)= 26.45, p < .001. Post hoc analysis revealed that those diagnosed with Major Neurocognitive Disorder performed the worst on the TOPF (M=39.801 ± .958), followed by those diagnosed with Mild Neurocognitive Disorder (M= 45.371 ± .767), while those diagnosed as cognitively normal performed the best (M= 49.826 ± .993). Additional ANCOVA analysis revealed a significant effect of TOPF performance on presumed neurologic etiology after controlling for education, F(3,148)=6.07, p = .001. Post hoc analyses revealed that participants with suspected AD (M= 40.728 ± 1.613) and those with suspected VCI (M= 32.804 ± 3.480) performed worse on the TOPF compared to those with suspected PD (M=46.964 ± 1.506), (p=.042 and p = .004, respectively).Conclusions:Results suggest that TOPF performance in older individuals is sensitive to cognitive impairment. Furthermore, these results suggest that this sensitivity may be further influenced by presumed neurologic etiology. These findings are consistent with prior studies which demonstrated a decline in irregular word reading in individuals with neurodegenerative diseases.

4 Assessing Visuospatial Skills in Parkinson’s Disease Using the Identi-Fi

Objective:Patients with Parkinson’s disease (PD) commonly show deficits on tests of visuospatial functioning. The Identi-Fi is a new measure of visual organization and recognition composed of two components. The Visual Recognition (VR) subtest asks persons to identify an object that has been broken its pieces and rearranged, akin to the Hooper Visual Organization Test, but using updated and colorful pictures. The Visual Matching (VM) subtest involves showing the same stimuli, but the examinee must select the correct response from among five choices (1 correct and 4 foils), placing greater demand on visuospatial discrimination. Together, the two subtests comprise the Visual Organization Index (VOI), reflecting overall visual processing and organization ability. The present study examined performance on the Identi-Fi in patients with PD and its association with other aspects of cognition.Participants and Methods:Participants were 23 patients with PD (95% male; mean age = 69.7 years [SD = 7.8], range = 47-79) and 12 patients with cognitive concerns (CC) who were intact on neuropsychological testing (excluding consideration of Identi-Fi scores; 50% male, mean age = 71.08 [SD = 6.27], range = 60-78) seen for a neuropsychological evaluation at a large Northeastern medical center. As part of a larger battery, patients completed the Identi-Fi, Trail Making Test (TMT), Category Fluency, Test of Premorbid Functioning (TOPF), and Brief Visuospatial Memory Test, Revised (BVMT-R).Results:The PD group performed significantly worse than the CC group on VR and VM, as well as VOI, of the Identi-Fi (p < .001). Within the PD group, poorer VR, VM, and VOI performance was associated with lower scores on the TOPF (p < .05), BVMT-R learning (p < .05) and delayed recall (p < .05), as well as TMT Parts A and B (p < .05). VR was significantly correlated with Category Fluency (p < .05), while a trend was seen for the association between VOI and Category Fluency (p = .094).Conclusions:Identi-Fi performance was worse in the PD group than the CC group, which is consistent with prior research indicating that visuospatial processing is often abnormal in patients with PD. Furthermore, findings indicate that poorer performance on the Identi-Fi in the PD group is associated with poorer cognitive functioning in other domains (i.e., visuospatial learning and memory, processing speed, cognitive flexibility, and semantic fluency), as well as lower premorbid intellectual functioning. While these findings suggest that the Identi-Fi is useful in identifying visuospatial dysfunction in PD, findings should be interpreted with caution given the small sample sizes and uneven gender distribution

51 Importance of Using Baseline Verbal Abilities When Interpreting the MOCA Test Performance

Objective:The Montreal Cognitive Assessment (MOCA) is widely used as a mental status screening test to detect cognitive impairment in adults over 55 years of age. Performance on this test ranges from 0 to 30. One point is given to individuals with 12 or lower years of education. This accommodation is based on the fact that low education may be a risk factor for dementia (Milani et al., 2018). However, studies suggest the one-point adjustment may not be sufficient to address the impact of low education on test performance (Malek-Ahmadi et al., 2015). The aim of this study is to compare the effects of educational achievement versus baseline verbal abilities on MOCA performance.Participants and Methods:Fifty patients (25 male; mean age=72.78, SD = 8.11; mean education=16.18, SD = 2.73) with cognitive concerns were referred to Massachusetts General Brigham. All underwent neuropsychological evaluation, including screening with the MOCA. Total MOCA scores were calculated. In this patient group, the MOCA scores ranged from 10 to 29 (mean=22, SD=5.129). Measures of literacy (Wechsler Test of Adult Reading or Test of Premorbid Functioning) were used to estimate baseline verbal abilities. Educational achievement was based on self-reported years of education.Results:Correlational analyses included the Total MOCA scores, measures of literacy, and years of education. Performance on the MOCA significantly correlated with measures of literacy, r(43)=.578, p< .001, and a stepwise regression analysis revealed that literacy predicted performance on the MOCA, R2=.041, F(3,139)= 9.172, p<.001. Years of education correlated with measures of literacy, r(44)=.494, p< .001, but not with performance on the MOCA.Conclusions:Findings suggest that education-adjusted scoring on the MOCA may not be sufficient to “level the playing field” in terms of MOCA performance. Years of education had less of an effect on the Total MOCA scores than did baseline verbal abilities. It may be the case that literacy has a more robust effect on MOCA performance due to the inherent verbal nature of the MOCA. Data from this study highlight the importance of considering a patient’s baseline verbal abilities in the interpretation of their MOCA performance.

29 Associations Between Social Support and Cognitive Performance Among Persons with MS

Objective:Social support is an emerging protective factor against cognitive decline. However, the relationship between social support and cognitive functioning in the multiple sclerosis (MS) population is not well understood. The present study aimed to investigate the associations between different aspects of social support and cognitive performance among persons with MS.Participants and Methods:A volunteer sample of 63 persons with MS (% female = 88.9, mean age = 48.16) completed measures assessing perceived levels of social support measured by the Medical Outcomes Study Support Social Survey 5-item short form (MSSS-5), and social network (social network diversity and total size of social network) measured by the Social Network Index (SNI). Cognitive functioning was assessed by a brief virtual examiner-administered neuropsychological test battery (using a teleconferencing platform), including the Rey Auditory Verbal Learning Test, Controlled Oral Word Association Test, animal naming, and the Symbol Digit Modalities Test. Participants also completed brief, self-paced, virtual cognitive tests through the testmybrain.org platform, which consisted of digit span and the Trail-Making Test. A principal component analysis (PCA) was carried out to reduce the number of neuropsychological outcomes into fewer dimensions. Multiple linear regressions were conducted to examine the associations between social support measures and cognitive performance. Regression models were adjusted by the levels of depressive symptoms (operationalized by the Chicago Multiscale Depression Inventory or the Hospital Anxiety and Depression Scale) and premorbid functioning (measured by the Test of Premorbid Functioning).Results:A PCA reduced neuropsychological outcomes into 3 components representing cognitive domains of 1) processing speed/executive functioning, 2) verbal memory, and 3) verbal fluency / simple attention. In the unadjusted models, both perceived social support (i.e., to what extent one receives assistance from their social network) as well as total size of social network (i.e., total number of people one regularly talks to) were significant predictors of the processing speed/executive functioning component score of moderate strength, where F(1, 59) = 11.93, p = .001, β = 0.41 and F(1, 59) = 11.57, p = .001, β = 0.41, respectively. These associations were maintained after adjusting for depressive symptoms and level of premorbid functioning (F(4, 55) = 3.31, p = .003 and F(4, 55) = 3.31, p = .006, respectively). On the other hand, social network diversity (i.e., number of different types of close social relationships one has) was not a significant predictor of the processing speed/executive functioning component score (p > 0.05). None of the social support measures were significantly associated with the verbal memory and verbal fluency/simple attention component scores.Conclusions:Greater social support (specifically, perceived levels of assistance and total size of social network) is associated with better performance on processing speed/executive functioning measures among persons with MS, independent of effects from depressive symptoms and premorbid functioning. Maintaining a strong social support network may be an important factor in optimizing cognitive health in MS.

B - 93 Appropriateness of Test of Premorbid Functioning for Predicting Premorbid Functioning in Spanish/English Speaking Military Veterans Affairs Population.

To examine the degree of discrepancy between Test of Premorbid Functioning (TOPF) predicted and actual WAIS-IV FSIQ between monolingual English-speaking veterans (MV) and bilingual English/Spanish-speaking veterans (BV). Data from neuropsychological evaluation of 97 clinically referred veterans (Mage = 53.02, SD = 14.24, range = 23-80; Medu = 13.87, SD = 2.86, range = 6-20; 81 MV, 16 BV) were included. The percentage of male participants was 80.4. Inclusion criteria were completion of the TOPF and the full standard Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Exclusion criteria were PVT failure, neurocognitive disorder, learning disability, substance use disorders, and psychotic disorders. Mean TOPF-predicted FSIQ (combined demographic + TOPF) and mean WAIS-IV FSIQ were computed for each group, as well as mean discrepancy between observed and predicted FSIQ (DISo-p). MV and BV differed in mean WAIS-IV FSIQ (t = 3.20, p = .0002) and mean TOPF-predicted FSIQ (t = 2.09, p = .039). Mean DISo-p was -1.88 for MV and -5.75 for BV. Mean DISo-p did not differ significantly between monolingual and bilingual groups (t = 1.71, p = .090). In a veteran sample, the TOPF combined prediction model functioned similarly for MV and BV without cognitive impairment. This provides preliminary support for the use of this measure to predict premorbid intellectual functioning among English/Spanish bilingual veterans. Additional research is needed to examine impact of English proficiency, age of acquisition, and education level on FSIQ prediction among bilingual veterans and in the population at large.

B - 49 Exploring the Factor Structure of Sluggish Cognitive Tempo and Impact on Processing Speed Performance.

The present study investigated: 1) factor structure of the Sluggish Cognitive Tempo (SCT) sub-scale from the Barkley Adult ADHD Rating Scale-4th Edition (BAARS-IV) and 2) the association between SCT sub-factors and processing speed. Cross-sectional data were collected from 586 adults undergoing neuropsychological evaluation for suspected attention-deficit/hyperactivity disorder (ADHD) at an academic medical center. Patients were excluded if they failed two or more performance validity tests and/or had not completed all measures. Final sample included 155 patients (Mage = 28.52; Meducation = 16.26; 63.2% female; 38.1% White, 21.9% Hispanic, 20% Black, 12.9% Asian, 7.1% other race/ethnicity; 69% diagnosed with ADHD). Factor structure of the SCT sub-scale was investigated via exploratory factor analysis with Oblimin rotation. Hierarchical multiple regressions were used to assess the relationship between SCT sub-factors and processing speed (Wechsler Adult Intelligence Scale-4th Edition, Processing Speed Index), controlling for estimated intelligence (Test of Premorbid Functioning) and self-reported inattention (Clinical Assessment of Attention Deficit-Adult). Kaiser-Meyer-Olkin measure [KMO = 0.78] and Bartlett's test [χ2(36) = 469,p < 0.001] suggested the data were factorable. Parallel analysis scree plot suggested a two-factor solution: "Cognitive Complaints" and "Lethargy" accounting for 46.3% of SCT scale variance. Only Lethargy predicted processing speed in the first (beta = -0.221, p < 0.05) and final models (beta = -0.197, p < 0.05). The overall model including estimated intelligence and inattention accounted for 6.2% of the variance in processing speed (F(4,150) = 3.57, p < 0.05). Previous studies demonstrated mixed results of two or three sub-factors of SCT including daydreaming, lethargy, and/or cognitive complaints. Present findings support the more parsimonious two-factor solution in a clinical sample. Higher lethargy complaints are modestly associated with poorer processing speed.

Premorbid cognitive functioning influences differences between self-reported cognitive difficulties and cognitive assessment in multiple sclerosis.

Cognitive difficulties are reported in up to 60% of people with MS (pwMS). There is often a discrepancy between self-reported cognitive difficulties and performance on cognitive assessments. Some of this discrepancy can be explained by depression and fatigue. Pre-MS cognitive abilities may be another important variable in explaining differences between self-reported and assessed cognitive abilities. PwMS with high estimated premorbid cognitive functioning (ePCF) may notice cognitive difficulties in daily life whilst performing within the average range on cognitive assessments. We hypothesised that, taking into account depression and fatigue, ePCF would predict (1) differences between self-reported and assessed cognitive abilities and (2) performance on cognitive assessments. We explored whether ePCF predicted (3) self-reported cognitive difficulties. Eighty-seven pwMS completed the Test of Premorbid Functioning (TOPF), the Brief International Cognitive Assessment for MS (BICAMS), self-report measures of cognitive difficulty (MS Neuropsychological Questionnaire; MSNQ), fatigue (MS Fatigue Impact Scale; MFIS) and depression (Hospital Anxiety and Depression Scale; HADS). Results revealed that, taking into account covariates, ePCF predicted (1) differences between self-reported and assessed cognitive abilities, p < .001 (model explained 29.35% of variance), and (2) performance on cognitive assessments, p < .001 (model explained 46.00% of variance), but not (3) self-reported cognitive difficulties, p = .545 (model explained 35.10% of variance). These results provide new and unique insights into predictors of the frequently observed discrepancy between self-reported and assessed cognitive abilities for pwMS. These findings have important implications for clinical practice, including the importance of exploring premorbid factors in self-reported experience of cognitive difficulties.

A pilot study investigating cognitive impairment associated with opioid overdose

BackgroundIn 2021, while overdose (OD) deaths were at the highest in recorded history, it is estimated that >80% of ODs do not result in a fatality. While several case studies have indicated that opioid-related ODs can result in cognitive impairment, the possible association has not yet been systematically investigated. Methods78 participants with a history of OUD who reported experiencing an OD in the past year (n=35) or denied a lifetime history of OD (n=43) completed this study. Participants completed cognitive assessments including the Test of Premorbid Functioning (TOPF) and the NIH Toolbox Cognition Battery (NIHTB-CB). Comparisons were made between those who experienced an opioid-related OD in the past year versus those who denied a lifetime OD history while controlling for factors including age, premorbid functioning, and number of prior ODs. ResultsWhen comparing those who experienced an opioid-related OD within the past year to those without a history of OD, uncorrected standard scores were generally comparable; however, differences emerged in the multivariable model. Specifically, compared to those without a history of OD, those who experienced a past year OD evidenced significantly lower total cognition composite scores (coef. = −7.112; P=0.004), lower crystalized cognition composite scores (coef. = −4.194; P=0.009), and lower fluid cognition composite scores (coef. = −7.879; P=0.031). ConclusionsFindings revealed that opioid-related ODs may be associated with, or contribute to, reduced cognition. Extent of the impairment appears contingent upon individuals’ premorbid intellectual functioning and the cumulative number of past ODs. While statistically significant, clinical significance may be limited given that performance differences (∼4 – 8 points) were not particularly robust. More rigorous investigation is warranted, and future studies must also account for the many other variables possibly contributing to cognitive impairment.

Cross-Walk Comparison of the DVBIC-TBICoE and LIMBIC-CENC Combat-Related Concussion Prospective Longitudinal Study Datasets

ObjectiveTo describe and compare cohorts between 2 large, longitudinal, federally-funded TBI studies of Service members and veterans across demographic, self-report, and neuropsychological variables. DesignAnalysis of data from the DVBIC-TBICoE and LIMBIC-CENC prospective longitudinal studies (PLS). SettingRecruitment locations spanning Department of Defense and Veterans Affairs hospitals across the U.S. Participants1463 participants (N=1463) enrolled in the DVBIC-TBICoE study and divided among non-injured (NIC) (n=191), injured control (IC) (n=349), mild TBI (mTBI) (n=682), and (severe, moderate, penetrating, and complicated mild traumatic brain injury (smcTBI) (n=241) subgroups. 1550 participants enrolled in the LIMBIC-CENC study and divided between IC (n=285) and mTBI (n=1265) subgroups. IC and mTBI study groups were compared across demographic and military characteristics, self-reported symptoms, and neuropsychological test scores. InterventionsNone. Main Outcome MeasuresNeurobehavioral Symptom Inventory, PTSD Checklist-Military Version, TBI quality of life, Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-IV Visual Puzzles, Symbol Search, Coding, Letter-Number Sequencing, and Digit Span, Trail Making Test, Delis-Kaplan Executive Functioning System Verbal Fluency, Letter Fluency, and Category Fluency, California Verbal Learning Test-II, and Grooved Pegboard. ResultsCompared with DVBIC-TBICoE, LIMBIC-CENC participants have higher enrollment age, education level, proportion of Black race, and time from injury as well as less combat deployments and are less likely to be married. The distribution of military service branches also differed. Further, symptom profiles differed between cohorts. LIMBIC-CENC participants endorsed higher posttraumatic stress disorder symptomatology. DVBIC-TBICoE study IC participants endorsed higher somatosensory and vestibular symptoms (medium effect sizes). Other symptom measure differences had very small effect sizes (≤0.2). Differences were found on many cognitive test results, but are difficult to interpret given the demographic differences and generally very small effect sizes. ConclusionsThe heavy use of National Institutes of Health common data elements in both studies and collaboration with the DVBIC-TBICoE study team on development of the LIMBIC-CENC assessment battery enabled this comparative analysis. Results highlight unique differences in study cohorts and add perspective and interpretability for assimilating past and future findings.

Do demographic factors influence detection of invalid neuropsychological test performance using common performance validity tests? A multisite investigation.

This study examined the extent to which demographic variables (i.e., age, education, premorbid IQ, sex, ethnoracial identity, and presence/absence of external incentive) affect performance validity test (PVT) performance. This cross-sectional study examined two distinct, diverse outpatient clinical samples at an academic medical center (AMC, N = 268) and a Veterans Affairs (VA) medical center (N = 111). All patients completed a battery including five PVTs. Premorbid IQ was assessed using the Test of Premorbid Functioning (TOPF) in the AMC sample. Multiple correlations between demographic variables and individual PVT performance were statistically significant, but accompanying effect sizes were small, except for the relationship of premorbid IQ and reliable digit span (RDS). Regressions showed demographic variables accounted for 7%-11% of the variance in individual PVT scores in the AMC sample, and 6%-26% in the VA sample, premorbid IQ driving results in the AMC sample and compensation-seeking status in the VA sample. Other demographic variables did not correlate with compensation-seeking status. Additionally, premorbid IQ was found to be significantly higher in validly performing individuals compared to those performing invalidly in the AMC sample. Most demographic factors evaluated accounted for relatively little variance in individual PVT performance and did not significantly predict overall validity categorization. Compensation-seeking status correlated with validity classification across both groups, but offers limited diagnostic utility itself compared to objective PVT scores. Premorbid IQ within the AMC group demonstrated influence on particular PVTs (i.e., RDS) reflecting the difficulty of assessing validity within low IQ populations, particularly with PVTs more strongly correlated with IQ. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A-256 Literacy Level May Mediate the Relationship Between an Individual’s Ethnicity and Letter Fluency Ability

Abstract Objective: Previous research suggests that literacy level may be a better predictor of cognitive performance than years of education in minoritized groups. Although literacy tests remain a mainstay in the context of neuropsychological evaluations due to their role in the estimation of premorbid intellectual functioning, there is relatively little research examining the role of literacy in the relationship between ethnicity and cognitive performance. This study examined whether literacy level influences the relationship between ethnicity and letter fluency ability. Method: This cross-sectional study included 64 adult patients consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. The sample was 54.7% male, 43.8% White, 56.3% Black, with Mage of 57.8 years (SD=11.7) and Meducation of 12.6 years (SD=2.5). A mediation analysis was performed using Hayes’ PROCESS macro within SPSS to evaluate whether literacy, as measured by the Test of Premorbid Functioning (TOPF), mediated the association between ethnicity (dichotomized as Black/White) and letter fluency via raw scores from the F/A/S trials. Results: The main model of the mediation analysis was significant, F (4, 51) = 13.89, p &amp;lt;.001, R2 = .521. After accounting for age and years of education, there was a significant mediation effect of literacy on the relationship between ethnicity and letter fluency (B = .740, SE = .143, t = 5.19, p &amp;lt;.001). Conclusion(s): In sum, this study provided evidence that literacy level helps explain the letter fluency performance differences observed between Black and White patients.

A-119 Adverse Childhood Experiences, Cognitive Functioning, Depression, and Anxiety in Adulthood

Abstract Objective: Increasing evidence suggests that adverse childhood experiences (ACEs) predict neurocognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding as to how ACEs affect cognitive health in mid-adulthood. Therefore, this study compared adults with high vs. low ACE scores on measures of cognitive performance and psychopathology. Method: This cross-sectional study included 211 adult patients (46.9% female; Mage = 44.9, SD = 17.1; Meducation = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. A series one-way analysis of variances (ANOVAs) were conducted to compare high vs. low ACE groups on the Test of Premorbid Functioning (TOPF), Digit Span (DS), Trail Making Test-Part B (TMT-B), Rey Auditory Verbal Learning Test (RAVLT; Immediate and Long Delayed Recall), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) scores. Results: Significant group differences were detected for BDI-II and BAI scores, F(1,159) = 18.38, p.05. Non-significant cognitive measure findings cannot be attributed to group differences in premorbid functioning, as TOPF score also did not significantly differ by ACE group, p &amp;gt; 0.05. Conclusions: Results of this investigation suggest that greater ACEs increase risk of depression and anxiety, but not neurocognitive dysfunction, in adulthood.

Are TOPF and WRAT WR Interchangeable Measures among Psychiatric Inpatients?

To examine whether Test of Premorbid Functioning (TOPF) and Wide Range Achievement Test-Word Reading subtest (WRAT WR) are interchangeable measures, and the relationship between these measures and intelligence, among patients with schizophrenia. In this archival study, the authors examined neuropsychology referrals of an inpatient forensic state hospital. Patients with a schizophrenia spectrum disorder (SSD) who received the Wechsler Adult Intelligence Scale-Fourth Edition or the Wechsler Abbreviated Scale of Intelligence-Second Edition and either TOPF or WRAT WR were considered for inclusion. The final sample consisted of 119 individuals (73.1% male). Although there was a linear relationship between most TOPF variables and WRAT WR, their concordance was weak (concordance correlation coefficients [CCC] < 0.90). Poor concordance was also observed between current FSIQ and all standard scores (SS) derived from word reading measures. FSIQ-word reading measure discrepancy scores differed significantly from a hypothesized mean of 0 (mean discrepancy range = -7.42 to -16.60). Discrepancies greater than one standard deviation (>1 SD) were highest among demographics-based SS (i.e. TOPF Predicted and Simple without TOPF). Performance-based SS, particularly TOPF Actual and WRAT4 WR, had the fewest discrepancy scores >1 SD fromFSIQ. TOPF and WRAT WR should not be used interchangeably among institutionalized patients with SSDs. TOPF and WRAT WR were discrepant from FSIQ, with demographic variables producing higher SS relative to performance-based variables. Future research is needed to determine which of these measures more accurately estimates intelligence among inpatients withSSDs.

The Alcohol and Drug Cognitive Enhancement (ACE) Screening Tool: A simple and brief questionnaire to screen for cognitive impairment in substance use disorder treatment services

The objective of this study was to determine the test–retest reliability; construct and criterion validity; and test operating characteristics of a newly developed cognitive impairment risk factor screening instrument, the Alcohol and Drug Cognitive Enhancement (ACE) Screening Tool. Participants in the validation study were 129 adults with substance use disorder (SUD) enrolled in residential SUD treatment services and 209 normal controls. Test and retest data were available for 36 participants with SUD and 40 normal control individuals on the ACE Screening Tool. Test–retest reliability was excellent (ICC = 0.97). The ACE Screening Tool was significantly correlated with the Montreal Cognitive Assessment (MoCA), Behavior Rating Inventory of Executive Functioning—Adult Version (BRIEF-A), Test of Premorbid Functioning (TOPF) and Five Point Test, establishing construct validity. Criterion validity was established using a ternary severity variable constructed using results obtained on the MoCA and BRIEF-A. Test operating characteristics analysis showed 93% sensitivity, 46% specificity, 33% positive predictive power, and 96% negative predictive power using a cut-score of >3. Those high levels of sensitivity and negative predictive power indicated that the tool would likely detect cognitive impairment when present and should therefore be considered suitable as an initial screening tool for cognitive impairment in individuals attending SUD services.

Investigating the Test of Premorbid Functioning (TOPF) in predicting Wechsler Abbreviated Scale of Intelligence – Second edition (WASI-II) scores in an Australian sample

ABSTRACT Accurate prediction of premorbid functioning is important in neuropsychological assessment. We aimed to investigate the predictive accuracy of the TOPF and examine this word list at an item level against WASI-II scores, using Australian pronunciations. The sample of 219 healthy Australians were aged 18–82 years. Multiple regression analyses were used to replicate the TOPF and simple demographic models based on the US TOPF standardization. Rasch analyses provided a comparison of Australian, US and UK word order from the proportion of words pronounced correctly. The variance explained in WASI-II index scores ranged from R2=.12 (PRI) to .33 (FSIQ-2), which was approximately half that reported in the US standardization study. The accuracy of predicted WASI-II scores was also slightly less in our sample. Thirty-two words were out of place by five places or more compared with the US word order and 30 compared with the UK. These results add to concerns about the application the TOPF with norms developed in the US and UK in the Australian context. Clinicians are advised not to apply the five error discontinue rule when using the TOPF in the local context. Development of a more accurate word reading task for use in Australia is warranted.

Relationship between intelligence and posttraumatic stress disorder in veterans

ObjectiveEvaluate the relationships between posttraumatic stress disorder (PTSD) and measures of intelligence in veterans. MethodVeterans (N = 338) who deployed to Iraq and/or Afghanistan were recruited for a VA study on primary blast exposure. PTSD was evaluated using the Clinician Administered PTSD Scale, 5th edition (CAPS-5) and the PTSD Checklist-5. Intelligence was measured using the Wechsler Adult Intelligence Scale, 4th edition and the Test of Premorbid Functioning (TOPF). Validity was assessed with the Medical Symptom Validity Test, b Test, and Structured Inventory of Malingered Symptomatology. Differences in Intelligence Quotient (IQ) estimates between individuals with and without PTSD were evaluated with t-tests. Correlations evaluated associations between symptom burden and intelligence. ResultsOf the seven IQ measures, only the Full Scale IQ score and TOPF Equated scores were significantly lower (but not abnormal) in the lifetime PTSD group. Moreover, these relationships were no longer significant when accounting for multiple comparisons, and symptom/performance validity appeared to better account for those relationships. Current symptom distress was weakly related to several outcomes, but not when using CAPS-5 measures. Neither lifetime nor current PTSD diagnoses were associated with significantly lower IQ scores. ConclusionsThis study did not support prior conclusions that low IQ is a risk factor for developing PTSD. This discrepancy is likely due to the use of ability and symptom validity checks, and sample characteristics (e.g., education). Future research should further evaluate the relationship of symptom distress on intellectual outcomes in combat veteran samples.

Test of Premorbid Functioning: You're Doing It Wrong, but Does It Matter?

Clarify procedures to correctly score Test of Premorbid Functioning (TOPF) and assess the accuracy of TOPF scores in the estimation of premorbid intellectual functioning. In this cross-sectional study, post-9/11 veterans (N=233, 84.12% male) completed the TOPF, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), and performance validity measures. All TOPF scores were significantly correlated with WAIS-IV FSIQ scores (range r=0.56-.73). The degree of discrepancy between TOPF scores and FSIQ varied with 10%-17% of TOPF scores deviating from FSIQ scores by one SD or more. Proper TOPF scoring procedures are presented. The TOPF Actual and Predicted scores were related to FSIQ. However, a higher percentage of Actual and Predicted scores were discrepant from FSIQ compared with the other three TOPF estimates, arguing against their use as independent premorbid estimates. Use of the TOPF as was designed is recommended.

Estimating Premorbid Ability in Rehabilitation Patients Using the Test of Premorbid Functioning and Wide Range Achievement Test-Fourth Edition.

Objective: This study examined premorbid ability estimate concordance using Test of Premorbid Functioning predicted Full Scale Intelligent Quotient (TOPF-IQ) and Wide Range Achievement Test-Fourth Edition Word Reading (WRAT4-WR). Method: The sample (N = 145) was 28% female with average age and education of 40.6 and 13.2 years, respectively. Outpatient neuropsychological evaluations were conducted in a rehabilitation setting. Measures included the TOPF, WRAT4-WR, Wechsler Adult Intelligence Scale-Fourth Edition, and other neuropsychological tests. Non-WAIS measures defined impairment groups. Analyses included t tests, pairwise correlations, concordance correlation coefficients, and root mean square differences. Results: TOPF-IQ, WRAT4-WR, and Full Scale Intelligent Quotient scores were not significantly different but were lower than normative mean. TOPF-IQ and WRAT4-WR showed acceptable agreement (concordance correlation coefficient = .92; root mean square difference = 5.9). Greater premorbid-current ability differences were observed in the impaired group. TOPF-IQ and WRAT4-WR showed lower but similar agreement with Full Scale Intelligence Quotient in the unimpaired group. Conclusions: Findings support the WRAT4-WR in predicting premorbid ability in rehabilitation settings.