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The degree to which patients should be prompted to give their best effort has not been adequately addressed in the literature, nor has the issue of the extent to which they should be informed that measures of effort will be included in the assessment battery. Three groups of undergraduates were given three different instructional sets prior to completing a neuropsychological evaluation. The instructions provided different levels of motivation to perform optimally as well as possible warning regarding the detection of poor effort. The three groups did not differ in performance on any of the cognitive measures, although outlier performance resulted in lower mean performance on the Finger Tapping Test by the most clearly warned group. The results are discussed in terms of the potential of different instructional sets to affect motivation for optimal test performance. [ABSTRACT FROM PUBLISHER]

Objective: To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Design: Cross-sectional, correlational. Setting: Urban, inpatient rehabilitation facility in the midwestern United States. Participants: Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Main Outcome Measures: Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Results: Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Conclusions: Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion. [ABSTRACT FROM AUTHOR]

A maximum likelihood confirmatory factor analysis (CFA) of the Wechsler Memory Scale-III (WMS-III) was performed by applying LISREL 8 to a general clinical sample (n=281). Analyses were designed to determine which of seven hypothesized oblique factor solutions could best explain memory as measured by the WMS-III. Competing latent variable models were identified in previous studies. Results in the clinical sample were crossvalidated by testing all models in the WMS-III standardization samples (combined n=1,250). Findings in both the clinical and standardization samples supported a four-factor model containing auditory memory, visual memory, working memory, and learning factors. Our analysis differed from that presented in the WMS-III manual and by other authors. We tested our models in a clinical sample and included selected word list subtests in order to test the viability of a learning dimension. Consistent with prior research, we were also unable to empirically support the viability of the immediate and delayed memory indices, despite allowing the error terms between the immediate and delayed memory subtests to correlate. [Copyright &y& Elsevier]

The reliability and validity of various short forms of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III; D. Wechsler, 1997) were evaluated in a sample of 100 patients with traumatic brain injury and in a demographically matched subgroup from the standardization sample. All short forms were based on 2-subtest estimations of the respective factor indexes. Although acceptable estimates could be obtained from all short forms for Verbal Comprehension, none of the possible short forms for Perceptual Organization consistently met the minimum criterion regarding the percentage of cases that fell within the 90% confidence interval of the full-length index. It is concluded that short-form estimates of the WAIS-III are not appropriate for clinical use when the goal is to obtain factor indexes. [ABSTRACT FROM AUTHOR]

Compares several methods of applying short forms of the Wechsler Adult Intelligence Scale-III (WAIS-III) within a clinical population in the U.S. Provision of prediction of full administration WAIS-III summary; Assessment on the performance of a patient; Determination of strengths and weaknesses of selected subtests.

The Postconcussion Syndrome Questionnaire (PCSQ) total and factor scores were compared to the primary validity and clinical scales from the Minnesota Multiphasic Personality Inventory — II (MMPI-2) in an effort to better define the structure of the PCSQ. The sample used was composed of a heterogeneous group of 79 patients referred for clinical neuropsychological evaluation. In reviewing the results, patients with higher PCSQ scores presented with higher clinical elevations on the MMPI-2. In addition, each of the PCSQ factor scores was related to a different pattern of MMPI-2 scales and subscales. The somatic factor was most associated with physical ailments, generalized distress, and social insecurity. In contrast, the psychological factor was related to complaints of dysphoria, brooding, and social connectedness. The cognitive and infrequent factors were related to reports of cognitive changes and unusual sensory experiences, respectively. The data present validation of the multifaceted nature of the PCSQ and its general sensitivity to subjective complaints. [Copyright &y& Elsevier]

A maximum likelihood confirmatory factor analysis of the Wechsler Adult Intelligence Scale-III (WAIS-III) was performed by applying LISREL 8 to a clinical sample (n=328). Analyses were designed to determine which of the nine hypothesized oblique factor solutions could best explain intelligence as measured by the WAIS-III in the general clinical sample. Competing latent variable models were identified in previous studies and a priori model modifications were made to test derivations of the nine base models. Results in the clinical sample were crossvalidated by testing all models in the normative sample used in the standardization of the scale. Findings in both the clinical and standardization samples supported a six-factor model including Semantic Memory, Verbal Reasoning, Constructional Praxis, Visual Reasoning, Working Memory, and Processing Speed factors. Our analysis differed from that presented in the WAIS-III manual as we tested more complex models of intelligence in addition to the ones evaluated by the test publishers. As a result, a six-factor model that corresponded to an expanded version of a model based on Horn''s Gf–Gc theory was empirically supported as having the best fit to the data. More complex derivations of this model failed to achieve sufficient goodness of fit. [Copyright &y& Elsevier]

A retrospective study of Wisconsin Card Sorting Test (WCST) protocols wasundertaken to determine the equivalence of the full WCST (Heaton, Chelune,Talley, Kay, & Curtiss, 1993) with the single-deck version of the WCST.Census-matched and demographically adjusted standardized scores for the fullWCST were compared to the single deck WCST (WCST-64) with 332 clinical protocolsusing two methods. The comparisons were made using (1) standard scores derivedfrom the new WCST-64 norms (Kongs, Thompson, Iverson, & Heaton, 2000)and from (2) WCST-64 percent scores standardized with the norms intended forthe full WCST. The results revealed adequate correlations and accuracy scoresfor both census-based norms, although WCST-64 scores adjusted for demographicinformation were not comparable to full WCST scores. Furthermore, the numberof cases in which estimated scores performed within an acceptable range ofactual full-version WCST scores fell below acceptable ranges. Clinicians areencouraged to use data from the WCST-64 with caution. [ABSTRACT FROM AUTHOR]

Publication of the third editions of the Wechsler intelligence and memorybatteries in 1997 created a need for research identifying Wechsler Adult IntelligenceScale-Third Edition/Wechsler Memory Scale-Third Edition (WAIS-III/WMS-III)profile patterns associated with neuropathology. The WAIS-III/WMS-III TechnicalManual offers data on various diagnostic groups, including traumatic braininjury (TBI). Hawkins (1998) employed Technical Manual data to propose certaindiagnostic guidelines. In order to validate the conclusions put forth by Hawkinsas they apply to brain injury, we examined WAIS-III and WMS-III profiles inan independent sample of 46 TBI cases. As expected, the WAIS-III ProcessingSpeed Index (PSI) was more sensitive to brain injury than other WAIS-III composites;and specific WAIS-III scores were stronger than certain WMS-III scores. Onthe other hand, the predicted relationship for WMS-III auditory and visualindexes was not found. The lack of specificity for TBI of the proposed indexcomparisons confirms the need to validate such hypotheses in independent samples. [ABSTRACT FROM AUTHOR]

The administration times for each of the subtests from the Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) were recorded for a clinical sample of 81 patients. The findings revealed that the time needed to administer the WAIS-III subtests to generate the summary scores, index scores, and both scores were 58, 51, and 65 min, respectively. The time required to complete the primary subtests on the WMS-III was 21, 15, and 6 min for Immediate Memory, General Memory, and Working Memory, respectively, resulting in a total administration time of 42 min. The time necessary to administer most of the subtests was unrelated to age, education, or performance level. These data demonstrate a shorter than expected administration time for the WAIS-III and a longer than anticipated administration for the WMS-III. Results for other clinical settings will be impacted by examiner familiarity and patient composition. [ABSTRACT FROM PUBLISHER]

The application of seven-subtest short forms of the Wechsler Adult Intelligence Scale-III (WAIS-3) was evaluated in a sample of 281 mixed clinical patients from three Veterans Affairs Medical Centers. Short-form summary scores were derived from deviation quotient tables and from prorating. They included either Block Design or Matrix Reasoning. Short-form summary scores for Full-Scale IQ (FSIQ) and Verbal IQ (VIQ) demonstrated good alternate-forms reliability with the full WAIS-3 scores, whereas Performance IQ (PIQ) summary scores were less accurate. Short forms derived from deviation quotients and prorating did not differ from each other. However, the inclusion of Matrix Reasoning resulted in somewhat better accuracy with WAIS-3 PIQ than did Block Design. The results of this study support the use of the seven-subtest short form of the WAIS-3 in estimating full WAIS-3 summary scores, especially for FSIQ and VIQ. [ABSTRACT FROM PUBLISHER]

Deals with a study wherein equations for prorating the Wechsler Memory Scale--III Index scores were derived and validated on a sample of mixed clinical cases. Background information on the scale; Characteristics of the participants; Methodology used; Findings and conclusions.

Presents a study which discussed the confirmatory factor analyses of the Wechsler Adult Intelligence Scale-Third Edition standardization data. Method; Results; Discussion.

Evaluates the application of the nine-subtest prorated version of the Wechsler Adult Intelligence Scale-III (WAIS-III) in estimating Verbal, Performance and Full Scale Intelligence Quotient scores. Comparison of the full and prorated versions of the WAIS-III; Frequency distributions of difference scores between full and prorated WAIS-III summary scores.

Neuropsychiatric measures consisting of dichotomously scored items are commonly used in clinical assessment. After summing these items, clinical guidelines frequently recommend cutoff scores to determine the presence or degree of a particular attribute, such as depression. However, blind application of such cutoffs neglects whether the total score is significantly different from chance. This confounding problem is illustrated using the Geriatric Depression Scale (GDS), and recommendations for interpreting the degree to which a GDS score significantly exceeds chance are presented. Specifically, GDS scores between 11 and 20, inclusive, were found not to differ significantly from chance (p >0.05), assuming a random response pattern. The importance of supportive clinical evidence of depressive symptomatology is increased for scores in this range. These guidelines will be helpful in using such measures with patients who may vary with respect to response accuracy, and in assessing possible incomplete effort or random responding. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Efforts to determine premorbid intellectual functioning for a patient prior to their current evaluation has been attempted using demographic information, current performance data, or a combination of both. Five of these premorbid intellectual prediction methods were assessed in a sample of 104 neurological patients referred for neuropsychological evaluation and a matched control sample. Predicted Full-Scale Intelligence Quotient (FSIQ) scores of patients did not differ from the true FSIQ scores of the matched controls. Logistic regression analyses found no difference in classification accuracy among the prediction methods. The findings of this study found combined demographic and performance methods developed by Vanderploeg and Schinka (1995), Vanderploeg, Schinka, and Axelrod (1996), Krull, Scott, and Sherer (1995) and Williamson, Krull, and Scott (1996) to be accurate estimates of premorbid functioning. This study found estimates of premorbid functioning based on demographic data alone (Barona, Reynolds, & Chastain, 1984) not to differ from the other methods, which is at odds with prior studies. Prospective studies employing all of these methods are recommended to clarify the utility of demographically based estimates. [ABSTRACT FROM PUBLISHER]