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A response by Lester B. Mayers and Thomas S. Redick to a commentary to their article "Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues," published in a 2012 issue, is presented. Both Mayers and Redick agree that the nature of their paper was an opinion rather than a review. They explain their framework for identifying published articles. They refute claims that their review had a selective and biased nature.

Changes in the hippocampal system have been proposed as a possible marker of incipient Alzheimer’s disease (AD) at the mild cognitive impairment (MCI) stage. The Placing Test (TPT) evaluates the efficiency of the hippocampal system by measuring the ability to remember associations between images and their locations. Our aim was to validate a novel paper-and-pencil (PnP) version of TPT featuring people’s faces in color (versus the traditional test carried out with black-and-white images) and a computerized Placing test with categories of objects, faces, and animals (versus a version featuring the categories of objects, faces, and shapes). A total of 78 subjects were divided into 2 groups; each group included 20 normal control subjects, 10 subjects with MCI, and 9 with AD. All subjects underwent TPT. The correlation between the two versions of the test was highly significant (r= .770,p< .001), demonstrating that the transfer of the test format from PnP to computer was acceptable. Computerized object and animal subtests had the highest overall sensitivity and specificity for discriminating MCI from AD, while PnP faces in color discriminated controls from MCI best. Although this was a preliminary assessment on a small sample of subjects, the results of our study demonstrated that total scores on both the traditional and computerized versions of the test discriminate all three diagnostic categories, but the subtests had varying discriminatory abilities. [ABSTRACT FROM PUBLISHER]

A commentary to the article "Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues," published in a 2012 issue, is presented. It points out a failure to document any detailed inclusion criteria for identifying published articles to guide the review of the current literature. It contends that the use of Pearson's correlation coefficients as a measure of test-retest reliability is hampered by the kind of data obtained from the measurement.

A brief paper-and-pencil instrument was developed to rapidly assess visuospatial ability and serve as an alterative to the WAIS Block Design subtests during screening or when assessment time is limited. The Design Organization Test (DOT) consists of square black-and-white grids with visual patterns similar to those of the Block Design subtests. Administration is straightforward and requires examinees to reproduce as many designs as possible in 2 minutes using a numerical code key. For 411 college students, alternate forms of the DOT yielded reliability estimates comparable to that of the test-retest reliability of WAIS-III Block Design subtest. In a clinical sample, the DOT was significantly correlated (r = .92) with WAIS-III Block Design scores and was successfully substituted in place of Block Design raw scores without significant change in Performance IQ or Full Scale IQ. The results suggest that the DOT provides a useful and rapid screening measure of visuospatial ability. [ABSTRACT FROM AUTHOR]

Although it is currently not known whether early assessment and treatment of hemispatial neglect improves rehabilitation outcome, identification in the acute phase of post stroke is important for nursing, counseling families, and planning intervention strategies. Previous tests of neglect either fail to detect mild forms of neglect or are too lengthy for use at the bedside. We tested and selected an efficient, small battery of tests to address this gap. Two hundred and twenty-four stroke patients completed the Sunnybrook Neglect Assessment Procedure (SNAP). Normal performance was determined from a population of 100 normal elderly volunteers. The SNAP was shown to be a highly reliable and valid instrument. Factor analysis showed good internal consistency, suggesting that performance on each subtest is positively correlated with the others. The SNAP is a useful and reliable tool to assess neglect at the bedside in acute stroke patients. [ABSTRACT FROM AUTHOR]

Introduction: Validity of neuropsychological assessment depends, inter alia, on the cooperation of the examinee, requiring separate assessment. Stand-alone tests devised for detecting negative response bias (NRB) are exposed to potential threats to their validity. In this study, an algorithm was developed for assessing NRB within a standardized, computerized neuropsychological battery (NeuroTrax), making it difficult to detect and circumvent. Method: Data were collected from the archived medical records of 75 outpatients with mild to moderate head injury, all in litigation. Participants were classified as low or high likelihood for NRB, using a known test for effort assessment (Test of Memory Malingering). Results: Variables judged to be prone for exaggeration and showing large differences between the groups were entered into a logistic regression analysis. The resulting formula exhibited high specificity (98.0%) and sensitivity (87.5%), classifying correctly 94% of the cases. Conclusion: It is suggested that the algorithm developed empirically using scores on the NeuroTrax computerized battery can be a useful tool for assessing effort. This algorithm should resist threats to its validity and can be automatically computed while assessing a range of cognitive skills. [ABSTRACT FROM AUTHOR]

Introduction: The Rey Complex Figure Test (RCFT) is a popular measure of visuospatial and executive functioning. Clinical interpretations of RCFT performance are partly based on how an individual approaches the task with piecemeal organization often considered indicative of impairment. This is despite little previous research examining RCFT organizational variability in healthy adults and considerable individual differences previously shown in processing the global and local features of visual stimuli. Method: Fifty-seven undergraduate university students (44 females, 13 males), aged 18 to 34 years (M = 20.14, SD = 3.29) participated in the study. Participants completed the RCFT copy trial followed by a hierarchical shape task. RCFT organization was measured using the qualitative score (Q-score). Results: Extensive variation was demonstrated in the distribution of RCFT organization and global processing scores with largely nonsignificant deviation from a normal distribution (p ≤.05). Only 53% of participants commenced the RCFT copy by completing the base rectangle using four consecutively drawn lines. The diagonals were completed using two consecutive lines by 40% of participants with only 11% doing so immediately following completion of the base rectangle. Only 32% completed the bisectors as two consecutive lines, and only 18% did so immediately following completion of the base rectangle. Global processing scores significantly predicted RCFT organization (b = 0.63, p =.006) with individuals demonstrating higher global processing on average exhibiting more organized RCFT copies than those demonstrating lower global processing. Conclusions: A sample of healthy individuals demonstrated a wide range of RCFT organizational strategies with the variation partly explained by individual differences in global/local processing. [ABSTRACT FROM AUTHOR]

Objective: Within-person variability in cognitive performance is related to neurological integrity, but the association with functional abilities is less clear. The primary aim of this study was to examine the association between cognitive dispersion, or within-person variability, and everyday multitasking and the way in which these variables may influence performance on a naturalistic assessment of functional abilities. Method: Participants were 156 community-dwelling adults, age 50 or older. Cognitive dispersion was calculated by measuring within-person variability in cognitive domains, established through principal components analysis. Path analysis was used to determine the independent contribution of cognitive dispersion to functional ability, mediated by multitasking. Results: Results of the path analysis revealed that the number of subtasks interweaved (i.e., multitasked) mediated the association between cognitive dispersion and task sequencing and accuracy. Although increased multitasking was associated with worse task performance in the path model, secondary analyses revealed that for individuals with low cognitive dispersion, increased multitasking was associated with better task performance, whereas for those with higher levels of dispersion multitasking was negatively correlated with task performance. Conclusion: These results suggest that cognitive dispersion between domains may be a useful indicator of multitasking and daily living skills among older adults. [ABSTRACT FROM AUTHOR]

The current study aimed to address error monitoring impairments in dementia using an intervention for execution deficits. Thirty-eight participants completed the Naturalistic Action Test (NAT) under two conditions: Standard and User-Centered. The Standard NAT followed the manual procedures; in the User-Centered NAT, objects were arranged sequentially, and distractor items were separated from target objects. While participants committed fewer errors in the User-Centered condition, there was no difference in the proportion of errors detected. However, the neuropsychological processes associated with monitoring differed across conditions. The results have implications for a neuropsychological model of error monitoring in dementia. [ABSTRACT FROM AUTHOR]

Previous studies investigating subclinical signs of cognitive decline in presymptomatic carriers of Huntington's disease (HD) have shown conflicting results. The current study examines cognition in 105 at-risk individuals, using a broad neuropsychological test battery and adopting strict inclusion criteria for attaining a homogeneous sample. Results obtained by analyses of variance and effect size calculations indicate no clinical evidence of significant cognitive decline in asymptomatic HD carriers very far from onset of illness compared to noncarriers. Closeness to disease onset amongst gene carriers influenced cognition negatively whereas cytosine-adenine-guanine (CAG) repeat size did not. The findings call for longitudinal follow-up studies using a combination of clinical instruments and experimental paradigms to pinpoint when subtle cognitive deficits occur and within which of the cognitive domains. [ABSTRACT FROM AUTHOR]

Practice effects in serial neuropsychological assessment have led to the use of alternate forms to measure change in cognitive functioning. The construct validity of three variants of the Trail Making Test was explored over a 3-week period in a sample of 158 undergraduate students. Using confirmatory factor analysis, a two-factor (sequencing-shifting) model was identified to best represent the data. Latent means structural analysis indicated the absence of order effects, lending support for the construct validity of the three tests. The study provides evidence that the three tests can be offered as potential alternative instruments in serial assessment. [ABSTRACT FROM AUTHOR]

Pain may contribute to cognitive decline, which is a common complication in the early postoperative period. We compared the effects of two common pain management techniques, intravenous patient-controlled analgesia (PCA-IV) and patient-controlled epidural analgesia (PCEA), on cognitive functioning in the immediate postoperative period. Patients hospitalized for elective surgery were randomly assigned to one of the treatment groups (30 patients per group). A battery of objective, standardized neuropsychological tests was administered preoperatively and 24 hours after surgery. Pain intensity was also evaluated. Nonoperated volunteers served as controls. Patients of the PCA-IV group exhibited significantly higher pain scores than did patients of the PCEA group. PCA-IV patients exhibited significant deterioration in the postoperative period in all the neuropsychological measures, while the PCEA patients exhibited significant deterioration only in one cognitive index, compared to controls. [ABSTRACT FROM AUTHOR]

Performance on neuropsychological tests is affected by age and education, which makes the early detection of cognitive impairment difficult when assessing individuals of varying levels of education. We examined the effects of age, education, and gender on three memory indexes of the Wechsler Memory Scale-III, Delayed Memory, Working Memory and the difference between Working-Delayed Memory in a sample of patients with amnestic Mild Cognitive Impairment, patients with mild probable Alzheimer's disease, and a nondemented elderly comparison group. Whereas Delayed and Working Memory scores were affected by participant type, age, and education, the Working-Delayed Memory difference score was affected by participant type, only. Our preliminary conclusions, pending replication of the findings with a larger sample, are that working-delayed memory difference was sensitive to early memory decline without being affected by age and education. [ABSTRACT FROM AUTHOR]

Normative data for a healthy sample of older adults (n=108) ranging in age from 60 to 96 are provided for the Cognistat, a mental status exam previously known as the neurobehavioral Cognitive Status Examination (NCSE). A Cognistat Composite Score is also introduced that is intended to be used as a marker of general cognitive impairment, allowing the Cognistat to be used to match patients in terms of severity of their cognitive dysfunction. The "screen and metric" approach of the Cognistat was abandoned in order to improve the reliability and standardization of this measure by administering the entire metric to all patients. The impact of demographic variables on Cognistat performance was examined, demonstrating that both age and education contribute uniquely to a number of Cognistat subtests as well as the Cognistat Composite Score. This study highlights the importance of matching an examinee's demographic background to the normative sample with which his or her test score is being compared. Normative data were stratified accordingly by age and by both age and education. Current results indicate that the Cognistat is sensitive to normal aging and promises greater sensitivity to the impact of age than the commonly employed Mini-Mental State Examination (MMSE). [ABSTRACT FROM AUTHOR]