California neuropsychological screening battery (CNS/B I & II)

Neuropsychological assessment of individuals exposed to workplace or environmental neurotoxins is a lengthy, highly specialized, and costly endeavor. Literature that documents the central nervous effects of neurotoxins is reviewed, and neuropsychological tests currently used in this type of assessment are discussed. The California Neuropsychological Screening Battery (CNS/B I & II) was designed to afford rapid and broad assessment of the variety of brain functions typically affected by toxic brain injuries. The CNS/B I & II is comprised of: (1) Wechsler Memory Scale; (2) Visual Information Processing; (3) WAIS-R subtests of: Digit Span, Vocabulary, Block Design, Arithmetic, and Digit Symbol; (4) Trail Making Test A and B; (5) Dynamometer; (6) Finger Tapping Test; (7) Purdue Pegboard; (8) Benton Visual Retention Test; and (9) Neurotoxic Anxiety Scale (Bowler, Becker, & Harrison, 1985). Administration time is 50 to 60 minutes. The CNS B/ I & II facilitates intraindividual and intergroup comparisons through examination of subtest scores within the battery.     

Effects of visual acuity and visual motor speed and dexterity on cognitive test performance.

This study examined the hypothesis that near visual acuity and visual motor speed and dexterity contribute significantly to performance on cognitive tests that place a premium on these functions. Near visual acuity for both eyes, Finger Tapping Test - average taps with dominant hand, and Grooved Pegboard Test - dominant hand time, served as the independent variables. The dependent variables were Trail Making Test-Part B and the Performance subtests of the Wechsler Adult Intelligence Scale. Results indicated that while visual acuity was significantly correlated with all six test variables, it did not contribute to the regression model as well as Pegboard time or Tapping speed. Pegboard time and Tapping speed contributed to the regression model, but in different ways depending upon which test was examined.     

Cognitive functioning of individuals aged 90 years and older without dementia: A systematic review

IntroductionReference values to define cognitive impairment in individuals aged 90 years and older are lacking. We systematically reviewed the literature to determine the level of cognitive functioning of individuals aged 90 years and older without dementia.MethodsThe search identified 3972 articles of which 20 articles were included in the review. We calculated mean cognitive test scores and cut-off scores for cognitive tests published in two or more articles.ResultsThe mean cognitive test scores (SD)/cut-off scores for individuals aged 90 years and older without dementia of the five most commonly used cognitive tests were: MMSE: 26.6 (2.6)/23.3 points, Digit Span forward: 5.9 (1.8)/3.6 digits, Digit Span backward: 4.4 (1.6)/2.4 digits, TMT-A: 85.8 (42.5)/140.2 s and TMT-B: 220.3 (99.2)/347.3 s.DiscussionWe provided mean cognitive test scores and cut-off scores that will improve the diagnostic process of cognitive impairment in individuals aged 90 years and older.     

Neuropsychological correlates of suboptimal adherence to metformin

The goal of this study was to determine if neuropsychological function is associated with adherence to prescribed medication. Altogether, 79 patients with type II diabetes at a VA primary care clinic had adherence to the antihyperglycemic drug metformin measured with MEMS^® caps over a 4-week period. They completed several tests of neuropsychological function: Mini-Mental Status Exam (MMSE), Trails A and B, Stroop, Digit Span, Digit Symbol, and Grooved Pegboard. In separate multivariate analyses, Stroop word score and time to complete Trails B were independently associated with adherence, as was age. Secondary analyses of the relationship between neuropsychological variables and other adherence-related measures were conducted. Low scores on the MMSE and non-Caucasian ethnicity were associated with missed appointments. None of the neuropsychological variables were associated with glycosylated hemoglobin. These results suggest that cognitive abilities should be considered when counseling patients concerning their adherence.     

Neuropsychological Test Scores,Academic Performance,and Developmental Disorders in Spanish-Speaking Children

Limited information is currently available about performance of Spanish-speaking children on different neuropsychological tests. This study was designed to (a) analyze the effects of age and sex on different neuropsychological test scores of a randomly selected sample of Spanish-speaking children, (b) analyze the value of neuropsychological test scores for predicting school performance, and (c) describe the neuropsychological profile of Spanish-speaking children with learning disabilities (LD). Two hundred ninety (141 boys, 149 girls) 6- to 11-year-old children were selected from a school in Bogota, Colombia. Three age groups were distinguished: 6- to 7-, 8- to 9-, and 10- to 11-year-olds. Performance was measured utilizing the following neuropsychological tests: Seashore Rhythm Test, Finger Tapping Test (FTT), Grooved Pegboard Test, Children's Category Test (CCT), California Verbal Learning Test-Children's Version (CVLT-C), Benton Visual Retention Test (BVRT), and Bateria Woodcock Psicoeducativa en Espanol (Woodcock, 1982). Normative scores were calculated. Age effect was significant for most of the test scores. A significant sex effect was observed for 3 test scores. Intercorrelations were performed between neuropsychological test scores and academic areas (science, mathematics, Spanish, social studies, and music). In a post hoc analysis, children presenting very low scores on the reading, writing, and arithmetic achievement scales of the Woodcock battery were identified in the sample, and their neuropsychological test scores were compared with a matched normal group. Finally, a comparison was made between Colombian and American norms.     

Neuropsychological test scores, academic performance, and developmental disorders in Spanish-speaking children

Limited information is currently available about performance of Spanish-speaking children on different neuropsychological tests. This study was designed to (a) analyze the effects of age and sex on different neuropsychological test scores of a randomly selected sample of Spanish-speaking children, (b) analyze the value of neuropsychological test scores for predicting school performance, and (c) describe the neuropsychological profile of Spanish-speaking children with learning disabilities (LD). Two hundred ninety (141 boys, 149 girls) 6- to 11-year-old children were selected from a school in Bogota, Colombia. Three age groups were distinguished: 6- to 7-, 8- to 9-, and 10- to 11-year-olds. Performance was measured utilizing the following neuropsychological tests: Seashore Rhythm Test, Finger Tapping Test (FTT), Grooved Pegboard Test, Children's Category Test (CCT), California Verbal Learning Test-Children's Version (CVLT-C), Benton Visual Retention Test (BVRT), and Bateria Woodcock Psicoeducativa en Espanol (Woodcock, 1982). Normative scores were calculated. Age effect was significant for most of the test scores. A significant sex effect was observed for 3 test scores. Intercorrelations were performed between neuropsychological test scores and academic areas (science, mathematics, Spanish, social studies, and music). In a post hoc analysis, children presenting very low scores on the reading, writing, and arithmetic achievement scales of the Woodcock battery were identified in the sample, and their neuropsychological test scores were compared with a matched normal group. Finally, a comparison was made between Colombian and American norms.     

Impaired Cognitive Executive Dysfunction in Adult Treated Hypertensives with a Confirmed Diagnosis of Poorly Controlled Blood Pressure

Background. High blood pressure (BP) poses a major risk for cognitive decline. Aim of the study was to highlight the relationship between cognitive assessment scores and an effective therapeutic BP control.Methods. By medical visit and ambulatory BP monitoring (ABPM), we studied 302 treated hypertensives, subdivided according to office/daytime BP values into 120 with good (GC) and 98 poor (PC) BP control, 40 with “white coat hypertension” (WCH) and 44 a “masked-hypertension” phenomenon (MH). Patients underwent neuropsychological assessment to evaluate global cognitive scores at the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) and attention/executive functions (Delayed Recall, Digit Span Forwards, Digit Span Backwards, Selective Attention, Verbal Fluency, Stroop Test and Clock Drawing). Carotid intima-media thickness (IMT) served as the index of vascular damage.Results. There were no differences among the groups in terms of gender, age, education, metabolic assessment, clinical history and hypertension treatment. GC presented lower office and ambulatory BP values and IMT. PC performed worse than GC on global executive and attention functions, especially executive functions. In PC, office systolic BP (SBP) was significantly associated to the MMSE and FAB scores and, in particular, to Verbal Fluency, Stroop Errors and Clock Drawing tests. Office diastolic BP (DBP) was associated to Selective attention, nocturnal SBP to Digit Span backwards and Verbal Fluency. Worse cognitive assessment scores were obtained in WCH than GC.Conclusions. The findings showed that in adult treated hypertensives, a poor BP control, as both doctor''s office and daytime scores, is associated to impaired global cognitive and especially executive/attention functions.     

Normative data for the Halstead-Reitan neuropsychological tests stratified by age and sex

Normative data, stratified by age and sex, are presented for the Halstead-Reitan neuropsychological tests: Name Writing, Speech-Sounds Perception, Trail Making, Halstead Category, Finger Tapping, Dynamometer, Tactual Performance, Seashore Rhythm, Tactile Form Recognition, Finger-Tip Number Writing Perception, Face-Hand, and Finger Localization. Correlations of the test variables with age, education, and WAIS-R Verbal and Performance IQ are reported. The normative sample consisted of 225 adults (127 males, 98 females) 15 to 40 years of age. The subjects who were included did not report any history of forensic involvement, head injury, neurological insult, prenatal or birth complication, psychiatric problems, or substance abuse.     

Effects of hemodialysis on the cognitive and sensory-motor functioning of the adult chronic hemodialysis patient

Twenty chronically dialyzed adults were administered a repeatable battery of 14 cognitive and sensory-motor tests on 3 consecutive days: immediately prior to their midweek dialysis, approximately 20 hr after their midweek dialysis, and again immediately prior to their end-of-the week dialysis. Serum electrolyte and methylamine analyses were performed at each test session. When compared to established norms, these patients scored within the normal range in a wide variety of areas. Limited impairments, probably due to peripheral neuropathy, were in evidence on the Grooved Pegboard, Finger Tapping (females), and Grip Strength (females) measures. Impairments suggestive of cerebral dysfunction were also noted on the Benton Visual Retention Test and on the Trail Making Test, Parts A and B, with particularly severe impairment noted on Part B. Despite significant daily changes in serum levels of toxic substances retained in uremia, there was little or no evidence to suggest that well-dialyzed patients undergo daily fluctuations in their cognitive and sensory-motor functioning.     

Normative data stratified by age and sex for 12 neuropsychological tests

Normative data stratified by age and sex are presented for 12 neuro-psychological tests from a large neurologically intact, nonpsychiatric adult sample (127 males, 98 females, aged 15–40 years). The tests include Language Modalities Test for Aphasia, Memory-for-Designs, Coloured Progressive Matrices, Symbol-Gestalt, Minute Estimation, Controlled Word Association, Written Word Fluency, Purdue Pegboard, Williams Clinical Memory, Symbol Digit Modalities, L. J. Tactile Recognition, and Wisconsin Card Sorting.     

The influence of serum vitamin B12 and folate status on cognitive functioning in very old age

This study examined the relationship between low levels of serum vitamin B12 and folic acid (FA) and cognitive functioning in very old age. The four subsamples of non-demented persons aged 75-96 years - normal B12/normal FA; low B12/normal FA; normal B12/low FA; and low B12/low FA, were matched for age and education. A battery of cognitive tests was administered including Clock Tests, Block Design, Trail Making Tests (TMT), Digit Span, and tests of verbal fluency. Subjects with low levels of vitamins showed deficits in Block Design, TMT-B, Digit Span Backward, and letter fluency, but not in the remaining tests. In general, the effects of FA exceeded those of B12. This pattern of results was interpreted to mean that elderly persons with low vitamin levels have difficulty when fast and accurate processing of novel information is required, but are quite efficient in utilizing pre-existing knowledge structures.     

Association study of a functional catechol-O-methyltransferase polymorphism and executive function in elderly males without dementia

Cognitive function in older people is a major factor influencing quality of life. The catechol-O-methyltransferase (COMT) gene, which is essential in the metabolic degradation of prefrontal dopamine, has been considered as a leading candidate gene in the variation in cognitive performance. The aim of this study was to investigate the effect of a functional COMT (Val158Met) polymorphism on several cognition domains in a relatively homogeneous population consisting of elderly Chinese males without dementia. Six neuropsychological measurements, including Spatial Span Forward and Backward, Digit Span Forward and Backward, and Trail Making Test-A and -B, were assessed in 161 aged males. It was found that the Met/Met carriers showed a better performance than the Val/Met and Val/Val subjects on the Digit Span Forward (a measure of general attention; p=0.017, after correction for education level) test, but not on the other cognitive tests. These findings suggest that the COMT Val158Met genotype may contribute to differences in normal cognitive aging, particularly in the area of general attention.     

Determining neuropsychological impairment using estimates of premorbid intelligence: comparing methods based on level of education versus reading scores.

When inferring brain dysfunction, test scores are typically compared to normative data based on estimates of premorbid intelligence (e.g., by educational level or reading scores). However, these methods are likely to lead to differing results, with important diagnostic and forensic implications. The current study compared estimates of impairment (reported in z-scores) based on educational level versus reading scores in a population with traumatic brain injury. The study included 174 patients (M age = 27.3; M education = 12.3) evaluated as outpatients at a university hospital rehabilitation department. Wilcoxen ranked sign tests indicated that the two methods yielded estimates that were statistically different (p <.0001) for all variables. The education based method yielded greater estimates of impairment than the reading score method for WAIS-R FIQ. Grip Strength, and Finger Tapping, with a pattern of generally consistent impairment across cognitive/motor areas (z-score range = -0.59 to -.97). In contrast, the reading score based method yielded greater estimates of impairment in processing speed (Trails A) and flexibility (Trails B), with a wider range of impairment noted between cognitive and motor domains (z-score range = +0.21 to -2.95). Clinical implications are discussed.     

Heroin addiction and the Wechsler digit span test

There is some evidence that a Wechsler Digit Span scaled score well above the mean of an individual's other WAIS subtest scores is diagnostically significant. Such positive Digit Span scatter seems to be a correlate of an interpersonal detachment syndrome characterized by superficial relationships and anhedonia. Negative scatter or Digit Span scaled scores considerably below the mean of other WAIS subtest scores have been viewed by some investigators as indicating depressive symptoms. Forty-two heroin addicts were compared with 41 neurotic depressive patients. The former group attained significantly higher average positive Digit Span scatter. Since heroin addicts appear more interpersonally distant and anhedonic for non-drug-related experiences, this finding was according to expectation. Digit Span scaled scores alone did not differentiate the groups. Digit Span scatter scores are clearly more desirable than scaled scores in the search for cognitive correlates of personality variables.     

Age differences in Wechsler Memory Scale performance

Calculated mean scores for older persons utilizing data from previous studies that measured Wechsler Memory Scale performance in healthy samples and compared with those of younger adults and a sample of neurologically impaired aged (N = 384). Statistical analysis indicated that in total raw scores, as well as in all subtest scores but Digit Span, there are significant differences in the performance of different age groups. The degree to which age is associated with subtest performance varies depending on the particular subtest involved. Results are discussed in terms of their clinical implications and current theories of aging and memory.     

Digit Span Changes From Puberty to Old Age Under Different Levels of Education

The goal of this study is to demonstrate the age-related changes in multimodality digit span under a research design in which level of education is controlled. Volunteer participants (n 5 1183) were distributed over levels of age (13-98 years) and education (5-8, 9-11, and 121 years). Digit span was measured through 11 scores of the Visual Aural Digit Span Test-Revised on aural or visual stimulation and oral or written response execution, thus allowing for the measurement of intra- and intersensory integration. The increase in digit span scores reversed to a decrease with early adulthood. The slope of the regression line was small but significant. A 4 3 3 3 2 multivariate analysis of variance showed a significant effect of age and education on a combined score comprising the 11 digit span scores. Differences of age and education were predicted by the auditory and visual input scores. The article discusses the cognitive correlates and the age-related changes in digit span from the biological standpoint.     

Digit span changes from puberty to old age under different levels of education

The goal of this study is to demonstrate the age-related changes in multimodality digit span under a research design in which level of education is controlled. Volunteer participants (n 5 1183) were distributed over levels of age (13-98 years) and education (5-8, 9-11, and 121 years). Digit span was measured through 11 scores of the Visual Aural Digit Span Test-Revised on aural or visual stimulation and oral or written response execution, thus allowing for the measurement of intra- and intersensory integration. The increase in digit span scores reversed to a decrease with early adulthood. The slope of the regression line was small but significant. A 4 3 3 3 2 multivariate analysis of variance showed a significant effect of age and education on a combined score comprising the 11 digit span scores. Differences of age and education were predicted by the auditory and visual input scores. The article discusses the cognitive correlates and the age-related changes in digit span from the biological standpoint.     

The relationship between intelligence and verbal and spatial memory.

Administered the Logical Memory Test (LM) and the Rey-Osterreith Test (RO), which have been assumed to pertain to verbal and spatial cognitive functioning, to 150 Ss referred for neuropsychological screening. Ss also were administered the short version of the WAIS, plus Digit Span. It was found that LM did relate more to verbal IQ than to spatial IQ and vice-versa for RO. It was not clear exactly what aspect of cognitive functioning Digit Span was tapping. The clinical implications of the study are that LM scores must be viewed in the light of verbal IQ level, and RO scores interpreted in relation to both spatial IQ and age. Data are presented that can be used for the statistical interpretation of an individual case test scores.     

Do Russian and American normal adults perform similarly on neuropsychological tests?: Preliminary findings on the relationship between culture and test performance

To learn how culture may affect neuropsychological performance, eight tests were administered to non-brain damaged adult volunteers in the United States and Russia. The tests included Ruff Figural Fluency Test (RFFT), Color Trails Test (CTT), Digit Span Forward and Backward, and Category Fluency Test. Verbal and Visual Memory measures and Blind Clock Test were selected from Luria's (1980) battery. Forty-two Russian and 42 American volunteers (age 18-44) were assessed. It was hypothesized that the American group would outscore the Russian on timed measures (RFFT & CTT) due to cultural differences in familiarity with timed testing procedures. Otherwise, significant differences between the two groups were not expected to emerge. Consistent with the hypotheses, significant effect of culture was found on CTT and RFFT in favor of the American group. ANCOVA suggested that intergroup differences were not fully explained by differences in subjective relevance of the tasks to culture-specific experiences. The rest of the tests appeared similar for potential application in both cultures.     

Normative data on selected neuropsychological measures from a nonclinical sample

Normative neuropsychological data are provided from a sample of 365, recruited from a nonclinical population. The sample was divided evenly between males and females, although males were somewhat overly represented in the youngest group, and females were somewhat overly represented in the oldest group. The measures included the Trail Making Test, Seashore Rhythm Test, Finger Tapping, Grooved Pegboard, and Dynamometer. The limited number of measures was a result of the time available to study each subject. Normative data were stratified by sex, age, and educational level. The present data were discussed in relationship to previous normative studies and also in the context of the need for additional normative studies.