The bird's nest drawing and accompanying stories in the assessment of attachment security

ABSTRACT

Art therapists recognise the importance of clients’ early attachment experience. The Bird's Nest Drawing (BND) is an attachment security measure with potential for research and practice, developed by American art therapists. The client draws a bird's nest and writes a corresponding narrative, the latter assisting an integrative evaluation. A systematic rating procedure currently only exists for the drawings. The present study was conducted to determine the psychometric properties of the BND after adding new ratings of the BND story using data from an earlier study with university students. The current investigators established a systematic method for coding BND stories (N?=?136). Content analysis yielded five ratings, which were examined in conjunction with the corresponding drawings and existing drawing ratings, and two self-report attachment questionnaires. Four of the 11 drawing rating items and the overall attachment rating had acceptable psychometric properties, as did two of the new story ratings. However, the seven items did not inter-correlate consistently, nor yield improved internal reliability. Construct validity using the established attachment scales was not established convincingly. Results suggest a need for further development of the BND taking greater account of psychometric principles of scale development, with implications for art therapy research and practice.

Plain-language summary

The relationship people have with others can be greatly affected by the childhood experiences they have with those caring for them and can cause what art therapists call ‘attachment difficulties’. The Bird's Nest Drawing, first developed in America, provides a way for therapists (and researchers) to understand people's attachment difficulties. Drawings can express what is difficult to say in words. The person draws a bird's nest and writes a short story about it. Inclusion of the story is intended to provide richer information about the client and his or her drawing.

It is important that the drawing and accompanying story provide an accurate view of people's attachment experiences. This is more likely if they use a tested set of instructions to rate elements in the drawing, such as how the nest is positioned on the tree. Instructions for rating drawings already exist, however no instructions existed for rating the stories people tell. In this study, we used 136 drawings and stories from a previous study with American university students, and also participants’ scores (from the same study) on well-established questionnaires about attachment relationships. We devised a rating system for the stories. Then we checked how reliable and accurate the ratings were for both the drawings and the stories. Part of this checking involved comparing the ratings with the questionnaire scores.

We found that neither the existing drawing ratings nor the new story ratings were sufficient when judged by established principles for good design of assessment measures. For example, the ratings did not sufficiently fit the pattern of scores on the established questionnaires. Although drawings can be helpful in art therapy when people find it difficult to use words, we suggest that therapists and researchers exercise caution in how they use the Bird's Nest Drawing (even with stories) until it can be further developed as an assessment measure.     

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive–Compulsive Scale

BackgroundPreliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version.MethodsParticipants included 86 individuals with a principal diagnosis of obsessive–compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview.ResultsThe two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings.ConclusionsThe study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.     

Psychometric evaluation of the Ward Atmosphere Scale in a Russian psychiatric hospital

Aim: The aim of the study was to evaluate the psychometric properties of the 10 subscales of the Ward Atmosphere Scale (WAS) in a Russian psychiatric hospital. Methods: A total of 212 patients and 96 staff members at five wards for acute psychiatric patients completed the WAS. We calculated Cronbach's alpha, the Corrected Item Total Subscale Correlation (CITC), and item-revised subscale intercorrelations. Results: By removing a total of 32 items, the psychometric properties for all subscales except “Autonomy”, reached an acceptable level for the patient scores. Although several of the revised subscales were highly intercorrelated, the specificity of the items of the revised scales appeared acceptable. Conclusions: The revised WAS version appeared applicable within this Russian psychiatric hospital context. Several of the items that were dropped appeared inapplicable because of differences between Russian and Western culture and psychiatry.     

Differential utility of teacher and parent–teacher combined information in the assessment of Attention Deficit/Hyperactivity Disorder symptoms

Background

Consistent research findings indicate that parents and teachers observe genuinely different Attention Deficit/Hyperactivity Disorder (ADHD) behaviours in their respective settings.

Objective

To evaluate the utility of information provided by teacher informant assessments (INFAs) of ADHD symptoms, and the implications of aggregation algorithms in combing parents’ information, i.e. using ‘or-rule’ (endorsement by either one informant) versus ‘and-rule’ (endorsement by both informants).

Method

Teacher ratings on Conners scales and clinical data from parental accounts on 1383 probands and their siblings from the IMAGE study were analysed. The psychometric properties of teacher and combined ratings using the item response theory model (IRT) are presented. Kappa coefficients, intraclass correlations and linear regression were employed.

Results

First, teacher endorsement of symptoms is located in a narrow part of the trait continuum close to the average levels. Symptoms exhibit comparable perception in the measurement of the trait(s) with similar discrimination ability and information (reliability). Second, the IRT properties of the ‘or-rule’ ratings are predominantly influenced by parent-INFAs; and the ‘and-rule’ ratings predominantly by teacher-INFAs ratings. Third, parent-teacher INFAs agreement was low, both for individual items (κ = 0.01–0.15) and for dimensional scores (r = 0.12–0.16). The ‘or-rule’ captured milder expressions of ADHD symptoms, whereas the ‘and-rule’ indexed greater severity of ADHD.

Conclusions

Parent and teacher-INFAs provide different kinds of information, while both are useful. Teacher-INFA and the ‘and-rule’ provide a more accurate index of severity than an additive symptom count. Parent-INFA and the ‘or-rule’ are more sensitive for detecting cases with milder ADHD.

     

Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression

ABSTRACT

Objective: Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders.

Methods: Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups.

Results: The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ² = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models.

Conclusions: Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.     

Comparing self- and expert rating: a self-report screening version (SIAB-S) of the Structured Interview for Anorexic and Bulimic Syndromes for DSM-IV and ICD-10 (SIAB-EX)

Objective: Carrying out structured interviews in larger numbers by well-trained interviewers is costly and time consuming. Therefore, we developed parallel to the existing Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX) a similarily designed questionnaire for symptoms of disordered eating and related areas (SIAB-S). Method: 377 treated eating disordered patients were assessed within a two-week time period using both the SIAB-EX and SIAB-S. Results: Generally, self-ratings based on the SIAB-S were quite similar to expert ratings. Cohen's kappa showed good agreement between self- and expert ratings. Factor structure based on principal component analyses of expert ratings or self-ratings led to rather similar results confirming the robustness of the subscales in self- and expert ratings. Using expert rating as a criterion, the self-rating (SIAB-S) – which can more easily be used for screening purposes – had a sensitivity of 0.70, a specificity of 0.80 and a PPV = 0.91 for the DSM-IV diagnoses of AN and/or BN (worst ever condition). Diagnostic sensitivity (79/73%) and specificity (66/63%) were in an acceptable range (past/current). If we focus on the differences between the two approaches the following was found: self-rating (compared to expert-rating) resulted in lower scores for items inquiring about binges and inappropriate compensatory behaviour, attitudes towards food and eating, and social interaction. On the other hand, self-rating (compared to expert-rating) led to higher scores for items measuring general psychopathology and atypical bingeing. Conclusion: compared to the “gold standard” of data obtained with investigator-based standardised or structured interviews, data based on self-rating with items formulated clearly and concisely can lead to reliable and valid results. While complex issues (what is a binge) are difficult to assess in self-ratings, some (very personal) questions may even be better asked in a self-report questionnaire. Received: 21 June 1999 / Accepted: 22 March 2000     

Development and Validation of the Stroke Knowledge Test

Abstract

Purpose: The purpose of this study was to develop a measure of stroke knowledge (the Stroke Knowledge Test [SKT]) using a systematic test construction process and to investigate the psychometric properties of this test. There are relatively few published measures of stroke knowledge, and, of those that exist, relatively little is documented about test construction or psychometric properties. Such tests are important for evaluation of stroke education programs. Method: Test construction involved systematic generation of pilot test items, expert review of pilot items, and calculation of pilot item properties. After final item selection, two experiments were conducted to determine if the SKT was sensitive to varying levels of stroke knowledge and to estimate the reliability of the test. Results: The final version of the test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Results from psychometric investigations suggest that SKT has relatively good reliability (internal consistency and test-retest reliability) and construct validity (i.e., SKT scores significantly increased after stroke education [cf. nonstroke education], and community-dwelling older adults who had a relative with stroke [and more prior exposure to stroke information] scored higher on the SKT than those without a stroke relative). Conclusion: Findings provide preliminary support for the SKT as a valid and reliable tool for assessing stroke knowledge. The SKT may be used to identify individual information needs of stroke survivors and their caregivers or as a tool to evaluate group- or community-based stroke education programs.     

The 15-item version of the Boston Naming Test as an index of English proficiency

Objective: The present study was designed to examine the potential of the Boston Naming Test – Short Form (BNT-15) to provide an objective estimate of English proficiency. A secondary goal was to examine the effect of limited English proficiency (LEP) on neuropsychological test performance.Method: A brief battery of neuropsychological tests was administered to 79 bilingual participants (40.5% male, M_Age = 26.9, M_Education = 14.2). The majority (n = 56) were English dominant (EN), and the rest were Arabic dominant (AR). The BNT-15 was further reduced to 10 items that best discriminated between EN and AR (BNT-10). Participants were divided into low, intermediate, and high English proficiency subsamples based on BNT-10 scores (≤6, 7–8, and ≥9). Performance across groups was compared on neuropsychological tests with high and low verbal mediation.Results: The BNT-15 and BNT-10 respectively correctly identified 89 and 90% of EN and AR participants. Level of English proficiency had a large effect (partial η² = .12–.34; Cohen’s d = .67–1.59) on tests with high verbal mediation (animal fluency, sentence comprehension, word reading), but no effect on tests with low verbal mediation (auditory consonant trigrams, clock drawing, digit-symbol substitution).Conclusions: The BNT-15 and BNT-10 can function as indices of English proficiency and predict the deleterious effect of LEP on neuropsychological tests with high verbal mediation. Interpreting low scores on such measures as evidence of impairment in examinees with LEP would likely overestimate deficits.     

Improved Diagnostic Validity of the ADOS Revised Algorithms: A Replication Study in an Independent Sample

Recently, Gotham et al. (2007) proposed revised algorithms for the Autism Diagnostic Observation Schedule (ADOS) with improved diagnostic validity. The aim of the current study was to replicate predictive validity, factor structure, and correlations with age and verbal and nonverbal IQ of the ADOS revised algorithms for Modules 1 and 2 in a large independent Dutch sample (N = 532). Results showed that the improvement of diagnostic validity was most apparent for autism, except in very young or low functioning children. Results for other autism spectrum disorders were less consistent. Overall, these findings support the use of the more homogeneous revised algorithms, with the use of similar items across developmental cells making it easier to compare ADOS scores within and between individuals.     

Specific Effects of Individualized Cognitive Training in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): The Role of Pre-Training Cognitive Impairment and Individual Training Performance

ABSTRACT

Objective: We investigated the impact of the pre-training neuropsychological (NP) impairment and of the training progress on the NP and behavioural outcome after computerized cognitive training (CogT) in children with ADHD. Method: Thirty-one participants underwent individualized CogT (focussing on one or two cognitive domains: working memory, inhibition, attention) over 12 weeks. NP tests and behaviour ratings served as outcome measures. Results: After CogT, significant improvements emerged according to parents’ ratings, but only on very few NP test measures. Children with milder/no pre-training NP impairment showed larger improvements on behavioural ratings than more impaired children. A steeper training performance slope was related to better behavioural outcomes. Conclusion: We find partial support for specific effects of CogT, but the assumption that an individually tailored selection of training tasks would be particularly beneficial for children with ADHD with NP deficits was not confirmed.

Trial registration number: NCT02358941.     

The relationship between objective balance,perceived sense of balance,and fear of falling in stroke patients

Objective: The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients.

Methods: Seventy patients aged 18–65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients’ objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study.

Results: There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = ?0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = ?0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients.

Conclusion: PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients’ balance capacities.     

Preference-based quality of life in patients with Alzheimer's disease

BackgroundThis study was developed to evaluate the feasibility, reliability, and validity of use of patients' ratings of health preference measures as outcomes for cost-effectiveness analyses in persons with very mild to moderate Alzheimer's disease (AD).MethodsPatients and caregivers completed ratings of the EuroQol-5D system (EQ-5D) and the Health Utilities Index Mark 2 (HUI2) and instruments that assess cognition, mood, insight, AD-specific and generic health-related quality of life (QOL) and activities of daily living.ResultsPatients' HUI2 scores were reliable. EQ-5D scores were somewhat less so. Patients rated their utility high, with overall EQ-5D and HUI2 scores greater than 0.8. Neither the EQ-5D nor the HUI2 scores had a relationship with severity of cognitive impairment. Both the EQ-5D and the HUI2 had expected relationships with patient-rated measures of QOL, function, mood, and specific subscales we hypothesized should be associated with patient preferences. Patient insight into functional and cognitive impairments had little association with their health preference scores.ConclusionsAD patients' scores on the EQ-5D and the HUI2 have many of the characteristics of valid preference measures. However, the proportions of persons who do not perceive any disability, the lack of association with the caregivers' ratings of activities of daily living, limited associations with insight, and no association with their Mini-Mental State Exam scores suggest that patients' reports of disability might reflect legitimate self-perceptions of mood and function that are associated with comorbidities rather than with AD.     

Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients’ perspectives

BACKGROUNDTreatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.AIMTo determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.METHODSThis is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.RESULTSScores on all the three WAI-Client subscales were significantly correlated with each other (r = 0.66-0.81; P < 0.0001). The total TRIP scores were associated with the total WAI-Client scores (r = 0.28; P < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale (r = 0.28-0.29; P < 0.01). The total TRIP scores were significantly associated with the total PSQ scores (r = 0.45; P < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 (“alliance and support”), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 (“trust and satisfaction”), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.CONCLUSIONA broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients’ perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.     

Le processus d’évaluation du risque de récidive en consensus : intérêts et limites

IntroductionThe risk assessment is a major issue for the mission of judicial experts. Research contend that to such assessment may improve by using consensus ratings.Objectives(a) To compare consensual and individual assessment relapse ‘predictive validities; (b) To better understand the decision-making process in consensual protective and risk factors assessment.MethodTwo researchers evaluated 160 forensic reports independently, then met to discuss their scores and reach a consensus on the scoring for all the instruments followed by a consensus time. We use AUC curves and structural equation models to analyses predictive validity over a follow-up period of 3 years after release from prison. We carried out a content’ thematic qualitative analysis of consensual decision-making process.ResultsConsensus ratings did not improve the predictive validity of violent or general relapse, but it did identify the most difficult factors to assess, the points of disagreement and the assessment subjective dimensions. Consensus ratings also facilitated mutual learning and assessment ‘resetting.ConclusionOur results suggest that above consensus or individual ratings, risk assessment prediction validity is related to the tool used and the summative logic of the factors. However, discussions among reviewers introduced rigor and lead to more accurate argumentations of risk factors ratings.     

Therapist immediacy: The association with working alliance,real relationship,session quality,and time in psychotherapy

Objective: This longitudinal analysis examined the relationship between amount of therapist immediacy in sessions and client post-session ratings of working alliance (WAI), real relationship (RRI), and session quality (SES). Method: Using hierarchal linear modeling (HLM), we disaggregated the variables into within-client (differences between sessions in immediacy) and between-clients (differences between clients in immediacy) components, in order to test associations over time in treatment. Three hundred and sixty four sessions were nested within 16 clients and 9 therapists. Results: When therapists used more immediacy in a session, clients gave higher SES ratings for that session, compared to their sessions with less immediacy (within-client effect). For WAI, it appeared to matter when immediacy was used in treatment. The interaction effect between time in treatment and within-client immediacy revealed that early in treatment, more immediacy in a session was related to lower WAI for that session, whereas later in treatment, more immediacy in a session was related to higher WAI for that session. Another interaction effect was found between time in treatment and between-clients immediacy. Clients with less immediacy in treatment, gave higher SES scores for early sessions, than clients with more immediacy in treatment. Conclusions: Immediacy has an overall positive effect on session quality, but the time in which it is used in treatment and client characteristics should be taken into account both in practice and research.     

Performance on the Test of Memory Malingering is predicted by the number of errors on its first 10 items on an inpatient epilepsy monitoring unit

Objective: Performance validity testing is an increasingly vital component of neuropsychological evaluation, though administration of stand-alone performance validity tests (PVTs) can be time-consuming. As the Test of Memory Malingering (TOMM) is among the most commonly used and researched PVTs, much work has focused on creating abbreviated versions while preserving diagnostic accuracy. A recent addition to this effort, errors on the first 10 items of Trial 1 (TOMMe10), was analyzed for its utility in predicting TOMM performance. Method: Subjects were 180 veterans seen on a long-term epilepsy monitoring unit. TOMM learning trials, Word Memory Test (WMT), and WAIS-IV Digit Span (for Reliable Digit Span; RDS) were administered as part of a larger battery. Performance invalidity was classified using established cut scores. Diagnostic classification statistics were calculated predicting TOMM, WMT, and RDS performance, including sensitivity, specificity, receiver operating characteristics (ROC), and positive and negative predictive values for multiple TOMMe10 cut scores. Results: A cut score of ≥2 errors on TOMMe10 yielded the highest sensitivity (.88) while maintaining ≥.90 specificity when predicting TOMM (also supported by ROC analysis). This cut score was also optimal when validated against combinations of PVTs (e.g. two of TOMM, WMT, and RDS; WMT and/or RDS). Conclusions: TOMMe10 shows great promise in predicting future TOMM performance. In settings where time with patients is at a premium, ≥2 errors on TOMMe10 may be used as an early TOMM discontinue criteria, allowing examiners to use their limited time more effectively. The use of TOMMe10 in settings with varying TOMM failure base rates was discussed.     

Detecting dissimulation: Profiles of simulated malingerers,traumatic brain-injury patients,and normal controls on a revised version of Hiscock and Hiscock's forced-choice memory test

Abstract

A computer-administered memory test was given to normal subjects instructed to feign brain damage, normal controls, and traumatic brain-injured (TBI) patients with complaints of memory dysfunction. The test, a revised version of an instrument developed by Hiscock and Hiscock (1989), employed forced, two-choice recognition of previously presented five-digit numbers. Two levels of item difficulty and three retention intervals were used. Control and TBI subjects performed at near ceiling level on easy items and items with short retention intervals. Feigning subjects performed worse than TBI and control subjects at all levels of item difficulty and all retention intervals. Subject groups were maximally distinguishable from one another by performance on difficult items and items with the longest retention interval. All TBI patients performed at or above chance level. Only 15% of the feigning subjects performed below chance level on any section of the test. Jack-knifed discriminant function analysis correctly classified 83% of all subjects into their respective groups. Although evaluation of patient performance relative to chance probability is useful for indicating the presence of extremely exaggerated memory deficits, criteria derived from sample distributions of group scores were superior for evaluation of motivation in less obvious cases. The Victoria Revision may be useful for detecting true memory deficit as well as dissimulation.     

Association of platelet-to-lymphocyte ratio with silent brain infarcts in patients with paroxysmal atrial fibrillation

Objectives: In this study, we aimed to evaluate whether the inflammation as measured by increased platelet to lymphocyte ratio (PLR) predispose to silent infarcts in patients with paroxysmal atrial fibrillation (PAF).

Methods: The present study investigated a total of 48 new diagnosed patients with PAF who had no signs of stroke. PLR, which was calculated as the ratio of the platelet count to the lymphocyte count, C-reactive protein and erythrocyte sedimentation rate were measured due to evaluate inflammatory state. Magnetic resonance imaging (MRI) was performed to evaluate the presence of silent brain infarcts (SBIs) in patients. We calculated CHA₂DS₂–VASc scores for stratifying the stroke risk of patients.

Results: Among our study population, the mean age was 56.40 ± 8.99; 36 patients were female. The leading vascular risk factor was hypertension (45.8%). SBI was determined in 16 patients (33.3%) on MRI. It was found that a higher PLR is significantly associated with the presence of SBIs in patients with PAF (P = .001). High PLR group showed silent lesions predominantly multiple, greater than 5 mm, bilateral and in the subcortical region; though no statistically significant differences were found in each lesion areas (P = .214; P = .509; P = .746; P = .059, respectively). Of 16 patients who showed SBI, 1 (6.3%) patient had CHA₂DS₂–Vasc scores of 0; 7 (43.8%) patients had CHA₂DS₂–Vasc scores of 1; 6 (37.5%) patients had CHA₂DS₂ -Vasc scores of 2 and 2 (12.5%) patients had CHA₂DS₂–Vasc scores of 3. We did not find any significant relationship between CHA₂DS₂–Vasc scores and presence of SBI in the study patients (P = .850).

Discussion: High PLR might be a factor to induce inflammatory process on SBIs even with low CHA₂DS₂–VASc scores.     

Portable eyetracking-based assessment of memory decline

Introduction: Preferential viewing of novel stimuli in the Visual Paired Comparison task has provided a useful marker of memory and medial temporal lobe function. We created a portable version of the VPC (P-VPC) and contrasted P-VPC metrics against the Montreal Cognitive Assessment (MoCA) in healthy adults, to assess the validity and reliability of the P-VPC as an indicator of memory function across age. A supplementary case series was conducted with individuals diagnosed with Alzheimer’s disease (AD) and other dementias, to provide a preliminary illustration of the P-VPC’s use as a measure in clinical populations.

Method: Participants (n = 207) were tested using the P-VPC. Individuals were familiarized with a set of objects, which were each presented alongside a novel object in the test phase. Novelty viewing scores were compared to MoCA scores to index concurrent validity. Item analyses were conducted as a test of internal reliability of the P-VPC. A complementary clinical case series was conducted with AD (n = 4) and dementia (n = 5) participants, who were tested using the P-VPC and further compared to healthy age-matched participants.

Results: Preferential viewing decreased with age in healthy participants, and was positively correlated with MoCA scores. Compared to the MoCA, P-VPC scores did not differ based on education and/or whether English was spoken as the native language. Item analyses revealed acceptable internal consistency. P-VPC viewing percentiles of healthy participants were modeled as a function of age, and illustrated that individuals of the clinical case series diagnosed with AD scored in below-average percentiles, while those with dementia did not score below-average.

Conclusion: Good concurrent validity and acceptable internal reliability were observed, and P-VPC scores were not confounded by education or language experience. Low performance was observed in individuals with clinically diagnosed AD, suggesting that the P-VPC may be a potential tool for screening memory decline.     

Assessing cognitive functioning in individuals with cocaine use disorder

Introduction: There have been mixed findings assessing the impact of regular cocaine use on cognitive functioning. This study employed a comprehensive cognitive battery to compare the performance of individuals diagnosed with a cocaine use disorder (N = 3 abusers, N = 17 dependent) against the performance of two control groups: (a) non-drug-users, and (b) marijuana users who report no cocaine use (N = 7 marijuana abusers, N = 0 dependent, N = 13 marijuana users with no Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, DSM–IV, diagnosis).

Method: This one-session, between-participants, outpatient study was conducted at the New York State Psychiatric Institute. Sixty research volunteers completed the study. Drug users in both groups had no signs of current intoxication, but had a positive urine toxicology—which indicated use within 72 hours in the cocaine use disorder group and within the past 30 days (depending on frequency of use) for the marijuana-using control group. The National Institutes of Health (NIH) Toolbox Cognition Battery was used to assess cognitive functioning across six domains: executive function, attention, episodic memory, working memory, processing speed, and language. Each participant’s score was also compared against a normative database adjusted for age.

Results: Although the mean cognitive scores for all groups fell within the normal range for all tests, marijuana-using control participants outperformed those with a cocaine use disorder on a cognitive flexibility and language measure.

Conclusions: Cognitive functioning of individuals diagnosed with cocaine use disorder was observed to be similar to that of control group participants on the majority of tasks and fell within the normal range when compared against normative data.