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The Response Bias Scale (RBS) is a measure of protocol validity that is composed of items from the Minnesota Multiphasic Personality Inventory − 2. The RBS has been successfully cross-validated as a whole, but the composition of the scale has not been reexamined until recently when three types of items were identified. In this study we sought to examine the reliability of the scale as a whole, as well as the items that are (a) empirically supported and conceptually similar (ES/CS), (b) empirically supported but not conceptually similar (ES/NS), and (c) not empirically supported (NES). Participants included 56 veterans undergoing neuropsychological evaluation for suspected traumatic brain injury. Results generally replicated Ratcliffe et al. finding that removing key NES items improved the internal consistency of the RBS from 0.706 to 0.747. Examined separately, ES/CS and ES/NS had internal consistencies of 0.629 and 0.605, respectively. One of the nine NES items had strong internal consistency, but none of the remaining eight had corrected item-total correlations above 0.194. NES items had an internal consistency of 0.177. Although the RBS is well-validated in detecting non-credible cognitive presentations, it may prove even more valuable after further item refinement whereby items detracting from its reliability and validity are excised. [ABSTRACT FROM AUTHOR]

The Response Bias Scale (RBS) was developed to predict non-credible cognitive presentations among disability claimants without head injury. Developers used empirical keying, which is independent of apparent content, to select items from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) item pool that distinguished between individuals passing or failing performance validity tests (PVTs). No study has examined which of these items would have psychometric value when used in clinical neuropsychological evaluations. This study reexamined items comprising RBS with reference to manifest item content, internal consistency, PVTs, and a symptom validity test (SVT) in a sample of 173 predominately White male veterans (MAGE = 50.70, MEDU = 13.73) in a VA outpatient neuropsychology clinic. Participants completed the MMPI-2 Restructured Form (MMPI-2-RF), PVTs, and an SVT. The 28-item RBS appears to contain three types of items: those that manifestly address cognitive functioning, those that are supported but do not appear to address cognitive functioning, and nine items that were unrelated to cognition and not statistically supported. The 19 empirically supported items, or RBS-19, predicted PVT and SVT failures marginally better than the RBS. Both the RBS and RBS-19 had stronger relationships with SVTs relative to PVTs. Although the removal of the nine problematic items improved the diagnostic accuracy of the scale, it still did not reach the level that is generally considered to be clinically optimal. The RBS-19 offers a measure with improved internal consistency and predictive validity compared to the RBS and warrants additional research. [ABSTRACT FROM AUTHOR]

Objective The Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations. Method Data were obtained from 18,410 participants using the National Alzheimer's Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test–retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach's alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change. Results Strong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level. Conclusions MoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores. [ABSTRACT FROM AUTHOR]

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed to briefly measure a broad range of cognitive abilities, but it initially lacked a scale to evaluate executive functioning. Robert Spencer and colleagues recently created an Executive Errors scale (RBANS-EE) that quantified executive functioning (EF) errors committed during four RBANS subtests: List Learning, Semantic Fluency, Coding, and List Recall. In the present paper we cross-validated the RBANS-EE with a sample of 234 U.S. military veterans (M AGE = 67.2, SD = 11.5 years; M EDUCATION = 13.3, SD = 2.4 years) who completed the RBANS and various EF criterion measures as part of neuropsychological assessments they underwent during their clinical care. We found the RBANS-EE to be significantly correlated with most of the criterion EF measures. The RBANS-EE scale demonstrated modest ability to classify EF impairment at mild and severe levels; and, similarly, the RBANS-EE was modestly capable of accurately classifying those veteran respondents who were determined to have or to not have a neurocognitive disorder. Overall, the RBANS-EE can be quickly calculated, adds no administration time to an RBANS assessment, and yields useful scores to screen for EF dysfunction without replacing standalone EF tests. [ABSTRACT FROM AUTHOR]

AbstractThe incidental learning index based on Similarities subtest (IL-Sim) from the Wechsler Adult Intelligence Test-Fourth Edition (WAIS-IV) has shown promise as a screening measure for memory impairment. We aimed to examine the reliability, convergent and divergent validity, and the utility of IL-Sim index in classifying at least mild and severe memory impairment. One hundred and fifty-three Veterans completed the WAIS-IV Similarities subtest and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as part of their clinical evaluations. IL-Sim had acceptable internal consistency (Cronbach’s α = .85). Among RBANS indices, IL-Sim had the largest association with the Delayed Memory Index (r = .69), followed by the Immediate Memory Index (r = .59), and relatively smaller associations with non-memory indices (rs = .26–.38). For both younger (ages 40–69) and older (ages 70–87) adults, IL-Sim had excellent discriminability between patients without memory problems and those with at least mildly or severely impaired RBANS memory (AUC = .83–.87). To enhance the ease of interpretation for IL-Sim scores, we presented logistic regression-derived probabilities across multiple base rates for each age group and impairment severity. IL-Sim showed strong convergent and divergent validity and discriminated along the memory impairment continuum highlighting its promise as an efficient screening measure of memory. [ABSTRACT FROM AUTHOR]

Although incidental learning (IL) routinely occurs in everyday life, it is infrequently assessed during neuropsychological evaluations. This study aimed to further examine the concurrent validity of IL measures based on the Vocabulary and Similarities subtests from the Wechsler Adult Intelligence Test-Fourth Edition (WAIS-IV). Participants included 43 Veterans referred for outpatient neuropsychological testing. Performances on the IL procedures correlated strongly with performances on the Repeatable Battery for the Assessment of Neuropsychological Status Immediate and Delayed Recall Indices (r = .48 to r = .78). These results indicate that the IL procedures from selected WAIS-IV subtests provided an efficient and valid measure of memory. In particular, the task based on the Similarities subtest provided exceptionally high value as a screen for memory problems. These IL procedures, which require minimal additional administration time, capitalize on the semantic encoding that is inherent in completing the Vocabulary and Similarities subtests, and offer a complementary approach to standard memory assessment. [ABSTRACT FROM AUTHOR]

The Grooved Pegboard Test (GPT) is used primarily as a measure of motor functioning, but some research indicates that performance on this test my also reflect cognitive factors, particularly attention and executive functioning. The aim of this study was to examine rule violations as a possible quantifiable measure of executive functioning, particularly inhibitory control. In a sample of 82 veterans undergoing neuropsychological evaluation at a Virginia (VA) outpatient clinic, we recorded instances of two types of rule violations: using the incorrect hand during insertion and placing pegs out of sequence. Criterion measures included the Trail Making Test, the Tower of London, and the Stroop Color and Word Test. As hypothesized, total number of rule violations correlated moderately to strongly with the criterion measures. Notably, 60% of individuals committing two or more rule violations were impaired on at least two of the criterion measures, whereas only 17% of individuals without any rule violations were impaired on two criterion measures. Rule violations during the GPT provide valuable supplementary data for assessing executive dysfunction with no additional task demand or time cost. These data suggest that making two or more errors should raise suspicion of executive dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Cognitive processing therapy is an evidence‐based treatment for posttraumatic stress disorder (PTSD); however, questions remain regarding variability in treatment response. Method: A total of 123 veterans participated in group‐based cognitive processing therapy (CPT) in residential PTSD treatment. Change over time in PTSD symptoms was modeled as a function of selected demographic and clinical variables. Results: PTSD checklist (PCL) scores decreased by an average of 1 point per session (standard deviation [SD] = 0.1). Initial PCL scores were predicted by the Beck Depression Inventory‐II (γ01 = 0.25; standard error [SE] = 0.08), Insomnia Severity Index (γ02 = 0.53; SE = 0.15), and Infrequency (F) scale of the Minnesota Multiphasic Personality Inventory‐2 (γ03 = 0.09; SE = 0.04). Rate of change was predicted by the Somatic Complaints (RC1) scale (γ11 = −0.03; SE = 0.01) and the Antisocial Behavior (RC4) scale (γ12 = 0.02; SE = 0.01). Conclusions: These results provide insight into characteristics that may influence degree of benefit received from group‐based CPT. [ABSTRACT FROM AUTHOR]

Objective: To explore the utility of Timed Digit Span (TDS) as an embedded performance validity test (PVT) in a sample of veterans with mild traumatic brain injury (mTBI). We hypothesize that TDS will predict PVT failure on an established stand-alone measure (Trial 1 of the Test of Memory Malingering; TOMM). Methods: TDS was compared to Digit Span accuracy (DS), using TOMM as a criterion measure, in a sample of 99 veterans with mTBI. Correlation and regression were used to characterize associations between PVTs. Logistic regression was utilized to examine the relationship between embedded PVTs and the odds of TOMM failure. Classification accuracy of TDS was examined using receiver operating characteristic (ROC) curves. Predictive power of TDS to estimate TOMM failure was calculated for the current sample and for hypothetical populations with common base rates (BRs). Outcomes: TDS significantly predicted failure on the TOMM and added greater incremental predictive value to the model compared to DS accuracy. Estimates of the predictive power of TDS were calculated using observed and hypothetical BRs. Sensitivity to stand-alone PVT, failure was 38% when specificity was set at 90%. Conclusion: TDS offers a promising embedded PVT method, given its strong convergence with an established stand-alone PVT. [ABSTRACT FROM AUTHOR]

Background: The drug D-Cycloserine (DCS) has been used as an adjunct to increase the pace of symptom reductions during exposure therapy for anxiety disorders. This procedure has met with mixed results andmany questions remain. Aims: The findings from two investigations are reported here, highlighting important domains for furthering our understanding of DCS effects., Method: Study 1 (n = 16) treated social anxiety among a sample of emerging adults, and in addition to self-report utilized a behavioral measure of symptom improvement to evaluate outcomes. Study 2 (n = 16), utilizing a similar design, introduced an algorithm based post-session administration strategy following sessions where anxiety reductions were evident. Both investigations were double-blind, placebo controlled, randomized trials with participants diagnosed with social anxiety. Treatment was an exposure-based CBT-protocol adopted in other investigations that tested DCS., Results: Findings of Study 1 yielded an interaction effect in favor of DCS for self-reported distress ratings ( p =.02) and on a behavioral measure of anxiety ( p =.01). Findings from Study 2 revealed a significant effect for self-reported subjective distress ratings ( p =.002)., Conclusions: Although limitations of small sample size constrain generalization and limit power, results illustrate some beneficial effects of DCS within the context of exposure-based intervention for social anxiety, yet are discussed in the context of statistical vs. clinical significance and the DCS literature as a whole. Present findings highlight the potential usefulness of a post-session administration strategy and the behavioral measure for future efforts with an eye towards preventing bias through more nuanced and powered studies., Competing Interests: The authors have no conflicts of interest with respect to this publication.