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Objective:To evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS), a 39-item Likert-type self-report instrument that requires a fifth grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline in older persons.Method:Participants were 512 consecutive outpatient referrals (71% women, mean age 60.6, and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was followed by a varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria including demographics, Cronbach’s alpha, Digit Span, and Wechsler Memory Scale-IV Logical Memory (LM) and Visual Reproduction (VR), and Minnesota Multiphasic Personality Inventory (MMPI)-2 measures of depression, anxiety, somatic preoccupations, and thought disturbance.Results:Six dimensions of cognitive complaint emerged accounting for 64% of the variance: attention/concentration, praxis, prospective memory, speech problems, memory for people’s names, and temporal orientation. The factors showed good internal consistency (alphas > .850). Correlations with Digit Span, LM, and VR were all nonsignificant. CDS scores were associated with MMPI-2 measures of anxiety, depression, somatic preoccupation, and thought disturbance. Percentiles and T-scores were derived for raw scores on the CDS and its six component subscales.Conclusion:The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has clinical utility and is a potentially useful tool in research involving age-related cognitive changes and meta-cognition.

The potential impact of depressive symptoms on neuropsychological test performance has been studied extensively yielding mixed results. Self-report depression inventories have been most often used, without a means to screen participants for response bias. Studies have also neglected to screen participants for incomplete effort in testing. In the present study, 48% of an initial sample of outpatient referrals (N = 247) failed to meet traditional validity criteria. The remaining participants were screened for cerebral pathology and then classified into high and low depressive symptom groups (ns = 46) using the median score on Scale D (Depression) of the MMPI-2. The "high depression" subjects scored over 70 T on the D scale (MN = 80 T). The "low depression" subjects scored below 65 T (MN = 58 T). Age, education, and estimated intelligence were equivalent across groups. Neuropsychological test performances were compared across eight tests: Revised Category Test, Trail Making Test, Part B, Tactual Performance Test (TPT), TPT Memory and Location, Reitan-Indiana Aphasia Screening Test, Seashore Rhythm Test, and the Speech Perception Test. A MANOVA revealed no main effect for group., F(8,69) = 1.05, n.s., and univariate analyses for each test also showed no intergroup differences. The results provide evidence that these neuropsychological tests are appropriately interpreted within a framework of brain-behavior relationships irrespective of an examinee's emotional status.

The impact of emotional factors on subjective cognitive complaints and memory test performance has been a topic of extensive research, produced conflicting results. Investigators typically used self-report inventories that lack measures of response bias. Studies have also neglected to use performance validity tests (PVTs) to screen participants for incomplete effort. In the present study, 27% of the original sample of non-litigating outpatient referrals (

We provide a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale - IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 273 neuropsychologically normal outpatient referrals to a neuropsychology clinic. The analysis indicated that about 43% to 48% of the neuropsychology referrals exhibited retrieval difficulties and were able to store more information in long-term memory than they were able to retrieve on the delayed free recall trial. The 20-item measure, freely available to qualified clinicians, provides useful information regarding a person's ability to store and access newly acquired information.

The MMPI-2 and WAIS-IV are commonly used together in neuropsychological evaluations yet little is known about their interrelationships. This study explored the potential influence of psychological factors on WAIS-IV performance in a sample of 180 predominantly male veteran referrals that underwent a comprehensive neuropsychological examination in a VA Medical Center. Exclusionary criteria included failed performance validity testing and self-report distortion on the MMPI-2. A Principal Components Analysis was performed on the 15 MMPI-2 content scales, yielding three broader higher-order psychological dimensions: Internalized Emotional Dysfunction (IED), Externalized Emotional Dysfunction (EED), and Fear. Level of IED was not related to performance on the WAIS-IV Full Scale IQ or its four indexes: (Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed). EED was not related to WAIS-IV performance. Level of Fear, which encompasses health preoccupations (HEA) and distorted perceptions (BIZ), was significantly related to WAIS-IV Full Scale IQ and Verbal Comprehension. These results challenge the common use of high scores on the MMPI-2 IED measures (chiefly depression and anxiety) to explain deficient WAIS-IV performance. In addition, they provide impetus for further investigation of the relation between verbal intelligence and Fear.

Objective Evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), a 39-item Likert-type self-report instrument that requires a fifth-grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline. Evaluation included an exploratory factor analysis, measures of internal consistency, relation to demographics, criterion validity, and normative table for raw to T score/percentile transformation. Method Participants were 643 consecutive referrals (71% women, mean age 60.6 and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was conducted followed by varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria. Results Six dimensions of cognitive complaint emerged accounting for 64% of the variance: Attention/Concentration, Fine Motor Skill, Prospective Memory, Speech Problems, Memory for Names, and Temporal Orientation. Factors showed good internal consistencies (alphas > .850). Correlations with Logical Memory, Visual Reproduction, and Digit Span were all nonsignificant. CDS factor scores were highly predictive of MMPI-2 measures of anxiety, depression, and somatic preoccupation. Percentiles and T-scores were derived for the CDS total score and its six component scales. Conclusion The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has substantial clinical utility, and is a potentially useful tool in exploring subjective cognitive decline as a prodrome to dementia.

Objective We introduce a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale – IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 168 female and 105 male neurologically normal outpatient referrals to a neuropsychology clinic. Method Ten 5-option items were developed for each of the three LM stories (A, B, and C) reflecting the stories’ narrative content, yielding 20 items for administration to examinees under 70 (Stories B and C) and older than 69 (Stories A and B). Four distractor options for each item were designed to be “plausible” alternatives for the examinee who had little or no recollection of the narrative material. Examinees (N=360), screened for performance validity (effort), completed the LM Recognition test immediately after delayed LM free recall. Results Internal consistency (Cronbach alpha) was acceptable for both 20-item LM Recognition tests. Individuals’ scaled scores on LM-Recognition were compared with LM-II (free recall). Recognition was superior (> one SD) to free recall performance in 43% (age 18 to 69) and 48.2% (age 70+). Conclusion Delayed free recall scores often underestimate a person’s ability to encode and store new information. For clinical application, separate LM Recognition norms were derived for older (Stories A and B) and younger examinees (stories B and C). This 20-item measure assists clinicians in differentiating between storage and retrieval deficits on the Logical Memory subtest.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

The psychological characteristics of acute traumatic brain injury (TBI) have received limited research focus, despite empirical evidence of their relevance for subsequent psychological adjustment and early therapeutic intervention. This study addressed a wide range of psychological features in 47 individuals who were hospitalized as a result of acute mild TBI (mTBI). Participants were screened from amongst consecutive TBI admissions for moderate to severe brain injury, and for pre-injury neurological, psychiatric, or substance abuse histories. Clinical and content scale scores on the MMPI-2 were explored in relation to patient gender, age, level of education, and extent of cognitive complaints. The results revealed diverse psychosocial problem areas across the sample, the most common of which were somatic and cognitive complaints, compromised insight, and a naively optimistic self-perception. The mediating roles of injury severity and demographic variables are discussed. Clinical implications and specific recommendations are presented.

This study examined fundamental psychometric characteristics of the Symptom Validity Scale-Revised (FBS-r) in a nonforensic sample of 303 neuropsychological referrals. FBS-r had a reliability (internal consistency) of .747 and two higher order factoral dimensions (Somatic Complaints and Optimism/Virtue). FBS-r had a discordant factor structure: Optimism/Virtue (7 items) was negatively related to Somatic Complaints (21 items) and undercut FBS-r measurement consistency (reliability). FBS-r scores, which purportedly reflect symptom exaggeration, are affected by as much as 23 T-score points on test items that are negatively related to symptom reporting. These data suggest that the FBS-r produces ambiguous scores reflecting two underlying dimensions that warrant additional research.

The Fake Bad Scale (FBS; Symptom Validity Scale) has fundamental psychometric flaws, interpretive problems, and potentially adverse societal consequences that are not appreciated by Ben-Porath et al. (Psychological Injury and Law 2(1), 62–85, 2009a, b). The FBS was constructed without due consideration to scientifically based guidelines for scale development (Clark and Watson, Psychological Assessment 7, 309–319, 1995; Jackson, Psychological Review 78, 229–248, 1971; Nunnally 1978; Holden and Troister, Canadian Psychology 50, 120–130, 2009). After almost two decades in existence, its face, content, and construct validity have not been established in the empirical literature. Oft-cited discriminant studies that appear to support the FBS are premature because of the scale’s unestablished psychometric foundation. In addition, these studies have significant methodological weaknesses that preclude definitive conclusions about what the scale actually measures. We review these weaknesses and recent legal cases that challenge the scale. We recommend that the FBS’s validity and fairness be addressed in an independent scientific review by the Buros Mental Measurement Test Evaluation System, a non-profit center specializing in the evaluation of commercially available tests.

Based on a focused review and careful analysis of a large amount of published research, Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) concluded that the Fake Bad Scale (FBS) does not appear to be a sufficiently reliable or valid measure of the construct “faking bad”. Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) pointed out examples of errors in some of the most widely cited studies (including meta-analytic) used to support the FBS and described potential biases if the FBS is used to impute the motivation to malinger in those reaching its variable and imprecise cutoff scores. In a response to this article, Ben-Porath et al. (Psychol Inj Law 2:62–85, 2009) dismissed all the concerns raised in it with suggestions that our conclusions were based on faulty premises, misunderstandings of basic concepts, misleading descriptions of Minnesota Multiphasic Personality Inventory (MMPI) research, flawed analyses, and so on. This reply corrects some of Ben-Porath and colleagues’ (Psychol Inj Law 2:62–85, 2009) multiple misrepresentations of the points made in Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) and identifies eight logical fallacies relevant to the FBS controversy. We end with a challenge to other psychologists to fully examine the underlying FBS research before adopting this scale in their clinical practice.

The Fake Bad Scale (FBS), developed to identify malingering of emotional distress among claimants seeking compensation for personal injuries, was recently added to the MMPI-2 scoring materials, resulting in its widespread dissemination across the various clinical settings that use the MMPI-2 in psychological evaluations. We examine: (1) questions of item bias in the FBS; (2) how malingering and nonmalingering groups are identified in FBS studies, including whether the research has been broadly inclusive and fully represents the populations assessed by the MMPI-2; (3) the reliability and validity of the FBS; (4) the highly variable recommendations for raw score cut-offs and how they relate to T scores; (5) two inpatient groups [men in a tertiary care Veterans Affairs Healthcare System (VA) unit and women in an eating disorders program] who may be inappropriately labeled as malingering by the FBS; (6) the publisher’s statement on use of the FBS; and (7) a Frye hearing in Florida where the FBS was excluded from expert testimony, one of three so far. We raise questions about its potential bias against people with disabilities and physical illnesses, women, individuals exposed to highly traumatic situations, and those motivated to present themselves in a favorable light. Psychologists using the FBS for making decisions about clients’ motivations need to be aware of the serious problems with the scale’s use and the cases of its inadmissibility in court.

The F(l=thorn) scale of the MMPI-2 is widely used to help identify exaggeration of psychological problems in psychiatric, forensic, and neuropsychological settings. The scale was constructed by selecting all MMPI-2 items (N = 27) that were endorsed by less than 20% of a sample of VA psychiatric inpatients and 20% of the normative sample used in restandardizing the MMPI-2. Although þ is used to measure symptom exaggeration and malingering, 4 of its 27 items load on the Lie (L) scale, which is known to be a measure of defensiveness and symptom underreporting. These four items, which express a denial of occasional anger, irritability, and procrastination, could conceivably measure an uncommon expression of defensiveness. This study used 150 neuropsychological referrals to test the hypotheses that (a) the four L scale items measure defensiveness, not exaggeration, and (b) the elimination of these items improves the utility of þ in assessing symptom exaggeration. The results indicate that the four L scale items are associated with defensiveness, not with symptom exaggeration. One third of the patients had an average T-score artifact of 9.5 points on þ as a result of endorsing these L scale items, with a range of OT to 21 T. Using the K scale as a criterion for level of problem disclosure, a shortened version of þ (omitting the four L scale items) was superior to þ as a measure of symptom exaggeration (r= -.46 vs. -.36, r2 = 21% vs. 13% of the variance). The implications for clinical practice are discussed.

The spectrum of neuropsychological features of familial Creutzfeldt-Jakob disease (CJD) have seldom been reported, possibly because of (a) the rarity of this hereditary form of prion disease; (b) frequent delays in diagnosis, and; (c) the typically rapid demise of the patient, which affords little opportunity for comprehensive testing or serial analysis. Here we describe the neurobehavioral characteristics of a 48-year-old right-handed male (JD) who presented with complaints of poor depth perception, unsteady gait, and unusual sensory experiences in his face and neck. JD was followed serially over the final 4 months of his 5-month illness. Immediately following hospital admission, he underwent a neuropsychological evaluation that revealed moderate to severe impairment of delayed (30-minute) verbal memory, tactual performance in his right hand, and word-finding ability. In contrast, other abilities that are commonly classified within the verbal, visuospatial, and memory domains showed minimal or no compromise. Parallel studies of electroencephalographic activity revealed diffuse slowing and, later, 1-Hz rhythmical discharges over the left hemisphere, and mild prominence of the lateral ventricles and cerebral sulci on magnetic resonance imaging. Autopsy revealed spongiform changes and reactive astrocytosis, and genetic testing demonstrated a codon 200 mutation in the prion protein gene. These findings indicate that CJD can result in clinical manifestations compatible with multifocal asymmetric cerebral involvement before more diffuse neurodegeneration ensues, providing a strong impetus for the study of additional cases. This long-term understanding can help to determine whether the multiple loci of clinical involvement are specified by genetic or epigenetic factors, or both.

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20-34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.

Although the Spanish version of the WAIS (Escala de Inteligencia Wechsler para Adultos, EIWA) is widely used as a measure of intelligence in Spanish-speaking populations, little is known about the psychometric characteristics of the test beyond the information given in the test manual. Despite this, users have assumed that the test functions clinically and statistically as does the original WAIS. This assumption has been applied to the area of short test forms which are assumed to be as valid as those used with the WAIS. The present study is an attempt to determine the optimal two-, three-, four-, and five-test short forms for estimation of Full Scale IQ based on the EIWA standardization test data. In addition, the relative amount of common and specific variance in the EIWA subtests was determined, along with the degree of measurement error. The study emphasizes the limitations of using the EIWA arising from its out-of-date norms, use of a restricted Spanishspeaking population, and failure to make updates since its introduction. These cautions suggest that the EIWA (long and short forms) should not be used for determining IQs; instead its use should be limited to research and to tracking cognitive changes over time.

The Spanish version of the Wechsler Intelligence Scale for Children-Revised (WISC-R, Wechsler, 1974)-the Escala de Inteligencia para Ninos-Revision (EIWN-R, Wechsler, 1982)-has a potentially important role in the assessment of Hispanic children. However, little is known regarding its psychometric characteristics. This study used the normative data from the EIWN-R standardization sample (N = 532 Cuban Americans) to examine its factorial composition and general comparability with the WISC-R. Within each of the 11 age groups (ages 6 1/2 to 16 1/2), the correlation matrix of raw scores was subjected to a principal components analysis and varimax rotation. The results supported a 2-factor solution across age groups roughly corresponding with Wechsler's verbal and performance dimensions. The existence of a meaningful third factor, which has empirical support in the WISC-R literature, failed to emerge for the EIWN-R.

Self-appraisal of cognitive difficulties by a sample of 63 male patients with closed-head injury (CHI) was examined in relation to their performance on the Wechsler Memory Scale - Revised (WMS-R; Wechsler, 1987), WAIS-R Digit Span (Wechsler, 1981), and to their scores on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) measures of anxiety and depression. In an initial step, the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), consisting of 39 self-report items, was factor analyzed using a sample of 255 consecutive neuropsychological referrals with documented brain impairment. Seven orthogonal dimensions emerged: Attention and Concentration, Orientation and Memory, Praxis, Domestic Activities, Facial Recognition, Task Efficiency, and Errand and Name Recall. Within a sample subset consisting of 63 patients with CHI, subjective complaints on the CDS were predictive of WMS-R Logical Memory performance (r = -.51, p < .0005). In contrast, CDS scores were generally poor predictors of Digit Span and Visual Reproduction scores (rs < .31). Cognitive complaints were also associated with emotional distress on the MMPI-2. The CDS appears to be a useful measure of self-appraised cognitive difficulties in patients with CHI, and may assist in the assessment of their self-reflective insight.

A substantial body of research suggests that the MMPI-2 contains a number of items that are sensitive to closed-head trauma (CHT) and other neurologic conditions. A correction procedure was recommended by Gass (1991) using an index consisting of 14 neurologically sensitive items that were extracted from a predominantly male veteran sample of CHT patients. The generalizability of these correction items was assessed in the present study by investigating the MMPI-2 scoring characteristics of an outpatient referral sample of 54 CHT patients (28 male, 26 female) who had sustained recent and mild head trauma. Their frequency of endorsement of MMPI-2 was contrasted with that of the MMPI-2 normative sample (N = 2,600). Chi-square analyses identified the 15 MMPI-2 items that best differentiated this CHT sample from normal subjects. The results indicate that: (a) unlike those in an inpatient psychiatric sample (n = 524), the MMPI-2 items that best distinguished the CHT Ss from normals consisted of neurologic symptom content; (b) of these 15 items, 10 were included in the 14-item correction (Gass, 1991); and (c) 13 of the 14 correction items effectively discriminated the cross-validation sample of CHT Ss from normals. These findings offer empirical support for the application of the MMPI-2 correction with patients who have mild and recent head trauma.

This is a case study of an 88-year-old man who presented with agenesis of the corpus callosum and colpocephaly. Symptomatically, he reported a sudden onset of mild, intermittent left hand apraxia, but denied any previous manifestations consistent with this type of brain malformation. The patient underwent neuroimaging, evaluation by neurology, and comprehensive neuropsychological testing to determine the nature of any other associated impairments. Test results indicated that he was, with a few exceptions, neuropsychologically normal. He performed well on tests that are highly sensitive to acquired brain dysfunction. His most notable deficit was failed performance in the simultaneous and coordinated use of both hands in using tactile and proprioceptive feedback on the Tactual Performance Test. This case is discussed in terms of plasticity of the developing brain, including compensatory mechanisms, highlighting the variability in clinical outcome in the context of congenital brain malformation. This case study illustrates the strong influence of cerebral plasticity as well as a possible circumscribed manifestation of interhemispheric disconnection.

Accumulating data indicate that the MMPI-2 contains items that may be sensitive to neurologic conditions independent of a patient's psychological status. Gass (1992) identified 21 stroke-related MMPI/MMPI-2 items which were recommended for use as a score-correction index. This study examined these items using a cross-validation sample of 50 VA stroke patients. Item endorsement rates were contrasted with those of the MMPI-2 normative sample. The following results were obtained: The MMPI-2 items that distinguished stroke patients from normals have neurologic symptom content, all 21 correction items were upheld as effective discriminators, and the 21 items were commonly endorsed by the CVA patients (mean = 52%, range: 22% to 75%). These findings support the composition of the MMPI-2 correction for stroke and the rationale on which its application is based.

Minnesota Multiphasic Personality Inventory (MMPI-2) validity scales were compared in 4 groups : nonclinical participants answering under standard instructions (n = 20), nonclinical participants instructed to fake closed-head injury (CHI) symptoms (n = 18), non-compensation-seeking CHI patients (n = 31), and compensation-seeking CHI patients (n = 30). The highest scores on MMPI-2 overreporting scales were obtained by nonclinical participants faking CHI, and significantly higher scores on these scales were obtained by compensation-seeking relative to non-compensation-seeking CHI patients. These results suggest that MMPI-2 overreporting scales are sensitive to fabrication of CHI complaints, and possibly to exaggeration of CHI complaints, although further research is necessary to evaluate the latter hypothesis fully.

A methodology to assist in distinguishing deficient memory storage from compromised retrieval operations is presented for use with the Logical Memory (LM) and Visual Reproduction (VR) subtests of the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987). A 21-item five-option multiple choice recognition test for LM and a cuing technique for VR are presented, followed by descriptive data based on a sample of 94 psychiatric inpatients (mixed diagnoses) and a sample of 99 brain-injured (BI) patients. The BI sample performed worse than the psychiatric sample on all of the LM and VR measures, with VR-CUED showing the highest degree of discrimination. In both groups, many subjects initially acquired much more information than they reported during the standard free recall format. The supplemental scoring format and reference data reported herein provide clinically useful information regarding a person's ability to store and access new information.

The measurement of personality and psychopathology in neuropsychological contexts is essential because brain injury affects psychological status, and psychological problems can mimic brain dysfunction. A neuropsychological evaluation is incomplete without an assessment of personality and emotional status. The MMPI-2 is, by far, the most widely researched and clinically utilized test to meet this need. The long history of its use in neuropsychology has generated numerous areas of investigation designed specifically to enhance its application with individuals with known or suspected brain damage. The MMPI-2 content scales, subscales, and RC Scales provide information that helps the clinician refine and supplement interpretation of Clinical Scales. This article reviews special administrative and interpretive considerations that apply in neuropsychological settings. It looks at recent and controversial developments in MMPI-2 research and application.

MMPI profiles of 130 male veterans with cerebrovascular accidents were examined in relation to type and degree of neuropsychological deficit, hemispheric location of lesion, and time poststroke. Three neurobehavioral factors (Verbal, Visuospatial, Sensorimotor) were extracted from the Halstead-Reitan Battery and Wechsler Memory Scale. Canonical analyses revealed verbal impairment to be associated with greater openness in reporting emotional difficulties (Scale F) and limited social facility (Scale Hy). Sensorimotor deficits were associated with anxiety and distress (Pt) in patients with left hemisphere (LHD) but not right hemisphere damage (RHD). Although RHD and LHD patients had similar composite MMPI profiles, neuropsychological deficits in RHD were unrelated to MMPI scores. Time poststroke was independent of MMPI findings in both LHD and RHD samples.

This study tested the hypothesis that depression, anxiety, and bizarre thought content, as measured by MMPI-2 scales, would show a negative relationship with performance on widely used measures of executive functioning. Subjects were 70 male psychiatric patients who were ostensibly free of any neurologic disease or history of substance abuse. Correlational analyses were performed between age and education-corrected scores on the Controlled Oral Word Association Test (FAS), Design Fluency, and WISC-R Mazes, and scores on MMPI-2 scales D, PT, Anxiety, Fears, Obsessional Thinking, Depression, and Bizarre Mentation. The findings suggest that fluency and maze performance is (1) largely independent of measures of depression (D, DEP) and bizarre mentation (BIZ); (2) mildly associated with a measure of generalized anxiety (ANX); and (3) strongly related to an MMPI-2 measure of fearfulness (FRS).

The potential impact of test anxiety on cognitive testing was examined in a sample of 300 predominantly male veteran referrals who were administered a comprehensive neuropsychological test battery. Exclusionary criteria included failure on effort testing (n ¼ 14). Level of test anxiety was significantly related to performance on the WAIS-III Working Memory Index (r ¼ 2.343, p , .001) but not to scores on the Processing Speed, Perceptual Organization, or Verbal Comprehension indexes. Test anxiety was not related to a global index of neuropsychological performance on the HRNES-R (Average Impairment Scale). Level of education had a collinear relationship with test anxiety in predicting cognitive test performance. Regression analyses revealed a more prominent role for education, indicating the possibility that test anxiety may be a reaction to, more than a cause of, deficient working memory performance. These results suggest that clinicians who use these particular tests should be reluctant to attribute poor test performance to anxiety that occurs during the testing process.

The provision of neuropsychological test feedback is of central importance in helping patients and their families cope with the consequences of brain injury. A general framework for presenting feedback is described, with an emphasis on techniques designed to maximize patient benefit. Special issues involving test-related limitations, patient characteristics, and family involvement in the feedback process are discussed.

The relation of specific MMPI scores to attention, concentration, and memory was assessed in an inpatient psychiatric sample diagnosed by DSM-III-R criteria as having schizophrenia, chronic undifferentiated type (n = 22); schizophrenia, paranoid type (n = 17); and schizoaffective disorder (n = 20). MMPI indices that are used widely to infer cognitive efficiency - including Scales 2 (Depression), 8 (Schizophrenia), SC-PT, D4 (Mental Dullness), Sc2A (Lack of Ego Mastery, Cognitive), PSY (Psychoticism) and ORG (Organic Symptoms)-were investigated in relation to actual performance on Digit Span and subtests of the Wechsler Memory Scale (WMS, Russell's Revision). Weak correlations emerged (maximum r =.31, p

The validity of the conventional Minnesota Multiphasic Personality Inventory (MMPI) interpretation as applied to neurologic patients has been increasingly questioned on the grounds of the test's psychiatric normative base and inclusion of items that may be sensitive to bona fide neurologic symptoms. This study used 110 patients with cerebrovascular disease (CVD) to (i) determine whether the 370-item pool of the MMPI-2 (abbreviated form) contains a unitary neurologic symptom factor, and (ii) devise a systematic approach to correct for patient endorsement of such items. Commonly endorsed items that differentiated the CVD sample from a group of normal adults were factor analyzed. Bona fide neurologic complaints (21 items) emerged as the major discriminative source of variance in the 370 MMPI-2 item pool that tends to inflate estimates of psychopathology (Scales 1, 2, 3, and 8), alter profile codes types, and potentially affect decision-making related to the diagnosis and treatment of CVD patients. Recommendations regarding a greater reliance upon content scales and the use of a corrective scoring key are discussed.

This study investigates the neurobehavioral components involved in Trail Making Test (TMT; Parts A and B) performance and their relation to MMPI–2 measures of anxiety and depression. Consecutive patients (N = 192) referred for a comprehensive neuropsychological evaluation at a U.S. Department of Veterans Affairs (VA) Medical Center comprised the sample. Results: graphomotor speed and mental shifting were significantly associated with Wechsler Adult Intelligence Scale–Third Edition (WAIS–III) indexes, whereas visual scanning efficiency was not. Graphomotor speed accounted for a substantially greater portion of the variance in TMT performance within impaired than within normal groups. Levels of anxiety and depressive symptoms were unrelated to TMT performance. Implications and directions for future research are discussed.

The MMPI is used commonly with neurologic patients despite concerns about its validity with this population. The basis for this concern--possible artifactual effects due to neurologic-related MMPI items (NRIs)--was assessed in this study of 58 closed head trauma (CHT) patients. The MMPI profiles of these patients were analyzed before and after statistical correction was made for 42 NRIs that were identified by three neurologists. Significant effects occurred on Scales 1 (HS), 2 (D), 3 (HY), 7 (PT), and 8 (SC) in regard to their T scores, frequency of pathological elevation (T greater than 69), and representation in configural codes. The results suggest that MMPI content scales and subscales may help to distinguish the relative contribution of neurologic and emotional complaints on MMPI profiles.

Conventional Minnesota Multiphasic Personality Inventory (MMPI) interpretation is widely applied to the profiles of neurologic patients, despite the test's psychiatric-based interpretative norms and inclusion of items that appear to be descriptive of neurologic dysfunction. This study used 75 closed-head-trauma (CHT) patients to examine the impact of neurologic-symptom items on MMPI-2 profiles. Commonly endorsed items that differentiated this sample from a group of normal adults were factor analyzed

Although previous studies have demonstrated the general success of neuropsychological tests in discriminating brain-impaired patients from normals and patients with psychiatric disorders, limited attention has addressed the more specific effects of emotional disturbance on test performance. This study investigated MMPI correlates of Halstead-Reitan test (HRB) performance in a sample of 105 neuropsychological referrals (predominantly psychiatric) who had negative neurologic findings. The results indicated significant effects for age and education on many of the tests, with smaller but statistically significant relationships between the quality of HRB test performance and MMPI scores.

This study assessed the effect of emotional factors on Trail Making Test Part B performance for a sample of 105 neuropsychological referrals for whom there was no neurodiagnostic evidence of brain damage. Trails B scores declined in relation to elevated MMPI scores on Scales 6, 7, and 8, though only nine patients performed within the impaired range. The results suggest that (a) Trails B performance is resilient to a variety of emotional influences, (b) psychotic symptoms and severe anxiety impede Trails B performance, though rarely to the extent caused by brain damage, and (c) the MMPI provides objective criteria that help rule out emotional effects on Trails B performance.

This study examined the validity of MMPI scores and MMPI-based cognitive complaints as indicators of memory and concentrational disturbances in 70 closed-head-trauma patients. The relation of scores on the MMPI Depression (D), Schizophrenia (Sc), Mental Dullness (D4), Lack of Ego Mastery, Cognitive (Sc2A), and Organic Symptoms (Org) scales to actual memory performance on the WA1S-R Digit Span and Wechsler Memory Scale (Russell's revision) subtests was explored. The results suggest an absence of any relation between actual memory performance on any of these subtests and MMPI scores or a Cognitive Complaint Index consisting of 8 MMPI items. Findings are discussed in light of the questionable validity of memory complaints in other samples, as well as possible limitations in the ecological validity of current tests of memory.

A number of studies have investigated the relationship between psychological disturbance and neuropsychological (NP) test performance. The current study is a replication and extension of who found that MMPI-2 indices of psychological disturbance are related to performance on NP tests of attention and memory in psychiatric and head-injured patients. In a large sample (N=381) referred for evaluation after sustaining presumed head injury, we examined the relationship between MMPI-2 indices of psychological disturbance and measures of attention and memory from the Wechsler Memory Scale-Revised (WMS-R), Wechsler Adult Intelligence Scale-Revised (WAIS-R), California Verbal Learning Test (CVLT), and the Memory Assessment Scales (MAS). Although related to other domains, MMPI-2 variables were most consistently related to measures of attention and List Learning. Even when demographic variables, injury severity, and litigation status were controlled, MMPI-2 indices significantly predicted performance on six out of eight tests. However, the correspondence between similar indices on the WMS-R and MAS were relatively low, especially for Verbal Memory and Visual Reproduction. Further, litigation was significant in predicting only 2 of 8 attention and memory indices.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used in neuropsychology, though its length (567 items) is sometimes prohibitive. This study investigated some psychometric characteristics of the 180-item version of the MMPI-2 () in order to delineate its strengths, limitations, and appropriate scope of clinical application. Limited reliability and poor predictive accuracy were recently reported for many of the MMPI-2 short-form scales in a study that used 205 brain-injured patients. In the present investigation, we used a psychiatric sample (N=186) with normal neurological findings to examine short-form accuracy in predicting basic scale scores, profile code types, identifying high-point scales, and classifying scores as pathological (T>/=65) or normal-range. The results suggest that, even as applied to neurologically normal individuals, the proposed short form of the MMPI-2 is unreliable for predicting clinical code types, identifying the high-point scale, or predicting the scores on most of the basic scales. In contrast, this short form can be used to predict whether the full-scale scores fall within the pathological range (T>/=65). These findings suggest that clinicians might be able to salvage a small amount of information from the shortened (180-item) version of the MMPI-2 when MMPI-2 protocols are incomplete. However, clinicians should not use a standard interpretive approach with this test, and routine clinical application is unwarranted. Future evaluations of short-form validity should provide a more detailed examination of individual protocols, including an analysis of the frequency of accurate prediction of full-form scores.

A 180-item short form of the MMPI-2 (MMPI-2-180) was recently developed by Dahlstrom and Archer and has been proposed for clinical use under special circumstances. This study investigated the psychometric characteristics of the MMPI-2-180 in order to delineate its strengths, limitations, and appropriate scope of clinical application. Using a neuropsychological referral sample (N = 205), we examined accuracy of the short-form as it pertains to the following (a) the prediction of basic scale scores and profile code types, (b) the identification of high-point scales, and (c) the classification of scores as pathological (T? 65) or normal range. The results indicate that the MMPI-2-180 provides an unreliable basis for predicting clinical code types, identifying the high-point scale, or predicting the scores on most of the basic scales. In contrast, scores on the MMPI-2-180 are accurate predictors of whether the full-scale scores fall within the pathological range (T? 65). These findings suggest that (a) standard interpretive procedures involving profile configuration should not be used, in most cases, with the 180-item short-form results, (b) properly interpreted, this shortened version provides potentially useful information regarding the probable presence of various problem areas, and (c) this information is very limited when contrasted with that obtained using the complete or abbreviated (i.e., 370 item) version of the MMPI-2.

Summary.-Although the Escala de Incel~genc~a Wechsler (ETWA) has remained the only standard Spanish version of the Wcchsler Adult Intelligence Scale (WAIS) and is consequently the most often-used intelligence test with Spanish-speaking clients, little information exists on the psychometric properties of the test beyond the information in the test manual (Wechsler. 1968). There is no information on the val~dity or reliability of commonly used short forms of the test, [he mro.test version using Block Design and Vocabulary, and the four-test version using Block Design, Vocabulary, Arithmetic, and Picture Arrangement. Using the sratisucal d313 in the test manual, the two-test version yielded reliabilities of .94 to .95 across the three standarhzacion age groups and validity ratings of .92 to .93. Values for the four-test version were slightly higher, and all were comparable to those for the WAIS and WAIS-R. The results suggest that the short forms can be used with the same confidence with the Spanish WAIS as on the WAIS. Although the Escala de Intehgencia Wechsler (EIWA) is the only standard Spanish version of the Wechsler Adult Intehgence Scale (WAIS), little informadon exists on the psychometric properties OF the test beyond the test manual (Wechsler, 1968). Despite this, interpretive strategies based on the statistical properties of the WAIS have been employed routinely in clinical work. Questions have been raised as to the appropriateness of these strategies as well as the test (Melendez, 1994). Given issues of time or patient's cooperation, short forms of the EIWA have been employed. Short forms have also been udzed for research purposes (Davis & Rodriguez, 1979). Des~ite these uses, there is no information on the validitv or reliabilitv of anv of the short forms. The present study was designed to evaluate the statistical properties of the two most commonly used short forms of the rest: a two-test version using Block Design and Vocabulary and a four-test version using Block Design, Arithmetic, and Picture Arrangement. To assess the usefulness of these short forms in estimating Full Scale IQ, statistical information (means, standard deviations, correlations) from the test manual (Wechsler, 1968) was used ro estimate short form validiues using McNemar's equation (1974). Reliabilities for each form were calculated using the formula of Tellegen and Briggs (1967) for each of the three age groups (16-19 years, 25-34 years, 45-54 years) presented in the manual. The Deviation Quotient Formula (Tellegen & Briggs, 1967) was employed to derive formulas for changing the sum of scale scores for each short form into deviation IQs.

This study investigated the emotional adjustment of patients (N = 31) with left hemisphere damage (LHD) as a function of the degree of impairment in verbal intelligence as measured by the Wechsler Adult Intelligence Scale. A multivariate comparison was made of the composite MMPI profiles of three groups of LHD patients classified according to Verbal IQ. The three groups produced fairly similar composite profiles, which indicated the presence of mild dysphoria, dissatisfaction, withdrawal, decreased initiative, and mild somatic preoccupations. Significant correlations emerged between the degree of verbal-intellectual disability and MMPI F, PT, SC, and SI. However, when the variance in MMPI scores due to premorbid status (education) was partialled out, these correlations dropped to nonsignificant levels. These findings failed to support previous studies that linked verbal deficits with emotional disturbance, and they underscore the importance of premorbid intelligence in the psychological adjustment to organic impairment.