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Evidence-based diagnostic methods have clinical and research applications in neuropsychology. A flexible Bayesian model was developed to yield diagnostic posttest probabilities from a single person’s neuropsychological score profile by utilizing sample descriptive statistics of the test battery across diagnostic populations of interest.
Three studies examined the model’s performance. One simulation examined estimation accuracy of true z-scores. A diagnostic accuracy simulation utilized descriptive statistics from two popular neuropsychological tests, the Wechsler Adult Intelligence Scale–IV (WAIS-IV) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The final simulation examined posterior predictive accuracy of scores to those reported in the WAIS manual.
The model produced minimally biased z-score estimates (root mean square errors: .02–.18) with appropriate credible intervals (95% credible interval empirical coverage rates: .94–1.00). The model correctly classified 80.87% of simulated normal, mild cognitive impairment, and Alzheimer’s disease cases using a four subtest WAIS-IV and the RBANS compared to accuracies of 60.67–65.60% from alternative methods. The posterior predictions of raw scores closely aligned to percentile estimates published in the WAIS-IV manual.
This model permits estimation of posttest probabilities for various combinations of neuropsychological tests across any number of clinical populations with the principal limitation being the accessibility of applicable reference samples. The model produced minimally biased estimates of true z-scores, high diagnostic classification rates, and accurate predictions of multiple reported percentiles while using only simple descriptive statistics from reference samples. Future nonsimulation research on clinical data is needed to fully explore the utility of such diagnostic prediction models.
Introduction: Major depressive disorder (MDD) is thought to negatively impact cognitive function; however, the relationship has not been well explored.
Objective: This study examined the association between depression severity and global cognitive function and memory in subjects with severe, treatment-resistant MDD.
Methods: We enrolled 66 subjects with Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosed unipolar MDD in a multicenter trial to assess the efficacy and neurocognitive effects of electroconvulsive therapy (ECT). We measured depression severity with the 24 item Hamilton Rating Scale for Depression (HRSD24). Neuropsychologic measures included the Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and the Complex Figure Test (CFT). Correlational and regression analyses were conducted to explore associations between depression severity and cognitive function.
Results: The mean age of the subjects was 53.6 years (SD=15.8), 65% were female, and mean HRSD24 was 33.9 (SD=6.7). Mean demographic-corrected T-scores for each neurocognitive measure were in the average to borderline range, and HRSD24 values were unrelated to performance on the MMSE, RAVLT immediate and delayed recall, and CFT immediate and delayed recall.
Conclusion: In this sample of severely depressed subjects referred for ECT, depression severity was unrelated to global cognitive function or memory. Future research should examine the interactions between other depressive characteristics and neurocognitive function.
The use of videoconference technology to deliver health care diagnostics and treatment continues to grow at a rapid pace. Telepsychiatry and telepsychology applications are well-accepted by patients and providers, and both diagnostic and treatment outcomes have generally been similar to traditional face-to-face interactions. Preliminary applications of videoconference-based neuropsychological assessment (teleneuropsychology) have yielded promising results in the feasibility and reliability of several standard tests, although large-scale studies are lacking. This investigation was conducted to determine the reliability of video teleconference (VTC) - based neuropsychological assessment using a brief battery of standard neuropsychological tests commonly used in the evaluation of known or suspected dementia. Tests included the Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test-Revised, Digit Span forward and backward, short form Boston Naming Test, Letter and Category Fluency, and Clock Drawing. Tests were administered via VTC and in-person to subjects, counterbalanced using alternate test forms and standard instructions. Two hundred two adult subjects were tested in both rural and urban settings, including 83 with cognitive impairment and 119 healthy controls. We found highly similar results across VTC and in-person conditions, with significant intraclass correlations (mean=.74; range: 0.55–0.91) between test scores. Findings remained consistent in subjects with or without cognitive impairment and in persons with MMSE scores as low as 15. VTC-based neuropsychological testing is a valid and reliable alternative to traditional face-to-face assessment using selected measures. More VTC-based studies using additional tests in different populations are needed to fully explore the utility of this new testing medium. (JINS, 2014, 20, 1–6)
This chapter reviews conceptual issues and definitions of the executive function. It is argued that executive function is a multidimensional construct and it is suggested that subspecialists in Behavioral neurology (BN) & Neuropsychiatry (NP) regard executive function principally as a cognitive domain. Executive function requires the integrated actions of the frontal-subcortical circuits, open-loop connections to other neocortical areas, limbic and paralimbic structures, thalamic nuclei, pontocerebellar networks, modulatory neurochemical projections from mesencephalic and ventral forebrain structures, and the white matter connections within and between all of these areas. As such, executive dysfunction is more accurately understood as dysfunction within or across these networks. The distributed structural and functional anatomy of executive function renders it vulnerable to disruption by many conditions affecting the brain. Finally, the chapter briefly discusses neuropsychological tests and bedside assessments of executive function.
There is limited understanding of the effects of normal and abnormal aging on gist-based memory in relation to the massive evidence regarding detail-based memory. This void is striking given the widely accepted view that memory is rarely veridical, but most often abstracted. The present study examined the effects of healthy advanced aging and mild Alzheimer's disease (AD) on three distinct forms of gist. Two of these gist forms involved a passage: transformed gist (global generalised meaning of a passage) and main-idea gist (main points of a passage). The third gist form involved a word list: categorical gist (clustering of words according to semantic categories during list recall). These gist forms were assessed in immediate and delayed recall conditions. A total of 36 participants were included: 12 cognitively healthy young seniors (65–79 years), 12 cognitively healthy old seniors (80–95 years), and 12 young seniors with mild AD (65–79 years). The findings revealed that age and dementia did not equally affect all three forms of gist. Specifically, transformed gist was relatively maintained in the cognitively healthy senior groups as compared to the other two gist forms (main-idea gist and categorical gist), whereas all three gist forms were impaired in individuals with AD. The present study suggests that transformed gist operates differently than detail-based memory in the cognitively healthy senior groups. These findings have important theoretical implications in terms of informing existing models on the interrelationship between gist and detail-based memory and clinical implications in diagnosis of AD.
Traumatic axonal injury (TAI) is a common mechanism of traumatic brain injury not readily identified using conventional neuroimaging modalities. Novel imaging modalities such as diffusion tensor imaging (DTI) can detect microstructural compromise in white matter (WM) in various clinical populations including TAI. DTI-derived data can be analyzed using global methods (i.e., WM histogram or voxel-based approaches) or a regional approach (i.e., tractography). While each of these methods produce qualitatively comparable results, it is not clear which is most useful in clinical research and ultimately in clinical practice. This study compared three methods of analyzing DTI-derived data with regard to detection of WM injury and their association with clinical outcomes. Thirty patients with TAI and 19 demographically similar normal controls were scanned using a 3 Tesla magnet. Patients were scanned approximately eight months postinjury, and underwent an outcomes assessment at that time. Histogram analysis of fractional anisotropy (FA) and mean diffusivity showed global WM integrity differences between patients and controls. Voxel-based and tractography analyses showed significant decreases in FA within centroaxial structures involved in TAI. All three techniques were associated with functional and cognitive outcomes. DTI measures of microstructural integrity appear robust, as the three analysis techniques studied showed adequate utility for detecting WM injury. (JINS, 2011, 17, 000–000)
The effect of bilingualism on qualitative aspects of verbal learning and memory was investigated. Equivalent list learning tests in English and Spanish were carefully constructed, and compared across two bilingual Hispanic groups of Mexican origin that differed in their level of English proficiency (“balanced” and “nonbalanced” bilinguals) and a group of monolingual English-speaking non-Hispanic subjects. Groups were matched for age, education, and gender composition. Nonbalanced bilinguals assessed in English utilized semantic clustering to the same extent as monolinguals, but learned fewer words overall, and demonstrated lower retention scores compared to monolinguals. Comparisons of groups assessed in their dominant languages, however, revealed no significant differences on any of the learning and memory indices examined. In addition to comparisons with standard clinical memory indices, assessment issues concerning bilingual individuals are addressed. (JINS, 1995, I, 10–16.)
Despite some well-documented differences, normal aging and Alzheimer's disease (AD) share a number of common neuropathological and neuropsychological features. Many of the reported differences are largely quantitative in nature and there is often overlap between the respective distributions of these populations. To assess the issue of overlap and distinguishing features in memory functions between these groups, and to minimize aging effects per se, samples of older individuals in good health (ages 75–95 yr) and younger patients in the early stages of AD (age < 75 yr) were selected to be similar in global cognitive functioning. Despite comparable language and visuospatial scores, these preliminary results suggest important qualitative differences in episodic memory functions between these conditions, even when “low-functioning” or “at-risk” controls are compared with early AD patients. These findings furthermore highlight some of the challenges in defining “normality” among the oldest segment of our population. (JINS, 1995, I, 100–103.)
Donepezil has been shown to improve aspects of cognitive functioning in persons with Alzheimer's disease (AD), but its impact on instrumental activities of daily living has received little attention. In a within-subject design, 24 community-dwelling persons with AD were treated with open-label donepezil over a 12-month period. To assess functional abilities, a brief, objective measure of instrumental activities of daily living skills was used (Texas Functional Living Scale; TFLS). Global cognitive abilities were assessed with the Mini-Mental State Examination (MMSE). Changes in TFLS and MMSE scores were much the same. Improvements on the TFLS and MMSE were seen over a 3-month period. At 12 months, both TFLS and MMSE scores declined slightly below baseline. These results support an effect of donepezil on cognitive measures and day-to-day function and also suggest that the MMSE reflects well the actual functional ability of persons with moderate AD.
Essential tremor (ET) is the most common type of movement
disorder, although its etiology and neurophysiological substrates
remain unclear. While thought to be a benign condition, it has
yet to be studied from a neuropsychological perspective. We
examined the neurocognitive functioning of 13 nondemented subjects
with severe ET, including aspects of memory, cognitive flexibility,
and attention. Results revealed that 12/13 subjects
demonstrated impairment on 1 or more cognitive measures in
comparison with published normative data. The pattern of findings
was suggestive of relative dysfunction of frontal-mediated
processes not unlike that seen in Parkinson's disease.
These deficits were found in subjects irrespective of the presence
of cognitive complaints, depression, or the existence of other
potential neurocognitive risk factors. These findings suggest
that mild cognitive deficits are not uncommon in association
with severe ET and may be related to subcortical systems.
(JINS, 2002, 8, 125–129.)
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