Showing papers by "Grant L. Iverson published in 2007"

Substantial risk of "Accidental MCI" in healthy older adults: base rates of low memory scores in neuropsychological assessment.

Abstract: When assessing older adults for mild cognitive impairment (MCI) or dementia, it is important to understand how often low memory scores are obtained in healthy people in order to minimize false positive diagnoses. This study examines the base rates of low memory scores in older adults across a battery of memory tests. Participants included older adults (55-79 years; N = 742) from the Neuropsychological Assessment Battery (NAB; Stern and White, 2003a) standardization sample. The NAB Memory Module consists of four co-normed memory tests (i.e., List Learning, Shape Learning, Story Learning, and Daily Living Memory) yielding 10 demographically corrected T-scores. When all 10 T-scores were examined simultaneously, 55.5% of older adults had one or more scores one standard deviation (SD) below the mean. At <1.5 SDs, 30.8% of healthy older adults obtained one or more low memory scores. Obtaining low memory scores occurs more often with lesser intellectual abilities. For example, 56.5% of older adults with low average intellectual abilities obtained one or more low memory scores (<1.5 SDs) compared to 21.1% with high average intellectual abilities. Understanding the base rates of low scores can reduce over-interpretation of isolated low memory scores and minimize false positive diagnoses of MCI.

Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain or Depression in Patients with Fibromyalgia

Abstract: Neuropsychologists routinely give effort tests, such as the Test of Memory Malingering (TOMM). When a person fails one of these tests, the clinician must try to determine whether the poor performance was due to suboptimal effort or to chronic pain, depression, or other problems. Participants were 54 community-dwelling patients who met American College of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM, they completed the Beck Depression Inventory-Second Edition, Multidimensional Pain Inventory-Version 1, Oswestry Disability Index-2.0, British Columbia Cognitive Complaints Inventory, and the Fibromyalgia Impact Questionnaire. The majority endorsed at least mild levels of depressive symptoms (72%), and 22% endorsed "severe" levels of depression. The average scores on the TOMM were 48.8 (SD = 1.9, range = 40-50) for Trial 1, 49.8 (SD = 0.5, range = 48-50) for Trial 2, and 49.6 (SD = 0.9, range = 45-50) for Retention. Despite relatively high levels of self-reported depression, chronic pain, and disability, not a single patient failed the TOMM. In this study, the TOMM was not affected by chronic pain, depression, or both.

Identifying exaggeration and malingering.

Abstract: Address correspondence and reprint requests to: Grant Iverson, PhD, Department of Psychiatry, 2255 Wesbrook Mall, University of British Columbia, Vancouver, B.C. Canada, V6T 2A1. Tel: +1-822-7588; Fax: +1-8227756; E-mail: giverson@interchange.ubc.ca. Author Notes: Portions of this editorial were adapted from Iverson GL. Ethical issues associated with the assessment of exaggeration, poor effort, and malingering. Appl Neuropsychol. 2006; 13:77–90, and Iverson GL, Detecting poor effort, exaggeration, and malingering. In Horton AM and Wedding D (eds.), Neuropsychology Handbook, New York, Springer Publishing Co., in press. EDITORIAL

Short-term neuropsychological outcome following uncomplicated mild TBI: effects of day-of-injury intoxication and pre-injury alcohol abuse.

Abstract: Research suggests that individuals who are intoxicated at the time of traumatic brain injury (TBI) have worse cognitive outcome compared with those who are sober. Worse outcome in patients with day-of-injury intoxication might (a) be related to the increased magnitude of brain injury resulting from a variety of negative responses not present following TBI in nonintoxicated individuals, or (b) reflect the effect of pre-injury alcohol abuse that is prevalent in individuals intoxicated at the time of injury. Most studies in this area have focused on patients with moderate to severe TBIs, and on medium- to long-term neuropsychological outcome. The purpose of this study was to examine the relative contributions of day-of-injury intoxication versus pre-injury alcohol abuse on short-term cognitive recovery following mild TBI. Participants were 169 patients with uncomplicated mild TBIs who were assessed on 13 cognitive measures within 7 days postinjury. The prevalence of intoxication at the time of injury was 54.4%. The prevalence of possible pre-injury alcohol abuse was 46.2%. Overall, the results suggest that pre-injury alcohol abuse, compared with day-of-injury alcohol intoxication, had the most influence on short-term neuropsychological outcome from uncomplicated mild TBI. However, the influence of pre-injury alcohol abuse was considered small at best.

Effects of an education training program on attitudes to electroconvulsive therapy.

Abstract: Widespread negative attitudes toward electroconvulsive therapy (ECT) are present in the general public and among heath care professionals. However, there is evidence to suggest that clinical experience and knowledge of ECT positively improve attitudes toward this treatment. The purpose of this study was to evaluate the effects of an ECT education training program on attitudes toward ECT. Participants were 73 student nurses (91.8% women) and 21 care aid students (81.0% women) undertaking a 6-week rotation in psychiatry at a large provincial psychiatric hospital in British Columbia, Canada. The ECT education training program consisted of a brief lecture, viewing of an educational videotape, familiarization with the ECT equipment, and observation of an ECT treatment. Participants completed a short questionnaire pretraining and posttraining program. Attitudes toward ECT did not substantially differ between the 2 groups. For the entire sample, only 8.5% reported that they were well informed about ECT before the training session. More favorable attitudes were reported upon completion of the ECT education program compared with attitudes reported before training. These findings suggest that attitudes toward ECT increase favorably when individuals are provided with training and experience.

Frequency of abnormal scores on the Neuropsychological Assessment Battery Screening Module (S-NAB) in a mixed neurological sample.

Abstract: The Neuropsychological Assessment Battery (NAB; Stern & White, 2003; White & Stern, 2003) is a comprehensive, modular battery of tests comprised of the following six modules: (a) Screening, (b) Attention, (c) Language, (d) Memory, (e) Spatial, and (f) Executive Functions. The Screening Module is an abbreviated version of the full NAB. The purpose of this descriptive study was to present index and primary test score information for the Screening Module in a mixed sample of patients with known neurological conditions. Participants were 37 outpatients with clear evidence of neurological damage or disease. Performance decrements were found on the Attention Index, most notably on the Numbers and Letters tests. Decrements were also found on the Executive Functions Index, most notably on the Word Generation test. Somewhat surprisingly, patients performed well across most of the individual test scores. This mixed clinical sample showed less neuropsychological compromise than the clinical samples presented in the NAB manual.

Clinical Validation of Canadian WAIS-III Index Short Forms in Inpatient Neuropsychiatry and Forensic Psychiatry

Abstract: Recent research has provided some support for the concurrent validity of two-subtest short forms for estimating Canadian WAIS-III Index scores in the standardization sample (Lange & Iverson, in press). The purpose of this study was to examine the efficacy of using various two-subtest short forms to estimate Canadian WAIS-III Index scores in a clinical population. Participants were 100 inpatients from two large psychiatric hospitals in British Columbia, Canada. Using all possible two-subtest combinations, estimated VCI, POI, and WMI scores were generated by prorating subtest scaled scores and using the Canadian normative data (Wechsler, 2001). The agreement rate between full form and short form index scores was very high for all subtest combinations (range = 90–98%). Two-subtest short forms were useful for estimating VCI, POI, and WMI scores in this population.