Wisconsin card sorting test as a measure of frontal pathology: A review

We reviewed studies of the Wisconsin Card Sorting Test (WCST) in which the test was administered to subjects with and without evidence of focal frontal-lobe dysfunction. This review indicated that few studies had investigated the differential performance of normals and those with frontal dysfunction. The evidence that frontal patients perform more poorly than nonfrontal patients is weak. There is insubstantial evidence to conclude that the WCST is a measure of dorsolateral-frontal dysfunction. The clinical utility of the test as a measure of frontal-lobe dysfunction is not supported nor is the use of the test as a marker of frontal dysfunction for research purposes.     

Utility of the Rey-15 Recognition Trial to Detect Invalid Performance in a Forensic Neuropsychological Sample

The current study sought to address the utility of the Rey Fifteen Item Test (Rey-15), with the use of a combined score [recall correct + (recognition correct – false positives)], to distinguish between valid and invalid performance among a sample of litigating persons referred for neuropsychological evaluation. Scores on the Rey-15 were analyzed across four comparison groups: (1) litigating persons with evidence of invalid performance (n = 29), (2) litigating persons with valid performance (n = 63), (3) learning-disabled patients (n = 36), and (4) a mixed clinical neuropsychological sample not involved in litigation (n = 54). A Rey-15 combined cutoff score of < 21 yielded the highest sensitivity (70%) and specificity (92.8%) rates. If the Rey-15 is to be used in clinical practice to detect invalid performance, the recognition trial with combined score < 21 should be used. Findings support the use of the combined Rey-15 score in place of the previously used recall Rey-15 score to improve sensitivity and specificity rates for detection of invalid performance in litigating neuropsychological referrals.     

Symptom Validity Test Failure Indicates Invalidity of Neuropsychological Tests

Neuropsychological and symptom validity test results from 220 archival cases were analyzed to determine if failing a symptom validity test (SVT) affects the relationship between neuropsychological tests and brain damage. Results reveal that among those who failed either the Word Memory Test (WMT) or the Computerized Test of Attention and Memory (CTAM) there was no correlation between the results of 25 commonly used neuropsychological tests and objectively determined brain damage. For those who passed SVTs, the expected relationship between neuropsychological tests and brain damage was found. Consistent with earlier findings, effort had a greater effect on test performance than did brain damage. SVT performance was not correlated with either brain damage or the presence of external incentives. Results indicate the need for symptom validity testing in all cases and that failure of a single SVT can invalidate the expected brain–behavior relationship that underlies neuropsychological test interpretation.     

Use of Trial 1 of the Test of Memory Malingering (TOMM) as a Screening Measure of Effort: Suggested Discontinuation Rules

Trial 1 of the Test of Memory Malingering (TOMM) has been suggested as a screening tool, with several possible cut-off scores proposed. The purpose of the present study was to replicate the utility of previously suggested cut-off scores and to characterize neuropsychological profiles of persons who “pass” the TOMM but obtain Trial 1 scores <45 and of persons with cognitive disorders. A total of 229 veterans were administered the TOMM as part of a neuropsychological evaluation. Trial 1 scores ≥41 and ≤25 showed good utility as discontinuation scores for adequate and poor effort, respectively, beyond which administration of additional trials were unnecessary. Findings suggest better Trial 1 performance is significantly related to better speeded mental flexibility and memory.     

Normative Adjustments to the D-KEFS Trail Making Test: Corrections for Education and Vocabulary Level

The Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test (TMT), a modification of the original TMT, was created to isolate set-shifting (Letter–Number Switching) from other component skills. This was accomplished by including four baseline conditions (Visual Scanning, Number Sequencing, Letter Sequencing, and Motor Speed) and by placing equal numbers of stimuli in the three sequencing conditions. Given that some studies with the original TMT demonstrated a significant effect of education and intellectual functioning on performance, we utilized the D-KEFS national standardization sample to examine the effects of education and vocabulary level—i.e., Vocabulary subtest from the Wechsler Abbreviated Scale of Intelligence (WASI)—on the D-KEFS TMT. The results indicate a significant effect of these variables on each D-KEFS TMT condition. Normative tables for education- and vocabulary-adjusted scaled scores based on the database from the D-KEFS national normative study were generated.     

Abuse,Not Financial Incentive,Predicts Non-Credible Cognitive Performance in Patients With Psychogenic Non-Epileptic Seizures

Participants with psychogenic non-epileptic seizures (PNES) who fail symptom validity testing (SVT) perform worse on neuropsychological testing than those who do not, consistent with results found in participants with different clinical presentations (e.g., mild traumatic brain injury). However, little is known about how variables typically associated with SVT failure in other populations (e.g., the presence of financial incentives, exaggerated report of psychopathology) correlate with SVT failure in participants with PNES. Likewise the relationship between SVT failure and reported abuse, one of the most frequently described demographic characteristics of the PNES population, has not been examined. We found that failure on the Word Memory Test (WMT) in 91 participants with PNES was strongly associated with reported abuse but, contrary to expectations, was not associated with the presence of financial incentives or severity of reported psychopathology. These results indicate that the factors driving WMT failure may differ significantly in participants with PNES in ways that are potentially clinically relevant.     

Measuring Hand Intrinsic Muscle Strength: Normal Values and Interrater Reliability

Abstract

Background: The intrinsic musdes of the hand are of interest in spinal cord injury (SCI) and other myelopathies, because they are innervated by the most caudal cord segments innervating the upper limb. ln addition, abnormalities of the peripheral nervous system, such as peripheral nerve entrapments, often affect hand intrinsic musde strength of SCI patients. Therefore, measuring hand intrinsic strength may allow for early diagnosis of neurologic dedine.

Methods: A method was developed for measuring strength of hand intrinsic musdes with a handheld myometer. With the use of a handheld myometer, this study examined the distribution of strength measurements for second-digit abductors, fifth-digit abductors, and thumb opposers in able-bodied participants and in individuals with weakness. The quantitative measurements were compared with manual musde test scores and interrater reliability is described for these hand intrinsic strength measurements. Thirty-one able-bodied individuals participated (17 men, 14 women; mean age = 37.7 years) . ln addition, 24, patients with SCI participated (23 men, 1 woman; mean age = 53.5 years; 9 with paraplegia and 14 with tetraplegia as a primary diagnosis). The Bland-Altman method was used to test for interrater reliability.

Results: Mean strength of able-bodied participants was 5.0 kg for second-digit abduction, 3.1 kg for fifth-digit abduction, and 5.0 kg for thumb opposition, and the lower Iimits of normal were 3 .0, 1 .8, and 3.4 kg, respectively. The 95th percentile of interrater differences were 2 9.3% for second-digit abduction, 38.5% for fifth-digit abduction, and 43.7% for thumb opposition.

Condusion: Abnormal hand intrinsic strength should be suspected if values are lower than the 5th percentile values listed above or if strength change exceeds the 95th percentile for interrater differences shown above. These quantitative hand strength measurements may allow for earlier diagnosis of secondary neurologic complications and may aid in monitaring neurologic recovery in persons with SCI.     

Estimating the prevalence of drinking problems among physicians

Objective

Surveys assessing alcohol use among physicians have most commonly employed the Alcohol Use Disorders Identification Test (AUDIT) or the AUDIT-C, the most common short version of the AUDIT. As with other screeners, prevalence estimation is dependent on the accuracy of the test as well as choice of the cutoff value. The aim of the current study is to derive more precise prevalence estimates of alcohol problems in physicians by correcting for false-positive and false-negative results.

Method

In the context of a survey, the AUDIT was sent out via email or standard postal service to all 2484 physicians in Salzburg, Austria. A total of 456 physicians participated. A published correction formula was used to estimate the real prevalence of alcohol use problems.

Results

Applying a cutoff of 5 points for the AUDIT-C, 15.7% of female and 37.7% of male physicians screened positive. Use of a correction based on general population data and the sensitivity and specificity of the AUDIT-C resulted in much lower prevalence rates: 4.0% for female and 9.5% for male physicians. Using the full AUDIT, 19.6% of the female physicians and 48% of the male physicians were screened positive. Using the correction, the estimated prevalence rates for females and males were 6.3% and 15.5%, respectively.

Conclusions

Our findings demonstrate that uncorrected screening results may markedly overestimate the prevalence of physicians drinking problems.