Test Of Premorbid Functioning Research Articles

NCOG-10. RELATIONSHIP BETWEEN COGNITIVE FUNCTION, MOOD, AND FUNCTIONING IN GLIOMA SURVIVORS

Abstract Ensuring optimal quality of life and functioning is a clinical priority in treating glioma survivors. Cognitive function and mood symptoms are prevalent in this population after treatment and it’s reasonable to consider these as significant contributors to patients’ functioning at work and in daily life. However, it’s unclear the degree to which these symptoms contribute to such outcomes. To address this question, we examined the relationships between cognitive tests (i.e., a neuropsychological battery) and mood measures (i.e., the Beck Depression Inventory-II, and the Beck Anxiety Inventory) and work and daily functioning (i.e., Work Productivity and Activity Impairment Questionnaire). Partial correlation of cognitive tests and regression models also included age and IQ (i.e., Test of Premorbid Functioning). Of the 11 participants who were currently working, worse work productivity was significantly associated with worse processing speed (Stroop color naming r=-.74,p=.03, Stroop color word r=-.78,p=.02). Similarly, worse ability in daily activities was also associated with worse processing speed and executive function (Stroop color naming, r=-.52,p=.04; Stroop color word, r=-.55,p=.03; Trails B, r=-.53,p=.03). Greater depression symptoms were strongly correlated with both worse work productivity (r=.83,p=.002), and worse ability in daily activities (r=.55,p=.01). Depression symptoms were generally uncorrelated with cognitive scores. In linear regression models that included both depression symptoms and cognitive scores, only depression emerged as a significant predictor of work productivity and ability to conduct daily activities. In sum, glioma survivors face multiple threats to work and daily functioning by way of tumor and treatment related symptoms. Our analyses suggest that both cognitive function and mood symptoms are important to consider in optimizing functioning, but depression appears to vastly outweigh cognitive function in this regard. These preliminary findings highlight the importance of careful attention to these symptoms in survivorship and point to future research directions elaborating on these relationships.

Clinical utility of WAIS-IV ‘excessive decline from premorbid functioning’ scores to detect invalid test performance following traumatic brain injury

Objective: Excessive Decline from Premorbid Functioning (EDPF), an atypical discrepancy between demographically predicted and obtained Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) scores, has been recently proposed as a potential embedded performance validity test (PVT). This study examined the clinical utility of EDPF scores to detect invalid test performance following traumatic brain injury (TBI).Methods: Participants were 194 U.S. military service members who completed neuropsychological testing on average 2.4 years (SD = 4.0) following uncomplicated mild, complicated mild, moderate, severe, or penetrating TBI (Age: M = 34.0, SD = 9.9). Using TBI severity and PVT performance (i.e., PVT Pass/Fail), participants were classified into three groups: Uncomplicated Mild TBI-PVT Fail (MTBI-Fail; n = 21), Uncomplicated Mild TBI-PVT Pass (MTBI-Pass; n = 94), and Complicated Mild to Severe/Penetrating TBI-PVT Pass (CM/STBI-Pass; n = 79). Seven EDPF measures were calculated by subtracting WAIS-IV obtained index scores from the demographically predicted scores from the Test of Premorbid Functioning (TOPF). Cutoff scores to detect invalid test performance were examined for each EDPF measure separately.Results: The MTBI-Fail group had higher scores than the MTBI-Pass and CM/STBI-Pass groups on five of the seven EDPF measures (p<.05). Overall, the EDPF measure using the Processing Speed Index (EDPF-PSI) was the most useful score to detect invalid test performance. However, sensitivity was only low to moderate depending on the cutoff score used.Conclusions: These findings provide support for the use of EDPF as an embedded PVT to be considered along with other performance validity data when administering the WAIS-IV.

Comparing the North American Adult Reading Test (NAART) and the Test of Premorbid Functioning (TOPF) to estimate premorbid Wechsler Adult Intelligence Scale - 4th edition FSIQ in a clinical sample with epilepsy

Estimating premorbid general cognitive functioning is an essential component to the neuropsychological evaluation process. The North American Adult Reading Test (NAART) is a method to predict premorbid general cognitive functioning based on word reading skills developed using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), which is currently in its fourth edition (WAIS-IV). The Test of Premorbid Function (TOPF) was developed using the WAIS-IV, based on the same method as the NAART, to estimate premorbid intellectual ability. There is a paucity of research comparing estimates of premorbid general intellectual ability between the NAART and TOPF. This study evaluated the clinical utility of premorbid estimates of FSIQ derived from the NAART and TOPF in a sample of 101 patients with temporal lobe epilepsy (TLE). Differences between NAART-derived premorbid FSIQs and TOPF simple demographic predicted FSIQs were significant (p < .001) with large effect sizes. NAART estimated premorbid FSIQ (M = 104.04, SD = 8.42) was significantly greater than TOPF premorbid estimates (M = 99.83, SD = 9.26). Results suggested NAART-derived estimates of premorbid FSIQ may be more accurate than TOPF-based estimates, which likely underestimated premorbid FSIQ in this sample of patients with epilepsy. Limitations and future directions are discussed.

Estimating premorbid intelligence in persons with traumatic brain injury: an examination of the Test of Premorbid Functioning

Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The Test of Premorbid Functioning (ToPF), a word reading test co-normed with the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV), was examined as a tool for estimating premorbid intelligence in persons with a history of TBI. Fifty-two participants with mild, moderate, or severe TBI were administered the ToPF and WAIS-IV between two weeks and 19 months post-injury. The independent ability of the ToPF/demographic score and the Verbal Comprehension Index (VCI) to predict WAIS-IV Full Scale IQ (FSIQ) was examined, as were discrepancies between ToPF and WAIS-IV scores within and between participants. The ToPF/demographic predicted FSIQ accounted for a significant proportion of variability in actual FSIQ, above and beyond that accounted for by education or time since injury. ToPF and WAIS-IV scores did not differ by injury severity. In our sample, the ToPF/demographic predicted FSIQ underestimated intelligence in a substantial portion of our participants (31%), particularly in those with high average to superior intelligence. Finally, VCI scores were more predictive of actual FSIQ than the ToPF/demographic predicted FSIQ. The ToPF frequently underestimated post-injury intelligence and is therefore not accurately measuring premorbid intelligence in our sample, particularly in those with above average to superior intelligence. Clinicians are encouraged to administer the entire WAIS-IV, or at minimum the VCI subtests, for a more accurate measure of intelligence in those with above average intelligence and history of TBI.

Subcortical Lesions Impact Confrontation Naming in Bilinguals with Later Age of Acquisition

Abstract Objective Multilinguals show greater subcortical activation during language tasks than monolinguals. Among multilinguals, prior studies found later age of acquisition (AoA) of a second language in association with more diffuse, non-traditional language representation. While such findings have clear clinical implications, little research has examined relationships among linguistic history, neuroanatomical integrity, and language skills in a clinical population. This study examined relationships between subcortical lesions and confrontation naming in strong bilinguals who acquired English (L2) later in life compared to those with earlier AoA. Participants and Method Forty-two bilinguals with Spanish as a first language (English L2) were selected from a database of veterans referred for clinical neuropsychological evaluation (M Age = 64 years; M Education = 12 years; 93% men). They reported strong bilingualism after L2 acquisition (M AoA = 10 years), with current English preference. Twenty-nine had neuroimaging, which was coded on a 4-point ordinal scale for lesion burden in white matter and striatum. Moderation models were tested for interaction between AoA and subcortical lesions in bilinguals using different L2 naming outcomes, controlling for age, education, occupation, and English fluency (i.e., Test of Premorbid Functioning). Results Moderation showed significant interaction of AoA with striatal lesion burden for scores on all naming tests, with a similar but less robust relationship between white matter lesions and naming outcomes. Graphical analysis revealed subcortical lesions had a negative impact on naming scores in those with later L2 AoA. Conclusions Results suggest “atypical” subcortical involvement in naming is more likely for bilinguals who acquired L2 later. While clinicians typically associate impaired naming with temporal lobe dysfunction, findings suggest subcortical dysfunction should be considered among bilinguals with later L2 AoA.

A-67 Where the Test of Premorbid Functioning (TOPF) Goes, the Hopkins Adult Reading Test (HART) may (not) Follow

Abstract Objective To determine if significant differences exist in estimates of premorbid intellectual functioning between the Test of Premorbid Functioning (TOPF) and Hopkins Adult Reading Test (HART) in a diverse sample of U.S. Veterans. Method Retrospective analysis of data obtained for routine clinical purposes. 102 Veterans (16% female), predominantly self-identified as African American (53.9%), with an average age of 61.79 years (SD = 13.29, range = 21-90 years) and an average education level of 14.45 years (SD = 2.73, range = 9-20 years); 48% received a neurocognitive diagnosis and 72.5% a psychiatric diagnosis. TOPF and HART standard scores and demographically predicted IQ scores were compared in terms of their linear relationship, absolute agreement, absolute magnitude of change, and discrepancy scores, including the degree to which discrepancy was affected by specific demographic factors. Results Despite strong Pearson correlations, concordance correlation coefficients (CCC) showed poor strength of agreement. Root-mean-squared differences (RMSD) was 10.284 (SD = 5.903) between standard scores and 9.948 (SD = 8.183) between predicted IQ scores. Discrepancy scores indicated 41.2% (46.1% for predicted IQ) performed equally well, with 58.8% (53.9%) performing significantly better on one measure than the other. Demographic comparisons for predicted IQ found those who performed better on the HART were older and those who performed better on the TOPF had more years of education. Conclusions The TOPF and HART have a strong linear relationship but insufficient agreement when differences in mean and standard deviation are taken into consideration. Estimates are inconsistent and not interchangeable, especially among older individuals and those with more education.

A-60 The Armed Services Vocational Aptitude Battery and Premorbid Intellectual Functioning

Abstract Objective The objective of this study is to evaluate correlations between the Armed Services Vocational Aptitude Battery (ASVAB) with other measures of premorbid functioning to validate the use of the ASVAB as an estimate of premorbid intellectual functioning. Method This study utilized archival data. Data were retrospectively reviewed and correlational analyses were conducted between scores on the ASVAB and another measure of premorbid intellectual functioning (i.e., Test of Premorbid Functioning (TOPF)). Results Preliminary results (N = 83) revealed significant positive correlations between the ASVAB &amp; TOPF (r2 = .75, p &lt; .01), irrespective of current intellectual abilities and neurocognitive diagnosis. Conclusion The ASVAB is strongly correlated with the TOPF and may serve as a useful tool for estimating premorbid intellectual functioning in neuropsychological evaluations of active duty services members.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary utility in adult neuro-oncology

Neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools may be insensitive to cognitive changes caused by medical treatments. Research supports the clinical value and psychometric properties of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in various medical populations; however, there is minimal evidence for its use in neuro-oncology. The purpose of the current study was to further explore the cognitive profile of patients with primary brain tumor (PBT) using the RBANS and to assess rates of below-expectation performance compared to normative data and estimated intellectual functioning. Data were collected on 82 PBT patients (54% male; age range, 19-81 years). All patients were administered the RBANS-Update and the Advanced Clinical Solutions-Test of Premorbid Functioning (TOPF) according to standardized instructions. Cognitive strengths and weaknesses were identified for PBT patients. Descriptive analyses, t tests, and chi-squared tests were utilized to identify and compare cognitive profiles. Overall, cognitive performance was low average for PBT patients. When compared to standardization data, PBT patients performed significantly worse across all 5 RBANS indexes, with Attention and Memory showing the largest discrepancies. Estimated intelligence analyses reflected greater deficits in cognitive functioning than when compared to a normal distribution. Preliminary research demonstrates the RBANS is an efficient screening tool to assess cognitive deficits in PBT patients. Data also support the importance of comparison to self, rather than normative distribution in ensuring proper identification and classification of patients.

Exaggerated reaction to novelty as a predictor of incipient cognitive decline among community-dwelling older adults

ABSTRACTObjective: The ability to detect covert markers of incipient cognitive decline among older adults before cognitive decline becomes overtly evident on traditional cognitive tests represents an important topic of research. Exaggerated reactions to novelty, reflected in novelty-induced increases in action planning latencies (“novelty effect”; NE) and low openness to experience (openness), have been previously associated with incipient cognitive decline among older adults who appeared cognitively normal at baseline. The purposes of the present study were to extend prior research on the utility of these markers by examining whether (a) NE and openness each predict cognitive change uniquely, and (b) whether these indices predict cognitive change above and beyond measures of memory, executive functions, processing speed/efficiency, premorbid IQ, and depressive symptoms.Method: Sixty-one cognitively normal community-dwelling older adults were administered a battery of tests assessing the relevant constructs at baseline and one-year follow up. Changes in cognitive status were assessed using the Demetia Rating Scale, 2nd Edition, NE was assessed using the Push–Turn–Taptap task (an electronic motor sequence learning task), and openness using the NEO Personality Inventory–Revised. The Test of Premorbid Functioning, and subtests from Repeatable Battery for the Assessment of Neuropsychological Status, Delis–Kaplan Executive Function System, and Wechsler Adult Intelligence Scale, 4th Edition, were used for additional assessment of baseline cognition. Depressive symptoms were assessed using the Geriatric Depression Scale.Results: Results confirmed our hypothesis that both NE and openness contribute to prediction of cognitive change beyond baseline cognition and depressive symptoms, but none of the covariates (i.e., depression, executive functions, processing efficiency, or memory) themselves contributed to the model. NE and openness each contributed unique variance and were independent of each other.Conclusions: Openness and NE have the potential to provide evidence-based methods for estimating risk of future cognitive change in persons with currently normal standardized test scores.

Developing a regression equation for predicting premorbid functioning in an Australian sample using the National Adult Reading Test

ObjectiveIn neuropsychological assessment, predicting the level of premorbid functioning is useful in ascertaining the presence or absence of cognitive decline post‐injury. This study set out to develop regression equations using the National Adult Reading Test (NART) in association with demographic factors to predict the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS‐IV) full‐scale intelligence quotient (FSIQ) and its index scores in a cognitively healthy Australian sample, and to compare the accuracy of these regression equation with the Test of Premorbid Functioning (TOPF) in a clinical sample.MethodThe 111 cognitively healthy male and female participants aged 18–65-years completed a battery of tests, including the WAIS‐IV, NART, and TOPF. The accuracy of the premorbid IQ estimates was then examined on 22 neurologically impaired participants.ResultsThe regression equation using NART errors explained 39.1% of the variance in WAIS‐IV FSIQ. When age, sex, and education were added to the model, the variance increased to 46.6%. Both the regression equations using NART errors and the TOPF significantly over‐estimated IQ in the clinical sample (p < .001), whereas the regression equation combining errors and demographics, and the TOPF with demographic correction, did not.ConclusionEstimating premorbid functioning is an important aspect of neuropsychological assessment. This paper developed a series of regression equations using the NART which are suitable for the Australian context.

The Influence of Cognitive Reserve on Recovery from Traumatic Brain Injury.

we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance. retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury. regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model. cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.

Estimating verbal fluency and naming ability from the test of premorbid functioning and demographic variables: Regression equations derived from a regional UK sample.

Neuropsychological assessment requires accurate estimation of an individual's premorbid cognitive abilities. Oral word reading tests, such as the test of premorbid functioning (TOPF), and demographic variables, such as age, sex, and level of education, provide a reasonable indication of premorbid intelligence, but their ability to predict other related cognitive abilities is less well understood. This study aimed to develop regression equations, based on the TOPF and demographic variables, to predict scores on tests of verbal fluency and naming ability. A sample of 119 healthy adults provided demographic information and were tested using the TOPF, FAS, animal naming test (ANT), and graded naming test (GNT). Multiple regression analyses, using the TOPF and demographics as predictor variables, were used to estimate verbal fluency and naming ability test scores. Change scores and cases of significant impairment were calculated for two clinical samples with diagnosed neurological conditions (TBI and meningioma) using the method in Knight, McMahon, Green, and Skeaff (). Demographic variables provided a significant contribution to the prediction of all verbal fluency and naming ability test scores; however, adding TOPF score to the equationconsiderably improved prediction beyond that afforded by demographic variables alone. The percentage of variance accounted for by demographic variables and/or TOPF score varied from 19 per cent (FAS), 28 per cent (ANT), and 41 per cent (GNT). Change scores revealed significant differences in performance in the clinical groups, particularity the TBI group. Demographic variables, particularly education level, and scores on the TOPF should be taken into consideration when interpreting performance on tests of verbal fluency and naming ability.

COGNITIVE FUNCTION AS A PROXY OF FINANCIAL DECISION MAKING IN OLDER PRIMARY CARE ADULTS

Adults over 54 in the United States own about 2/3 of all wealth in the country. However, many older adults appear to make sub-optimal financial decisions, leaving them at high risk for financial exploitation and large monetary losses. To provide greater insights into the relationship among aging, diminished cognitive capacity, and financial decision-making, we administered a unique and comprehensive battery of neuropsychological tests, as well as unique assessments measuring financial literacy and monetary choice delay discounting, to 60 subjects aged 35–85 years. We then used regression analysis to analyze the relationships among these measures. The Executive Function/Organization (EF-O), Attention Working/Memory (AWM), Delay Discounting (DD), and Visuospatial Functions (VF) variables were the best predictors of financial literacy. The EF-O, AWM, and VF coefficients displayed a positive sign, indicating that higher scores on these tests predicted higher levels of financial literacy. The DD variable coefficient appeared with a negative sign, suggesting that higher discount rates (implying higher levels of impulsivity) predict lower levels of financial literacy. The age variable was highly significant in a positive direction, suggesting that financial literacy rates increase with age. Performance on standard tests of intelligence, including the MMSE and the Test of Premorbid Functioning, did not appear to be significant predictors of financial literacy. Measures of verbal and visual memory also did not appear significant. Much of the attention on preventing financial exploitation among the elderly, especially within the financial services industry, has been focused on memory loss. However, our results suggests that the executive function-related deficits associated with Alzheimer's disease (or other forms of dementia) are the biggest threats to an individual's capacity to make good financial decisions. The significance of executive-function related capabilities suggests that memory loss is not the only, and perhaps not even the most consequential, indicator of diminished financial decision-making capacity. Executive function-related measures remained significant even after controlling for age. The study points to the desirability of closer communication among mental health professionals, family members, and financial advisers. Because they are often the first to observe behavioral changes in their clients, financial advisers need more training and tools to help them identify potential warning signs.

P18.05 Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary Data on Clinical Utility within the Brain Tumor Population

OBJECTIVE: The detrimental effects of brain tumors and related treatments on cognitive capacity are well documented. Since sustaining or improving quality of life is a goal of equal importance to prolonged survival rates, neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools are criticized because they are insensitive to cognitive changes caused by medical treatments. One measure that may offer unique utility is the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Research supports the clinical value and psychometric properties of the RBANS in various medical populations; however, there is minimal evidence for its use in the brain tumor population. The purpose of this study was to determine RBANS utility in a sample of brain tumor patients by assessing the incidence of cognitive impairment relative to normative data, as well as to an estimate of pre-morbid intelligence. Participants. Data was collected on 38 patients (53% male; mean age 51, range 27-81) with primary brain tumors, confirmed by histopathological diagnosis. Eighty-Two percent had received surgery as initial treatment, and 45% had undergone radiation, chemotherapy or both prior to assessment. METHODS: All patients were administered the RBANS and the Test of Premorbid Functioning (TOPF, an estimate of pre-morbid intelligence) according to standardized instructions. Composite and Index Standard Scores (SS) from the RBANS were compared to a normal distribution (SS ≤85 indicative of impairment) and TOPF (≥1 SD difference indicative of impairment) per patient. Correlations were completed to identify cognitive relationships within this cohort. RESULTS: Descriptive profiling of RBANS will be presented. Regarding demonstrated deficits, comparison with standardization norms (RBANS; 47% compositely impaired, 68% on at least one index, and 53% on multiple indexes) was strikingly similar compared to self (TOPF; 50%, 71%, 53%). However, patients had an increased likelihood of global impairment when compared to self (4 to 5 indexes impaired; 32% vs 8%). There was a positive correlation between quantity of deficits and TOPF (r = .636, p = .000), whereas there was a negative correlation when compared to RBANS normative distribution (r = -.351, p = .031). CONCLUSIONS: Accuracy and interpretation of neuropsychological assessment is crucial within the brain tumor population to correctly identify impairment, its influences on perception of illness, level of support, and recommendations for management. Our preliminary research demonstrates the utility of RBANS as an efficient tool to assess cognitive impairment in patients with primary brain tumors. Our data also supports the importance of comparison to self and estimated premorbid intelligence, rather than normative distribution, to ensure precision in estimation of impairment.

Are Tests of Premorbid Functioning Subject to the Flynn Effect?

ObjectiveWhile there is a wealth of research into the Flynn effect, as yet no research exists examining the effect on tests of premorbid functioning. This study investigated the ability of the National Adult Reading Test (NART), the Wechsler Test of Adult Reading (WTAR), and the Test of Premorbid Functioning (TOPF) to predict premorbid IQ. It was hypothesised that the tests of premorbid functioning would produce differing premorbid IQ estimates, with the NART predicting the highest premorbid IQ scores, followed by the NART‐2 and the WTAR, with the TOPF predicting the lowest scores.MethodNinety‐five unimpaired Australian male and female participants aged between 18 and 65 years were administered a comprehensive battery of tests, including each of the tests of premorbid functioning.ResultsResults indicated that premorbid IQ estimates were significantly different (p < .001) from each other, with the NART producing the highest premorbid IQ estimate and the TOPF the lowest estimate.ConclusionsThese findings indicate that premorbid estimates of functioning are subject to the Flynn effect, thus use of estimates produced by tests of premorbid abilities that were designed to predict to earlier editions of the Wechsler scales will tend to inflate the level of premorbid baseline, leading to the possibility of spurious diagnosis of deficit. Clinicians should employ the most recently normed versions of these tests and employ the premorbid estimate which has been validated to predict the edition of the Wechsler scales that the individual will actually be using during any testing.

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

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

B-31Single Word Reading as a Test of Premorbid Functioning in Chronic Severe Acquired Brain Injury

B-31Single Word Reading as a Test of Premorbid Functioning in Chronic Severe Acquired Brain Injury

Rates of Abnormally Low TOPF Word Reading Scores in Individuals Failing Versus Passing Performance Validity Testing.

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer's dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.

Estimates of premorbid ability in a neurodegenerative disease clinic population: comparing the Test of Premorbid Functioning and the Wide Range Achievement Test, 4th Edition

Objective: Two frequently used measures to assess premorbid intellectual ability include the Wide Range Achievement Test, 4th Edition Reading Subtest (WRAT-4 READ) and the Test of Premorbid Functioning (TOPF). The present study compared estimates obtained from these measures in a neurodegenerative disease population. Method: Records from 85 referrals seen for neuropsychological evaluation in a neurodegenerative disorders clinic were reviewed. Evaluations included TOPF, WRAT-4 READ, and measures of memory, reasoning, language, and executive functioning. Pairwise correlations and concordance correlation coefficients (CCC) were calculated between raw scores and predicted intelligence estimates. Discrepancy scores were calculated between estimates and data were divided into three groups based on size of standardized discrepancy score: Equal, WRAT-4 READ > TOPF, and TOPF > WRAT-4 READ. analysis of variances compared groups on demographic characteristics and cognitive performance. Results: Despite strong Pearson correlation, CCC between predicted IQ estimates showed poor agreement between measures, with evidence of both fixed and proportional bias. Discrepancies ranged from −24.0 to 22.0 (M = 1.78, SD = 6.65), with TOPF generating higher estimates on average. Individuals performing better on WRAT-4 READ were significantly older (M age = 76.26, SD = 7.53) than those performing similarly on both measures and those performing better on TOPF (F (2, 82) = 7.31, p < .001). All other comparisons between groups on demographic variables and cognitive measures were non-significant. Conclusions: Estimates of premorbid intelligence obtained from the TOPF and WRAT-4 READ have a strong linear relationship, but systematically generate inconsistent estimates in a neurodegenerative disease clinical sample and should not be used interchangeably.

Utility of the Montreal Cognitive Assessment and Mini-Mental State Examination in predicting general intellectual abilities.

To determine whether scores from 2 commonly used cognitive screening tests can help predict general intellectual functioning in older adults. Cutoff scores for determining cognitive impairment have been validated for both the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). However, less is known about how the 2 measures relate to general intellectual functioning as measured by the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). A sample of 186 older adults referred for neuropsychological assessment completed the MoCA, MMSE, and WAIS-IV. Regression equations determined how accurately the screening measures could predict the WAIS-IV Full Scale Intelligence Quotient (FSIQ). We also determined how predictive the MoCA and MMSE were when combined with 2 premorbid estimates of FSIQ: the Test of Premorbid Functioning (TOPF) (a reading test of phonetically irregular words) and a predicted TOPF score based on demographic variables. MoCA and MMSE both correlated moderately with WAIS-IV FSIQ. Hierarchical regression models containing the MoCA or MMSE combined with TOPF scores accounted for 58% and 49%, respectively, of the variance in obtained FSIQ. Both regression equations accurately estimated FSIQ to within 10 points in >75% of the sample. Both the MoCA and MMSE provide reasonable estimates of FSIQ. Prediction improves when these measures are combined with other estimates of FSIQ. We provide 4 equations designed to help clinicians interpret these screening measures.