The relationship of IQ to effort test performance

The relationship between IQ and nine effort indicators was examined in a sample of 189 neuropsychology clinic outpatients who were not in litigation or attempting to obtain disability. Participants with the lowest IQ (50-59) failed approximately 60% of the effort tests, while patients with an IQ of 60 to 69 failed 44% of effort indicators, and individuals with borderline IQ (70 to 79) exhibited a 17% failure rate. All patients with IQ < 70 failed at least one effort test. Cutoffs for the Warrington Recognition Memory Test (Words) and Finger Tapping maintained the highest specificities in low IQ samples.     

Psychological disturbance, incomplete effort, and compensation-seeking status as predictors of neuropsychological test performance in head injury

Indices from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) representing cognitive and emotional disturbance as well as incomplete effort on the Recognition Memory Test (RMT; Warrington, 1984) were examined as predictors of performance on the Halstead-Reitan Neuropsychological Test Battery (HRB; Reitan & Wolfson, 1993). In the current study, which included a large sample (N = 369) of patients referred for neuropsychological (NP) evaluation after presumptive head injury, MMPI-2 measures of psychological disturbance accounted for as much as 25% of the variance in HRB test scores, resulting in a moderate overall effect size (median Adj. R(2) = .16; R = .40). When demographic variables, head injury severity, and compensation-seeking status were entered in previous steps, incomplete effort as defined by chance performance on the RMT accounted for between 2% and 13% of the variance in HRB test scores, with modest overall effect size (median R(2) Delta = .07; R = .26) in multiple regression equations. Additionally, when MMPI-2 indices of psychological disturbance were included in the last step, they accounted for 2% to 11% of additional variance, retaining a modest overall effect (median R(2) Delta = .03; R = .17). Compensation-seeking status and injury severity as measured by duration of post-traumatic amnesia were, at best, modestly related to NP test performance. Findings confirm the reliable relationship between test performance and psychological disturbance as well as incomplete effort when assessing dysfunction following head injury. In contrast to previous studies, incomplete effort was unrelated to compensation-seeking status.     

Influence of poor effort on neuropsychological test performance in U.S. military personnel following mild traumatic brain injury

The purpose of this study was to examine the influence of poor effort on neuropsychological test performance in military personnel following mild traumatic brain injury (MTBI). Participants were 143 U.S. service members who sustained a TBI, divided into three groups based on injury severity and performance on the Word Memory Test and four embedded markers of poor effort: MTBI-pass (n?=?87), MTBI-fail (n?=?21), and STBI-pass (n?=?35; where STBI denotes severe TBI). Patients were evaluated at the Walter Reed Army Medical Center on average 3.9 months (SD?=?3.4) post injury. The majority of the sample was Caucasian (84.6%), was male (93.0%), and had 12+ years of education (96.5%). Measures included the Personality Assessment Inventory (PAI) and 13 common neurocognitive measures. Patients in the MTBI-fail group performed worse on the majority of neurocognitive measures, followed by the Severe TBI-Pass group and the MTBI-pass group. Using a criterion of three or more low scores <10th percentile, the MTBI-fail group had the greatest rate of impairment (76.2%), followed by the Severe TBI-Pass group (34.3%) and MTBI-pass group (16.1%). On the PAI, the MTBI-fail group had higher scores on the majority of clinical scales (p < .05). There were a greater number of elevated scales (e.g., 5 or more elevated mild or higher) in the MTBI-fail group (71.4%) than in the MTBI-pass group (32.2%) and Severe TBI-Pass group (17.1%). Effort testing is an important component of postacute neuropsychological evaluations following combat-related MTBI. Those who fail effort testing are likely to be misdiagnosed as having severe cognitive impairment, and their symptom reporting is likely to be inaccurate.     

Dementia rating scale performance: a comparison of vascular and Alzheimer's dementia

Differences in the pattern of neuropsychological dysfunction associated with Alzheimer's disease (AD) and vascular dementia (VaD) were examined using the Dementia Rating Scale (DRS). We examined three groups of patients: (1) Patients with AD; (2) patients with single stroke (CVA); and (3) patients with multiple cerebral infarctions (MI). Comparisons of cognitive dysfunction were conducted on patients that met the DRS criteria for dementia. Dementia groups were similar in age, education, and severity of dementia. Comparisons of the AD and two VaD groups across the specific DRS-scales (Attention, Conceptualization, Construction, Initiation/Perseveration, and Memory) indicated that patients with AD were more impaired on the DRS-Memory while the patients with VaD were more impaired on the DRS-Construction. Additionally, patients with VaD related to MI scored lower on the DRS-Initiation/Perseveration as compared to patients with AD, and patients with AD scored lower on the DRS-Conceptualization as compared to patients with VaD related to CVA. These results are indicative of qualitative differences in the pattern of cognitive deficits associated with the two types of dementia.     

Association between Dementia Rating Scale performance and neurocognitive domains in Alzheimer''s disease

The Dementia Rating Scale (DRS; Mattis, 1976, 1988) is commonly used in the assessment of dementia, although little is known about the relationship of performance on this test to specific cognitive deficits in Alzheimer's disease (AD). Additionally, cognitive profiles have not been investigated across different levels of dementia as determined by the DRS. A sample of 133 individuals diagnosed with possible or probable AD was administered the DRS as part of a comprehensive neuropsychological evaluation. Composite scores for the cognitive domains of attention, executive functioning, visuospatial skills, language abilities, immediate recall, and delayed memory were derived by averaging demographically corrected T scores of key measures. Individual domain scores were also averaged to develop a global index score. Pearson correlations between composite and total DRS scores were highly significant (p<.001) for all domains and the global index score, with the exception of delayed memory, which showed a floor effect. When the sample was divided into mild and moderate-to-severe groups to examine the effects of disease severity on the relationship between the DRS and standard neurocognitive domain scores, the resulting mean neuropsychological profile scores were significantly different while maintaining a parallel pattern of impairment across domains. Results demonstrate the relationship between the DRS and standard cognitive domain functions, which appears to underscore the validity and robustness of the DRS in characterizing patterns of cognitive impairment across the AD spectrum.     

Sensitivity and specificity of finger tapping test scores for the detection of suspect effort

Past studies indicate that patients with incentive to fake neuropsychological symptoms are likely to have lower finger tapping scores than credible patients. The present study builds upon past research by investigating finger tapping performance for seven groups: (a) noncredible patients (as determined by failed psychometric and behavioral criteria), and patients with (b) closed head injury, (c) dementia, (d) mental retardation, (e) psychosis, or (f) depression, and (g) healthy older controls. Results showed that men tapped faster than women, requiring that groups be divided by gender. Noncredible male and female patients tapped slower than their comparison group counterparts. Dominant hand score proved to be more sensitive to noncredible performance than other scores (nondominant, sum of both hands, difference between dominant and nondominant), especially for women. Sensitivity, specificity, and positive and negative predictive value tables are presented. With specificity set at 90% for the comparison groups combined, a dominant hand cutoff score of 相似文献   

Pattern of performance on the tactual performance test

This study explored the neuropsychological correlates of different performance patterns on the first two trials of the Tactual Performance Test (TPT) in normal subjects. Regression analysis showed a significant relationship between TPT pattern and neuropsychological summary scores, other TPT measures, and individual measures assessing visual-spatial skills and left-hand motor performance. A direct comparison of subjects who showed the expected pattern of improvement with reversal subjects, however, revealed differences only for other TPT measures and certain WAIS Performance subtests. These data are important because it appears that a reversal in the expected pattern of improvement on the TPT occurs fairly commonly in normals, especially those who are older and less well educated.     

Cross-cultural effects on IQ test performance: a review and preliminary normative indications on WAIS-III test performance

This article presents a review of cross-cultural influences on Wechsler IQ tests, together with a preliminary investigation into WAIS-III test performance (English administration) for a southern African sample (age range 19-30) stratified for white English first language and black African first language, level and quality of education. ('African language' is the term used to denote the indigenous languages of black populations in southern Africa). A two-way ANOVA revealed highly significant effects for both level and quality of education within the black African first language group. Scores for the white English and black African first language groups with advantaged education were comparable with the US standardization, whereas scores for black African first language participants with disadvantaged education were significantly lower than this. Thus indications from this research are that normative studies should take account of the influential variable of quality of education, in addition to level of education. Alternatively faulty conclusions may be drawn about the effects of ethnicity, with the potential for neuropsychological misdiagnosis.     

The performance of individuals with mental retardation on cognitive tests assessing effort and motivation

The purpose of this study was to determine which tests of effort and motivation would be appropriate for use with patients with mental retardation when feigning of cognitive deficits is suspected. The seven measures evaluated included the WMS-III Rarely Missed Index Test, forced-choice recognition portion of the California Verbal Learning Test-II, Reliable Digit Span test, Rey 15-Item Test, Rey Dot Counting Test, the Rey 15-Item Test with Recognition Trial, and the Vocabulary (V)-Digit Span (DS) difference score. Results indicated that the forced-choice portion of the CVLT-II, the V-DS difference score, and the Rarely Missed Index Test from the WMS-III might be appropriate for use with this population with passing rates of 89%, 98%, and 91% respectively.     

The base rate of effort test failure in patients with medically unexplained symptoms

BACKGROUND: "Effort tests" (i.e., tests that indicate whether appropriate effort is being made) are increasingly used in neuropsychological assessments. However, not all failures on effort tests are necessarily attributable to lack of effort. Understanding the factors that contribute to failure on effort tests has important clinical implications. OBJECTIVES: This study aimed (a) to establish the extent to which patients with medically unexplained symptoms (MUS) presenting to neurology fail effort tests, (b) examine the performance of "mild" and "strong" simulators on effort tests, and (c) compare the performance of simulators and MUS patients. METHODS: Forty-three MUS patients, 35 mild simulators, and 39 strong simulators undertook a battery of effort tests. The groups were matched for age, estimated IQ, and gender. The MUS patients were not involved in litigation. RESULTS: The failure rate (defined as failing two or more effort tests) was 11% in the MUS group, 94% in the mild simulation groups, and 100% in the strong simulation group. CONCLUSIONS: A minority of nonlitigant MUS patients who present to neurology fail effort tests. Possible reasons for this are discussed. In that they do not produce below-chance performance (in contrast with many of the simulators), there is no clear indication of deliberate failure, though this cannot be ruled out. The very high failure rate in the mild simulation group (who were instructed not to overact) indicates the sensitivity of effort tests to lack of effort and the value of including such tests in neuropsychological assessments.     

Type A, test performance and salivary cortisol

Forty first year medical students, previously screened for the presence or absence of the Type A behavior pattern, collected saliva samples for four days leading up to the forst major examination of their medical school course. It was observed that the day of the examination produced substantially different patterns of salivary cortisol concentrations for Type A and non-A subjects, depending on their level of performance. The Type A subjects who scored above the median on the examination showed higher concentrations of salivary cortisol than Type A subjects who scored below the median. The reverse of this pattern was found for non-A subjects. Visual analog scale ratings of subjective stress showed no behavior pattern effects and a very low correlation with the salivary cortisol concentrations. The results support the view that the occurrence of physiological arousal associated with the Type A behaviour pattern is intermittent and dependent on situational factors such as expectation of success and actual success. This is consistent with conceptualizing the Type A pattern as a strategy for resource allocation which may be elective, rather then the behavioural manifestation of an automatic physical response to stress.     

Above-average intelligence and neuropsychological test score performance.

Recent studies regarding the effects of above average intelligence and neuropsychological performance have been mixed with Dodrill (1977) suggesting that above-average performances on neuropsychological test scores should not be expected when intellectual abilities are above average and Tremont, Hoffman, Scott and Adams (in press) clearly suggesting better neuropsychological skills in the higher IQ group. This paper described a reanalysis of a previously presented Canadian data-set assembled by Pauker (1980) of three hundred and sixty-three persons (152 males, 211 females) who were administered the core tests of the Halstead-Reitan Neuropsychological Test Battery (HRNTB) and the Wechsler Adult Intelligence Scale (WAIS). The results were that subjects with higher intelligence had better neuropsychological test score performances except for the Finger Tapping with the dominant hand test.     

Dementia and neuroimaging

Early diagnosis of dementing conditions and an accurate monitoring of their progression are important clinical and research goals, especially given the improving prospects of disease-modifying therapies. Neuroimaging has played and is playing an important role in detecting reversible, treatable causes of dementia, and in characterizing the dementia syndromes by demonstrating structural and functional signatures that can aid in their differentiation. Many new imaging techniques and modalities are also available that allow the assessment of specific aspects of brain structure and function, such as positron emission tomography with new ligands, diffusion tensor magnetic resonance imaging (MRI) and functional MRI. In this review, we report the most recent findings from the papers published in the Journal of Neurology that used conventional and advanced neuroimaging techniques for the study of various dementing conditions.     

Metamemory and memory test performance in stroke patients

Memory Self-Efficacy (MSE) has been shown to be related to memory performance and social participation in a healthy elderly population. This relation is unclear in stroke. As about 30% of all stroke survivors report memory complaints, there is an urgent need for effective treatment strategies. Before implementing MSE as a potential target in memory training, it should be examined whether the association between MSE and memory performance demonstrated in healthy elderly people also applies in stroke patients. This study therefore explored the predictive value of MSE on two kinds of memory tests in stroke patients; adjusted and unadjusted for age, gender, education and location of stroke.

In 57 stroke patients, the Metamemory in Adulthood Questionnaire (MIA), an everyday memory test (RBMT) and a more traditional memory test (AVLT) were completed. The results show that MSE significantly predicts memory test performance on both memory tests (RBMT: β = .34; p = .01 AVLT: β = .28; p = .04). When adjusted for gender, age, education and location of stroke, the predictive value of MSE remained significant for the AVLT (RBMT: β = .23; p = .07; AVLT: β = .23; p = .05).

The results support the hypothesis that MSE predicts test performance in stroke patients and, by consequence, enables improving memory performance in post-acute memory rehabilitation after stroke.     

Neuropsychological test performance and affect in myasthenia gravis

Neuropsychological test performance, including memory, and affect were investigated in 16 patients with myasthenia gravis (MG) and in a matched control group. Clinical electroencephalograms (EEGs) were recorded from MG patients. Cognitive measures included the Randt Memory Test and a number of tests from the computerized Neurobehavioral Evaluation Battery which included a test of motor speed. Affect was assessed by means of an anxiety questionnaire (IPAT) and a computer based questionnaire similar to the Profile of Mood States (POMS). There were no significant intergroup differences in memory performance and only an isolated significant finding in a timed measure in symbol-digit comparison. The MG group revealed significantly reduced finger tapping. Significantly higher levels of anxiety, tension, anger, fatigue and confusion were associated with the MG group. Abnormal EEGs occurred in 35% of the MG patients, mostly mild-moderate diffuse slowing, but in one case epileptogenic activity was present. The failure to confirm memory deficits in this study appeared not to be related to age or whether patients had generalized or ocular MG. Medication was suggested as a possible factor. These, and other variables, need to be evaluated in further studies.