Wechsler Adult Intelligence Scale-Third Edition Research Articles

The Chinese Australian Neuropsychological Normative Study sample performance on Western and Chinese norms: Caveats for cross‐cultural neuropsychology

ObjectiveThe use of neuropsychological tests and norms developed for use with dominant culture English‐speaking Westerners when assessing persons from culturally and linguistically diverse (CALD) backgrounds has been appropriately questioned. Some authors have argued, however, that demographic corrections reduce or eliminate cross‐cultural differences. The primary purpose of the current study was to determine the suitability of using existing demographically adjusted Chinese and Western norms with Chinese Australians.MethodChinese Australian Neuropsychological Normative Study (CANNS) test data (based on N = 145 community dwelling Chinese Australians aged 55–87-years) were converted to demographically adjusted standard scores on the basis of comparison normative samples to examine whether the results were comparable across the CANNS and other Western and Chinese normative datasets.ResultsThe CANNS sample performed poorer than Westerners on the learning trials of the Rey Auditory Verbal Learning Test (RAVLT) but better than both Westerners and Chinese from China/Hong Kong on Trial 7. Performance on non‐verbal tests including the Rey‐Osterrieth Complex Figure Test (ROCFT) Copy, Wechsler Adult Intelligence Scale—Third Edition (WAIS‐III) Digit Symbol Coding (DSC) and Matrix Reasoning (MR), the Five‐Point Test, and the Clock Drawing Test was poorer than that of Westerners despite controlling for age and education. Use of Western norms resulted in significant false positive rates for all non‐verbal tests except MR.ConclusionThe findings of the current study caution against the use of Western tests for which CALD‐specific norms are not available, particularly non‐verbal tests.

WAIS Information Subtest as an indicator of crystallized cognitive abilities and brain reserve among highly educated older adults: A three-year longitudinal study

The Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Information Subtest (IS) is known as a neuropsychological “Hold” test that is relatively resistant to decline with aging. We administered neuropsychological tests among highly educated healthy older adults once a year for three subsequent years. Results showed highly stable performances on the IS across years (Mean Z score: T0 = 1.39, SD = 0.60; T1 = 1.37, SD = 0.77; T2 = 1.50, SD = 0.66; T3 = 1.48, SD = 0.66), that were significantly higher than zero (T0: t = 12.08; T1: t = 9.29; T2: t = 11.71; T3: t = 11.68; for all, p < 0.0001). In contrast, other neuropsychological tests showed differences in performance across time; some performances significantly declined (Rey Osterrieth Complex Figure test-copy, Rey-Auditory Verbal Learning Test, and Montreal Cognitive Assessment test [MoCA]), whereas others were improved, possibly due to practice effects (Rey Osterrieth Complex Figure test- delayed, Rey-Auditory Verbal Learning Test- delayed, and Trail Making Test- part A). Correlation with whole brain volumetric analysis revealed a positive correlation between gray matter volumes and IS scores (r = 0.46, p < 0.05) even when controlling for age and education (partial correlations: r = 0.43; r = 0.45, for both p < 0.05). No significant correlations were found between gray matter and other test scores. Therefore, the WAIS-III Information subtest appears to be an adequate neuropsychological measurement of crystallized ability in highly educated older adults and may be considered as a proxy measure of brain reserve.

The Chinese Australian Neuropsychological Normative Study: Neuropsychological Test Norms for Chinese Australians Aged 55–90-Years

ObjectiveGiven Australia's rapidly ageing population, demand for neuropsychological assessment to assist with the diagnosis and treatment/management of dementia and stroke will increase. Accurate and reliable neuropsychological assessment is dependent on the availability of appropriate normative data. Although more than a quarter of the Australian population comprises culturally and linguistically diverse (CALD) individuals, there have been no CALD‐specific normative studies published in Australia to date. The primary purpose of the current study was to collect norms on Australia's largest and one of its fastest growing CALD groups, Chinese Australians. Other aims included delineation of the influence of demographic factors and assessment of reliability coefficients of neuropsychological test scores for Chinese Australians.MethodA battery of neuropsychological tests was administered to N = 145 community dwelling Chinese Australians aged 55–87-years with the assistance of Chinese‐speaking interpreters.ResultsMultivariate analysis of variance revealed a significant influence of demographic factors across most test scores and norms were provided by the relevant stratifications. The Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Adult Intelligence Scale—Third Edition (WAIS‐III) Digit Symbol Coding (DSC) emerged as the most reliable tests for use with Chinese Australians.ConclusionThe influence of demographic variables and reliability coefficients of neuropsychological tests developed for dominant western cultural groups cannot be assumed to be the same across CALD groups. Use of CALD‐specific norms is recommended to increase the reliability and validity of neuropsychological testing.

An Exploratory Study of Mild Cognitive Impairment of Retired Professional Contact Sport Athletes.

To test the hypothesis that mild cognitive impairment (MCI) rates are higher among retired professional contact sport athletes than in noncontact athlete controls and compare history of contact sports with other MCI risk factors. University Concussion Management Clinic. Twenty-one retired National Football League and National Hockey League players and 21 aged-matched noncontact athlete controls. Case-control. Comprehensive criteria were used to assess MCI based on the following: Wisconsin Card Sorting Test, Delis-Kaplan Executive Function System; Trail Making Parts A and B; Wechsler Adult Intelligence Scale-Third Edition subtests; Neuropsychological Assessment Battery Memory Module List Learning, Story Learning, and Naming subtests; and Controlled Oral Word Association Test. The Wide Range Achievement Test was used as a proxy measure for IQ. Atherosclerotic cardiovascular disease risk factors were self-reported and blood cholesterol was measured. Depression was measured by the Beck Depression Inventory-II (BDI). Eight contact sport athletes (38%) and 3 noncontact athletes (14%) met MCI criteria (P = .083). Contact sport athletes' scores were significantly worse on Letter Fluency and List B Immediate Recall. Contact athletes were more obese, had more vascular risk factors, and had higher scores on the BDI than controls. Athletes with a history of playing professional contact sports had more vascular risk factors and higher depression scores. MCI rates were somewhat higher, though not significant.

Role of frontal white matter and corpus callosum on social function in schizophrenia

Patients with schizophrenia show severe impairment in social function and have difficulty in their daily social life. Although a recent large-scale multicenter study revealed alterations in white matter microstructures, the association between these anatomical changes and social dysfunction in schizophrenia remains unknown. Therefore, we investigated the association between the white matter integrity of regions of interest and social function in schizophrenia. A total of 149 patients with schizophrenia and 602 healthy comparison subjects (HCS) underwent DTI and completed the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale-Third Edition and the Finance subscale of the University of California, San Diego, Performance-Based Skills Assessment Brief, as social indices of interest. The fractional anisotropy (FA) in the anterior corona radiata and corpus callosum was significantly lower in patients than in HCS, and the radial diffusivity (RD) in the anterior corona radiata and corpus callosum was significantly higher in patients. The Picture Arrangement and Finance scores were both significantly impaired in patients. The effect of the FA of the right anterior corona radiata on the Finance score and the Picture Arrangement score, of the RD of the right anterior corona radiata on the Picture Arrangement score, and of the RD of the corpus callosum on the Picture Arrangement score were significant. In conclusion, our results confirmed the association between structural connectivity in the right frontal white matter and corpus callosum and social function in schizophrenia. These findings may provide a foundation for developing an intervention for functional recovery in schizophrenia.

High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance.

High-flow bypass followed by ligation of the internal carotid artery (ICA) is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. The present study evaluated the clinical results as well as cognitive performances after high-flow bypass using radial artery graft (RAG) with supportive superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, followed by ICA ligation. Ten consecutive patients underwent high-flow bypass surgery for large or giant ICA aneurysms of cavernous or cervical portion. Demographics, clinical information, magnetic resonance (MR) imaging, computed tomography, digital subtraction angiography (DSA), intraoperative somatosensory evoked potentials, neuropsychological examinations including the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R), and follow-up data were analyzed. The aneurysm was located on the cavernous segment in eight cases and cervical segment in two cases, and mean aneurysm size was 27.9mm. Postoperative DSA demonstrated robust bypass flow from the external carotid artery to MCA via the RAG, and no anterograde flow into the aneurysm. No patient showed new symptoms after the operation. Follow-up clinical study and MR imaging were performed in nine patients and showed no additional ischemic lesion compared with preoperative imaging. Seven patients completed neuropsychological examinations before and after surgery. All postoperative scores except WMS-R composite memory score slightly improved. High-flow bypass followed by ICA ligation can achieve good clinical outcomes. Successful high-flow bypass using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function.

Moderating Effects of Cortisol on Neural-Cognitive Association in Cognitively Normal Elderly Subjects.

Cortisol homeostasis is important for healthy brain and cognitive aging. The aim of the current study is to investigate the role of serum cortisol levels in the relationship between regional brain volumes and cognitive processing speed in a group of cognitively normal elderly subjects. Forty-one healthy elderly participants were from a parallel longitudinal study. The reported data in this study reflects baseline measurements. Whole-brain anatomical scanning was performed using a 3.0 Tesla Philips Medical Systems Achieva scanner. Cognitive processing speed was assessed by the digit-symbol and symbol search tests, from the Chinese version of the Wechsler Adult Intelligence Scale—third edition (WAIS-III). Serum cortisol levels (sampled in the late morning) were measured by ELISA kits. Whole-brain regression analysis revealed that serum cortisol levels positively predicted the white matter volumes (WMV) of the right thalamus, the gray matter volumes (GMV) of the left thalamus and right cerebellar tonsil, and negatively predicted the WMV and GMV of the left middle temporal gyrus (MTG) in 41 healthy elderly participants. Furthermore, serum cortisol significantly moderated the relationship between the GMV of the left MTG and processing speed, as well as the GMV of the left thalamus and processing speed. This study provided the first piece of evidence supporting serum cortisol levels in moderating the relationship between regional brain volumes and processing speed in healthy elderly subjects. This observation enriches our understanding of the role of cortisol in brain morphology and cognitive functioning.

Neurocognitive function in clinically stable individuals with long-term bipolar I disorder: Comparisons with schizophrenia patients and controls

This study compared the levels of the five domains of neurocognitive function—executive function, attention, memory, verbal comprehension, and perceptual organization—among clinically stable individuals with long-term bipolar I disorder, individuals with long-term schizophrenia, and a group of controls. We recruited a total of 93 clinically stable individuals with bipolar I disorder, 94 individuals with schizophrenia, and 106 controls in this study. Their neurocognitive function was measured using a series of neurocognitive function tests: the Wechsler Adult Intelligence Scale—Third Edition (WAIS-III), Line Cancellation Test, Visual Form Discrimination, Controlled Oral Word Association Test, Wisconsin Card Sorting Test, Continuous Performance Task, and Wechsler Memory Scale—Third Edition. Neurocognitive function was compared among the three groups through a multivariate analysis of variance. The results indicated that when the effect of age was controlled, clinically stable individuals with bipolar I disorder and those with schizophrenia demonstrated poor neurocognitive function on all tests except for the WAIS-III Similarity and Information and the Line Cancellation Test. The individuals with bipolar I disorder had similar levels of neurocognitive function compared with the schizophrenia group, but higher levels of neurocognitive function on the WAIS-III Comprehension, Controlled Oral Word Association Test, and Wechsler Memory Scale—Third Edition Auditory Immediate and Delayed Index and Visual Immediate and Delayed Index. The conclusions of this study suggest that compared with controls, individuals with long-term bipolar I disorder and those with long-term schizophrenia have poorer neurocognitive function, even when clinically stable. Individuals with long-term bipolar I disorder and those with long-term schizophrenia have similar levels of deficits in several domains of neurocognitive function.

Cognitive Deficits Post-Traumatic Brain Injury and Their Association with Injury Severity and Gray Matter Volumes.

Traumatic brain injury (TBI) is known to have a substantial though highly variable impact on cognitive abilities. Due to the wide range of cognitive abilities among healthy individuals, an objective assessment of TBI-related cognitive loss requires an accurate measurement of pre-morbid cognitive performance. To address this problem, we recruited 50 adults who sustained a TBI and had performed a cognitive baseline assessment in adolescence as part of the aptitude tests mandated by the Israeli Defense Forces. This group was matched with non-injured controls (n = 35). Pre- and post-injury cognitive assessments consisted of three domains-namely, verbal abstraction, mathematical reasoning, and non-verbal abstract reasoning (from the Wechsler Adult Intelligence Scale-Third Edition). The difference between post- and pre-injury scores was calculated as a measure of domain-specific cognitive decline. Voxel-based regression was used to correlate cognitive decline with modulated gray matter probability maps controlling for age, Glasgow Coma Scale, and total intracranial volume. Using objectively assessed cognitive scores, we found that abstract reasoning declined in both moderate-severe and mild TBI patients, whereas verbal abstraction declined only in the moderate-severe group. Mathematical reasoning was not affected by TBI. In the TBI patients, non-verbal abstract reasoning post-pre-injury change scores were negatively correlated with the volume of the insula. We conclude that access to pre-morbid neuropsychological data may have facilitated the discovery of the effects of mild TBI on abstract reasoning, as well as a significant correlation between TBI-related decline in this cognitive domain and the volume of the bilateral insula, both of which had not been appreciated in the past.

Exploring the neural substrates of attentional control and human intelligence: Diffusion tensor imaging of prefrontal white matter tractography in healthy cognition

We combined diffusion tension imaging (DTI) of prefrontal white matter integrity and neuropsychological measures to examine the functional neuroanatomy of human intelligence. Healthy participants completed the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) along with neuropsychological tests of attention and executive control, as measured by Trail Making Test (TMT) and Wisconsin Card Sorting Test (WCST). Stochastic tractography, considered the most effective DTI method, quantified white matter integrity of the medial orbital frontal cortex (mOFC) and rostral anterior cingulate cortex (rACC) circuitry. Based on prior studies, we hypothesized that posterior mOFC–rACC connections may play a key structural role linking attentional control processes and intelligence. Behavioral results provided strong support for this hypothesis, specifically linking attentional control processes, measured by Trails B and WCST perseverative errors, to intelligent quotient (IQ). Hierarchical regression results indicated left posterior mOFC–rACC fractional anisotropy (FA) and Trails B performance time, but not WCST perseverative errors, each contributed significantly to IQ, accounting for approximately 33.95–51.60% of the variance in IQ scores. These findings suggested that left posterior mOFC–rACC white matter connections may play a key role in supporting the relationship of executive functions of attentional control and general intelligence in healthy cognition.

Eye movement as a biomarker of schizophrenia: Using an integrated eye movement score.

Studies have shown that eye movement abnormalities are possible neurophysiological biomarkers for schizophrenia. The aim of this study was to investigate the utility of eye movement abnormalities in identifying patients with schizophrenia from healthy controls. Eighty-five patients with schizophrenia and 252 healthy controls participated in this study. Eye movement measures were collected from free viewing, fixation stability, and smooth pursuit tests. In an objective and stepwise method, eye movement measures were extracted to create an integrated eye movement score. The discriminant analysis resulted in three eye movement measures; the scanpath length during the free viewing test, the horizontal position gain during the fast Lissajous paradigm of the smooth pursuit test, and the duration of fixations during the far distractor paradigm of the fixation stability test. An integrated score using these variables can distinguish patients with schizophrenia from healthy controls with 82% accuracy. The integrated score was correlated with Wechsler Adult Intelligence Scale-Third Edition full scale IQ, Positive and Negative Syndrome Scale scores, and chlorpromazine equivalents, with different correlation patterns in the three eye movement measures used. The discriminant analysis in subgroups matched for age, sex, years of education, and premorbid IQ revealed a sustained classification rate. We established an integrated eye movement score with high classification accuracy between patients with schizophrenia and healthy controls, although there was a significant effect of medication. This study provides further evidence of the utility of eye movement abnormalities in schizophrenia pathology and treatment.

Self-awareness of cognitive dysfunction: Self-reported complaints and cognitive performance in patients with alcohol-induced mild or major neurocognitive disorder.

Patients with Korsakoff's syndrome (KS) typically have difficulties in recognizing the impact of their alcohol-related cognitive deficits on daily-life functioning. In this study, mean scores on self-reported complaints (measured with Minnesota Multiphasic Personality Inventory-2-Restructured Form; MMPI-2-RF) and cognitive performance (measured with the Wechsler Adult Intelligence Scale-Third edition; WAIS-III; and the California Verbal Learning Test; CVLT) are compared between two matched patient groups with severe (KS) and mild alcohol-related cognitive disorders or non KS (NKS). KS patients demonstrate significantly lower scores on the WAIS-III indices and on the CVLT than the matched NKS group, and significantly higher scores on MMPI-2-RF validity scales that indicate denial of psychological complaints. Both groups are in the normal range on MMPI-2-RF Cognitive Complaints (COG) and Neurological Complaints (NUC) scales compared with the normative sample. Finally, self-reported complaints and cognitive performance are not correlated significantly in both groups. Despite their alcohol-related cognitive impairments, both groups report no cognitive complaints at all indicating self-awareness impairment. In addition to KS patients, also NKS patients are at risk that their apparently "without cognitive complaints" appearance on self-report questionnaires can be easily overlooked. These findings may have important clinical implications for diagnostic and treatment purposes.

Searching for a neurologic injury’s Wechsler Adult Intelligence Scale-Third Edition profile

ABSTRACTThis study aimed to investigate the presence of a Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) cognitive profile in a Portuguese neurologic injured sample. The Portuguese WAIS-III was administered to 81 mixed neurologic patients and 81 healthy matched controls selected from the Portuguese standardization sample. Although the mixed neurologic injury group performed significantly lower than the healthy controls for the majority of the WAIS-III scores (i.e., composite measures, discrepancies, and subtests), the mean scores were within the normal range and, therefore, at risk of being unobserved in a clinical evaluation. ROC curves analysis showed poor to acceptable diagnostic accuracy for the WAIS-III composite measures and subtests (Working Memory Index and Digit Span revealed the highest accuracy for discriminating between participants, respectively). Multiple regression analysis showed that both literacy and the presence of brain injury were significant predictors for all of the composite measures. In addition, multiple regression analysis also showed that literacy, age of injury onset, and years of survival predicted all seven composite measures for the mixed neurologic injured group. Despite the failure to find a WAIS-III cognitive profile for mixed neurologic patients, the results showed a significant influence of brain lesion and literacy in the performance of the WAIS-III.

Predicting verbal fluency using Word Reading: Implications for premorbid functioning

ABSTRACTThe estimation of premorbid general intellectual functioning using word reading tests has a rich history of validation and is a common assessment practice for neuropsychologists. What is less well-researched is the approach used to estimate premorbid functioning of non-intellectual domains, such as executive functions, including verbal fluency. The current study evaluated this relationship with 41 adult college students who completed the Word Reading subtest of the Wechsler Individual Achievement Test-Second Edition (WIAT-II) and the Verbal Fluency test from the Delis–Kaplan Executive Function System (D-KEFS). Path analysis indicated that only Letter Fluency (a measure of phonemic fluency) was statistically significantly related to Word Reading and the relationship was somewhat weak. The relationship between Category Fluency (a measure of semantic fluency) and Category Switching (a measure of verbal fluency cognitive set-shifting) to Word Reading was nonsignificant. Participants also completed the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), and as expected a strong relationship was found between Word Reading and the Verbal IQ (VIQ), Performance IQ (PIQ), and Full Scale Intelligence Quotient (FSIQ). Results of this study strongly suggest that caution be exercised when extrapolating an estimate of premorbid verbal fluency abilities from measures of word reading.

Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance.

Clinical results as well as cognitive performances after extracranial to intracranial (EC-IC) bypass in conjunction with contralateral carotid endarterectomy (CEA) are poorly understood. Data from 14 patients who underwent unilateral EC-IC bypass for atherosclerotic internal carotid artery (ICA)/middle cerebral artery (MCA) steno-occlusive disease in conjunction with CEA for contralateral cervical carotid stenosis were retrospectively reviewed. Postoperative results were evaluated by MRI imagings. Nine patients also underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R) before and about 6months after bilateral surgeries. Postoperative MRI follow-up (median, 8months; interquartile range, 7-8months) confirmed successful bypass in all patients, with no additional ischemic lesions on T2WI when compared with preoperative imaging. Further, MRA showed patent bypass and contralateral smooth patency at CEA portion in all patients. In the group rate analysis, all five postoperative NPE scores (Verbal IQ, Performance IQ, WMS-memory, WMS-attention, and Average scores of all those four scores) were improved relative to preoperative NPE scores. Performance IQ and Average score improvements were statistically significant. Clinical results after EC-IC bypass in conjunction with contralateral CEA were feasible. Based on the group rate analysis, we conclude that successful unilateral EC-IC bypass and contralateral carotid endarterectomy does not adversely affect postoperative cognitive function.

Interpreting WAIS-III performance after primary brain tumor surgery

ABSTRACTThe literature lacks information on the performance of patients with brain tumors on the Wechsler Intelligence Scales. This study aimed to explore the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) performance profile of 23 consecutive patients with brain tumors and 23 matched controls selected from the Portuguese WAIS-III standardization sample, using the technical manual steps recommended for score interpretation. The control group was demographically matched to the tumor group regarding gender, age, education, profession, and geographic region. The technical manual steps recommended for score interpretation were applied. Patients with brain tumors had significantly lower performances on the Performance IQ, Full-Scale IQ, Perceptual Organization Index, Working Memory Index, Processing Speed Index, Arithmetic, Object Assembly, and Picture Arrangement, though all scaled scores were within the normal range according to the manual tables. Only Vocabulary and Comprehension scatter scores were statistically different between groups. No strengths or weaknesses were found for either group. The mean discrepancy scores do not appear to have clinical value for this population. In conclusion, the study results did not reveal a specific profile for patients with brain tumors on the WAIS-III.

Propranolol's impact on cognitive performance in post-traumatic stress disorder

BackgroundPropranolol has effectively diminished fear-based emotional memories in posttraumatic stress disorder (PTSD) and this effect has been attributed to traumatic memory reconsolidation blockade. However, propranolol may also exert cognitive effects by modulating stress and arousal. MethodWithin a randomized double-blind placebo controlled trial, propranolol's impact on cognitive functioning was examined in individuals who were diagnosed with chronic PTSD. Participants received a single dose of 1mg/kg of propranolol (n=20) or placebo (n=21), and completed subtests of the Wechsler Adult Intelligence Scale third edition (WAIS-III). PTSD symptoms were assessed 1 week before and after treatment by the Impact of Event Scale Revised (IES-R). ResultsThe propranolol group performed significantly better on the Processing Speed composite measure compared to the placebo group. Furthermore, greater heart rate decreases were associated with higher Perceptual Organization performance, within the propranolol group. LimitationsThe generalizability of results may have been reduced as participants were treatment seeking; the sample size was small and included a greater proportion of females.This study could not assess whether pre-existing psychological function influenced cognitive performance, post-trauma. Future studies might consider including a non-PTSD control group to determine if our findings are specific to propranolol's effect on PTSD associated cognitive impairment. ConclusionsOur preliminary results demonstrated that cognitive functioning improved following propranolol administration in PTSD patients. The implications are discussed with regards to the processing of traumatic events.

Postoperative transient neurological symptoms and chronic subdural hematoma after extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases: negative effect on cognitive performance.

The mechanisms underlying post-extracranial to intracranial (EC-IC) bypass neurocognitive changes are poorly understood. Data from 55 patients who underwent a unilateral EC-IC bypass for atherosclerotic internal carotid artery (ICA)/middle cerebral artery (MCA) steno-occlusive disease were retrospectively evaluated. These patients underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and Wechsler Memory Scale-Revised (WMS-R) before and 6months after EC-IC bypass. Results of NPEs were converted into Z-scores from which preoperative cognitive composite scores (CSpre) and postoperative cognitive composite scores (CSpost) were obtained. The association between the change of composite score between pre- and postoperative NPEs (CSpost-pre = CS post - CS pre) and various variables were assessed. These latter variables included occluded artery (ICA or MCA), preexisting ischemic lesion as verified in preoperative T2WI, robust bypass patency as verified by MRA performed approximately 6months postoperatively, and postoperative transient neurological symptoms and/or postoperative chronic subdural hematoma (CSDH), both of which were dichotomized as postoperative events. Postoperative MRI follow-up (median, 6months; interquartile range, 5-8 months) confirmed successful bypasses in all patients, with no additional ischemic lesions on T2WI when compared with preoperative imaging. Further, MRA showed patent bypasses in all patients. A nearly statistically significant CS post-pre decrease was observed in patients with postoperative events when compared with those without postoperative events (-0.158 vs. 0.039; p = 0.069). A multiple regression model predicting CSpost-pre was performed. After controlling for occluded arteries, postoperative events were identified as an independent predictor of a decline in CSpost-pre (p = 0.044). In the group rate analysis, three of four postoperative NPE scores (Performance IQ, WMS-memory, WMS-attention) were significantly improved relative to preoperative NPE scores. Postoperative transient neurological symptoms and/or CSDH might play a significant role in the subtle decline in cognition following an EC-IC bypass. However, this detrimental effect was small, and based on the group rate analysis, we concluded that a successful unilateral EC-IC bypass does not adversely affect postoperative cognitive function.

Embedded Performance Validity Measures with Postdeployment Veterans: Cross-Validation and Efficiency with Multiple Measures

Embedded validity measures support comprehensive assessment of performance validity. The purpose of this study was to evaluate the accuracy of individual embedded measures and to reduce them to the most efficient combination. The sample included 212 postdeployment veterans (average age = 35 years, average education = 14 years). Thirty embedded measures were initially identified as predictors of Green’s Word Memory Test (WMT) and were derived from the California Verbal Learning Test-Second Edition (CVLT-II), Conners’ Continuous Performance Test-Second Edition (CPT-II), Trail Making Test, Stroop, Wisconsin Card Sorting Test-64, the Wechsler Adult Intelligence Scale-Third Edition Letter-Number Sequencing, Rey Complex Figure Test (RCFT), Brief Visuospatial Memory Test-Revised, and the Finger Tapping Test. Eight nonoverlapping measures with the highest area-under-the-curve (AUC) values were retained for entry into a logistic regression analysis. Embedded measure accuracy was also compared to cutoffs found in the existing literature. Twenty-one percent of the sample failed the WMT. Previously developed cutoffs for individual measures showed poor sensitivity (SN) in the current sample except for the CPT-II (Total Errors, SN = .41). The CVLT-II (Trials 1–5 Total) showed the best overall accuracy (AUC = .80). After redundant measures were statistically eliminated, the model included the RCFT (Recognition True Positives), CPT-II (Total Errors), and CVLT-II (Trials 1–5 Total) and increased overall accuracy compared with the CVLT-II alone (AUC = .87). The combination of just 3 measures from the CPT-II, CVLT-II, and RCFT was the most accurate/efficient in predicting WMT performance.

Graves' hyperthyroidism‐induced psychosis in a patient with periventricular nodular heterotopia

Cases of gray matter heterotopia with schizophrenia,1 bipolar disorder,2 and depression3 have been reported; however, the relation between malformations of cortical development and psychotic symptoms is unknown. Here, we describe a woman with a malformation of cortical development who was diagnosed with Graves' hyperthyroidism-induced psychosis. The patient has provided written consent authorizing publication of this report. The patient was an unemployed 40-year-old woman who lived with her parents. About a year before her admission, she started to embarrass her parents occasionally by exhibiting transient paranoid and hallucinatory behavior. This culminated in an acute exacerbation of disorganized behavior, including self-injury and confining herself in a closet a week before her admission. While under the influence of an imperative hallucination, she jumped out of an upstairs window, and was brought to the emergency unit due to fractures of her thoracic and lumbar vertebrae and right calcaneus and damage of her lumbar spine. After admission, she responded sluggishly with a monotonous expression while sometimes crying out suddenly. She was under the strong influence of auditory hallucinations and exhibited delusions of persecution and disorganized thought and behavior. An examination revealed slight exophthalmos, tachycardia, elevated levels of free thyroxine (4.6 ng/dL [normal range: 0.8–1.8]) and free triiodothyronine (FT4; 7.2 pg/mL [2–4.5]), decreased level of thyroid-stimulating hormone (TSH; 0.005 μIU/mL [0.34–4.5]), and the presence of TSH-binding inhibitory immunoglobulin (TBII), which fulfilled the diagnostic criteria of Graves' disease. Brain magnetic resonance imaging revealed unilateral periventricular nodular heterotopia with polymicrogyria in the trigone of right lateral ventricle, accompanied by the dysplasia of right hippocampus and amygdala (Fig. S1). An electroencephalogram showed normal occipital alpha waves (range: 9–10 Hz) with no paroxysmal discharge. Testing with the Wechsler Adult Intelligence Scale-Third Edition showed an almost borderline IQ (verbal: 89; performance: 84; and full-scale: 85) with low processing speed (72). After her admission, we started treating her with olanzapine (up to 10 mg) and thiamazole (15 mg) once a day. As her FT4 levels normalized, so did her behavior. After tapering thiamazole to 5 mg and olanzapine to 1.25 mg once a day, we discharged her and continued treating her as an outpatient. During the 2 years after her discharge, very short recurrences of disorganized behavior were reported twice, while the hyperthyroidism remission and normal social functioning were maintained. To the best of our knowledge, this is the first reported case of heterotopia with Graves' hyperthyroidism-induced psychosis. This case may help clarify the relation between malformations of cortical development and psychotic symptoms. Figure S1. Brain magnetic resonance imaging of the present case. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.