Showing papers in "Clinical Neuropsychologist in 2009"
TL;DR: This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.
Abstract: During the past two decades clinical and research efforts have led to increasingly sophisticated and effective methods and instruments designed to detect exaggeration or fabrication of neuropsychological dysfunction, as well as somatic and psychological symptom complaints. A vast literature based on relevant research has emerged and substantial portions of professional meetings attended by clinical neuropsychologists have addressed topics related to malingering (Sweet, King, Malina, Bergman, & Simmons, 2002). Yet, despite these extensive activities, understanding the need for methods of detecting problematic effort and response bias and addressing the presence or absence of malingering has proven challenging for practitioners. A consensus conference, comprised of national and international experts in clinical neuropsychology, was held at the 2008 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) for the purposes of refinement of critical issues in this area. This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.
768 citations
TL;DR: Findings from clinical, basic science, and functional neuroimaging studies now establish a foundation on which to build integrative theories and testable hypotheses around a comprehensive model of MTBI recovery.
Abstract: The diagnosis and treatment of mild traumatic brain injury (MTBI)have historically been hampered by an incomplete base of scientific evidence to guide clinicians. One question has been most elusive to clinicians and researchers alike: What is the true natural history of MTBI? Fortunately, the science of MTBI has advanced more in the last decade than in the previous 50 years, and now reaches a maturity point at which the science can drive an evidence-based approach to clinical management. In particular, technological advances in functional neuroimaging have created a powerful bridge between the clinical and basic science of MTBI in humans. Collectively, findings from clinical, basic science, and functional neuroimaging studies now establish a foundation on which to build integrative theories and testable hypotheses around a comprehensive model of MTBI recovery. We review the current scientific literature on postconcussion symptom recovery, neuropsychological outcome, and neurophysiological healing after MTBI. Special emphasis is placed on how the new evidence base can help guide clinicians in the evaluation and management of military-related MTBI.
350 citations
TL;DR: Findings indicate that declines in MEM and EXEC over time make unique and independent contributions to declines in older adults’ ability to function in daily life.
Abstract: Impaired everyday function is a diagnostic criterion for dementia, and a determinant of healthcare utilization and caregiver burden. Although many previous studies have demonstrated a cross-sectional relationship between cognition (particularly executive functions and memory) and everyday function in older adults, very little is known about longitudinal relationships between these domains. This study examined the association between longitudinal change in episodic memory (MEM) and executive functioning (EXEC) and change in everyday function. Participants were a cognitively heterogeneous group of 100 elderly persons including those with normal cognition, as well as those with mild cognitive impairment and dementia. They were followed for an average of 5 years. Random effects modeling showed that change in both MEM and EXEC were independently associated with rate of change in informant-rated instrumental activities of daily living (IADLs), even after controlling for age, education, and gender. Findings indicate that declines in MEM and EXEC over time make unique and independent contributions to declines in older adults' ability to function in daily life.
245 citations
TL;DR: Four cases are described that illustrate the variability in negative response bias that occurs during neuropsychological evaluations; if effort had not been periodically sampled with heterogeneous types of effort indicators during these examinations, the suspect performance would not have been detected.
Abstract: While most neuropsychologists are now administering measures of response bias in neuropsychological evaluations, it is still likely that detection of non-credible test performance is inadequate due to faulty assumptions regarding poor effort, namely that it remains constant across a battery of tests. Four cases are described that illustrate the variability in negative response bias that occurs during neuropsychological evaluations; if effort had not been periodically sampled with heterogeneous types of effort indicators during these examinations, the suspect performance would not have been detected. These examples argue for both continuous and comprehensive sampling of effort, specifically that negative response bias be routinely monitored throughout neuropsychological evaluations, and that effort indicators involving differing cognitive abilities be employed to assess for feigning of selective deficits.
239 citations
TL;DR: The pairwise failure model is therefore a recommended criterion for identifying non-credible performance; however, there are of course other important contextual factors and influences to consider, which are also discussed.
Abstract: While it is recommended that judgments regarding the credibility of test performance be based on the results of more than one effort indicator, and recent efforts have been made to improve interpretation of multiple effort test failure, the field currently lacks adequate guidelines for using multiple measures of effort in concert with one another. A total of 103 patients were referred for outpatient neuropsychological evaluation, which included multiple measures of negative response bias embedded in standard test batteries. Using any pairwise failure combination to predict diagnostic classification was superior (sensitivity = 83.8%, specificity = 93.9%, overall hit rate = 90.3%) to using any one test by itself and to using any three-test failure combination. Further, the results were comparable to the results of logistical regression analyses using the embedded indicators as continuous predictors. Given its parsimony and clinical utility, the pairwise failure model is therefore a recommended criterion for...
200 citations
TL;DR: Archival data from 214 non-litigating patients with dementia on 18 effort indices derived from 12 tests indicated that recommended cut-offs for Digit Span indicators provided ≥90% specificity across participants, while the majority of other effort tests displayed specificities in the 30–70% range.
Abstract: Research on the performance of patients with dementia on tests of effort is particularly limited. We examined archival data from 214 non-litigating patients with dementia on 18 effort indices derived from 12 tests (WAIS-III/WAIS-R Digit Span and Vocabulary, Dot Counting Test, Warrington Recognition Memory Test-Words, WMS-III Logical Memory, Rey Word Recognition Memory Test, Finger Tapping, b-Test, Rey 15-Item, Test of Memory Malingering, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test). Results indicated that recommended cut-offs for Digit Span indicators (Vocabulary Minus Digit Span and four-digit forward span time score) provided > or =90% specificity across participants, while the majority of other effort tests displayed specificities in the 30-70% range. Analyses of test specificity as a function of Mini Mental Status Examination (MMSE) score and specific dementia diagnosis are provided, as well as adjustments to cut-offs to maintain specificity where feasible.
129 citations
TL;DR: The fact that Digit Span is notoriously insensitive to brain dysfunction underscores the robustness of the findings, for if the authors inappropriately excluded brain-damaged patients for lowDigit Span, this resulted in their sample reflecting more subtle degree of brain dysfunction, and the superiority of the AFB over the HRB was demonstrated under the most challenging of discriminative conditions.
Abstract: Russell (2009 this issue) has criticized our recently published investigation (Larrabee, Millis, & Meyers, 2008) comparing the diagnostic discrimination of an ability-focused neuropsychological battery (AFB) to that of the Halstead Reitan Battery (HRB). He contended that our symptom validity test (SVT) screening excluding 43% of brain dysfunction and 15% of control patients using computations based on Digit Span inappropriately excluded patients with brain damage, due to the correlation of Digit Span with the Average Index Score (AIS). Our exclusion of 43% of brain dysfunction participants matches the frequency of invalid neuropsychological data of 40–50% or more reported by numerous studies for a wide range of settings with external incentive. Moreover, our study was not an investigation of malingering; rather, we screened our data to insure that only valid data remained, for the most meaningful comparison of the AFB to the HRB. Russell's argument that Digit Span is correlated with brain damage confounds...
95 citations
TL;DR: The Dementia Profile correctly classified 36 patients with dementia and when only considering patients who failed symptom validity indices, sensitivity of the Dementsia Profile was 85%.
Abstract: When assessing symptom validity in patients with dementia, traditional approaches may be inappropriate because neurological factors may cause altered performance. The Medical Symptom Validity Test has a Dementia Profile that explicitly recognizes this fact. We prospectively evaluated classification accuracy of the Dementia Profile for 52 referrals to a memory disorders clinic. The Dementia Profile correctly classified 36/52 patients. Sensitivity was 54.8%, specificity was 90.5%, positive predictive value was 89.5%, negative predictive value was 60.0%, and the likelihood ratio was 5.77. Of 31 patients with dementia, 11 did not fail symptom validity indices. When only considering patients who failed symptom validity indices, sensitivity of the Dementia Profile was 85%. Classification accuracy statistics are also provided for the Genuine Memory Impairment Profile.
79 citations
TL;DR: Challenges associated with post-deployment screening for mild traumatic brain injury are discussed and additional research is necessary to refine the sequential screening methodology, with the goal of minimizing false negatives during initial post- de deployment screening and minimizing false positives during follow-up evaluations.
Abstract: There is ongoing debate regarding the epidemiology of mild traumatic brain injury (MTBI) in military personnel. Accurate and timely estimates of the incidence of brain injury and the prevalence of long-term problems associated with brain injuries among active duty service members and veterans are essential for (a) operational planning, and (b) to allocate sufficient resources for rehabilitation and ongoing services and supports. The purpose of this article is to discuss challenges associated with post-deployment screening for MTBI. Multiple screening methods have been used in military, Veterans Affairs, and independent studies, which complicate cross-study comparisons of the resulting epidemiological data. We believe that post-deployment screening is important and necessary--but no screening methodology will be flawless, and false positives and false negatives are inevitable. Additional research is necessary to refine the sequential screening methodology, with the goal of minimizing false negatives during initial post-deployment screening and minimizing false positives during follow-up evaluations.
78 citations
TL;DR: The findings provide evidence that unilateral DBS surgery is associated with verbal fluency declines and indicate that while these changes may not be systematically related to age, cognitive or depression status at baseline, semantic fluencies declines may be more common after left-sided surgery.
Abstract: Conflicting research suggests that deep brain stimulation surgery, an effective treatment for medication-refractory Parkinson’s disease (PD), may lead to selective cognitive declines. We compared cognitive performance of 22 PD patients who underwent unilateral DBS to the GPi or STN to that of 19 PD controls at baseline and 12 months. We hypothesized that compared to PD controls, DBS patients would decline on tasks involving dorsolateral prefrontal cortex circuitry (letter fluency, semantic fluency, and Digit Span Backward) but not on other tasks (Vocabulary, Boston Naming Test), and that a greater proportion of DBS patients would fall below Reliable Change Indexes (RCIs). Compared to controls, DBS patients declined only on the fluency tasks. Analyses classified 50% of DBS patients as decliners, compared to 11% of controls. Decliners experienced less motor improvement than non-decliners. The present study adds to the literature through its hypothesis-driven method of task selection, inclusion of a disease control group, longer-term follow-up and use of Reliable Change. Our findings provide evidence that unilateral DBS surgery is associated with verbal fluency declines and indicate that while these changes may not be systematically related to age, cognitive or depression status at baseline, semantic fluency declines may be more common after left-sided surgery. Finally, use of Reliable Change highlights the impact of individual variability and indicates that fluency declines likely reflect significant changes in a subset of patients who demonstrate a poorer surgical outcome overall.
72 citations
TL;DR: Norms for adults aged 18–80 are presented for the number of unique designs, the percent of perseverations, the% of rotated (strategic) designs, and theNumber of rule breakings as part of the measurement of figural fluency.
Abstract: The Five-point Test (Regard, Strauss, & Knapp, 1982) was introduced for the measurement of figural fluency as part of the examination of executive functions. Until now, no differentiated norms exist. We present normative data for adults aged 18-80 (n = 280) for the number of unique designs (productivity), the percent of perseverations (flexibility), the percent of rotated (strategic) designs, and the number of rule breakings. As age and education were correlated with test performance, norms were stratified by these two variables. Test-retest reliability and inter-rater reliability were calculated. Moreover, convergent and divergent validity as well as factorial validity were assessed through intercorrelations and correlations with other neuropsychological tests. All together, the Five-point Test proved to be reliable and valid.
TL;DR: A set of reporting standards for the presentation of percentile norms in neuropsychology is proposed and an accompanying computer program implements these standards and generates tables of point and interval estimates of percentile ranks for new or existing normative data.
Abstract: Normative data for neuropsychological tests are often presented in the form of percentiles. One problem when using percentile norms stems from uncertainty over the definitional formula for a percentile. (There are three co-existing definitions and these can produce substantially different results.) A second uncertainty stems from the use of a normative sample to estimate the standing of a raw score in the normative population. This uncertainty is unavoidable but its extent can be captured using methods developed in the present paper. A set of reporting standards for the presentation of percentile norms in neuropsychology is proposed. An accompanying computer program (available to download) implements these standards and generates tables of point and interval estimates of percentile ranks for new or existing normative data.
TL;DR: The physics of blast waves, as well as animal and human research, relevant to explosions, and additional factors that occur within the military blast exposure milieu are explored.
Abstract: In the military and Veterans Administration systems, individuals with potential MTBI are presenting with symptoms in excess of what would be expected based on initial injury characteristics and/or at unexpected time periods based on current research findings. This article investigates factors that might account for the discrepancy between current research expectations and some occurrences in clinical practice. The physics of blast waves, as well as animal and human research, relevant to explosions are reviewed. Additional factors that occur within the military blast exposure milieu are also explored because the context in which an injury occurs can potentially impact symptom severity and course of recovery. Differential diagnoses, iatrogenic illness, diagnosis threat, and symptom embellishment are also considered.
TL;DR: Most WCST scores were ineffective in discriminating malingering from non-malingering mild TBI patients, and Failure-to-Maintain-Set, the Suhr & Boyer formula, and the King et al. formula detected about 30% of malingerers at cutoffs associated with a false positive error rate of ≤11%.
Abstract: This study evaluates the ability of several Wisconsin Card Sorting Test (WCST; Psychological Assessment Resources, 1990) variables to detect malingering in mild traumatic brain injury (TBI). The sample consisted of 373 TBI patients and 766 general clinical patients. Classification accuracy for seven indicators is reported across a range of injury severity and scores levels. Overall, most WCST scores were ineffective in discriminating malingering from non-malingering mild TBI patients. Failure-to-Maintain-Set, the Suhr & Boyer formula, and the King et al. formula detected about 30% of malingerers at cutoffs associated with a false positive error rate of < or =11%. The clinical interpretation and use of these indicators are discussed.
TL;DR: Among elderly without dementia or other cognitive impairment, APOE does not appear to exert any major effects on cognition once other demographic influences are controlled, and gender and APOE effects disappeared once age and education were controlled.
Abstract: The Cache County Study of Memory in Aging (CCMS) is an epidemiological study of Alzheimer's disease (AD), mild cognitive disorders, and aging in a population of exceptionally long-lived individuals (7th to 11th decade). Observation of population members without dementia provides an opportunity for establishing the range of normal neurocognitive performance in a representative sample of the very old. We examined neurocognitive performance of the normal participants undergoing full clinical evaluations (n = 507) and we tested the potential modifying effects of apolipoprotein E (APOE) genotype, a known genetic risk factor for the later development of AD. The results indicate that advanced age and low education are related to lower test scores across nearly all of the neurocognitive measures. Gender and APOE ϵ 4 both had negligible and inconsistent influences, affecting only isolated measures of memory and expressive speech (in case of gender). The gender and APOE effects disappeared once age and education we...
TL;DR: In this paper, the authors provide co-normed baseline data with demographic adjustments and test-retest standardized regression based (SRB) models for three time points for several measures.
Abstract: While the application of normative standards is vital to the practice of clinical neuropsychology, data regarding normative change remains scarce despite the frequency of serial assessments. Based on 285 normal individuals, we provide co-normed baseline data with demographic adjustments and test-retest standardized regression based (SRB) models for three time points for several measures. These models delineate normal, expected change across time, and yield standardized z-scores that are comparable across tests. Using a new approach, performance on any previous trial was accounted for in the subsequent models of change, yielding serial normative formulas that model change trajectories rather than simple change from point to point. These equations provide indices of deviation from expected baseline and change for use in clinical or research settings.
TL;DR: It is argued that the current practice of expressing confidence limits on test scores on a standard score metric should be supplemented with confidence limits expressed as percentile ranks, because the latter provide a more direct and tangible indication of the uncertainty surrounding an observed score.
Abstract: Many commentators on neuropsychological assessment stress the disadvantages of expressing test scores in the form of percentile ranks. As a result, there is a danger of losing sight of the fundamentals: percentile ranks express scores in a form that is of greater relevance to the neuropsychologist than any alternative metric because they tell us directly how common or uncommon such scores are in the normative population. We advocate that, in addition to expressing scores on a standard metric, neuropsychologists should also routinely record the percentile rank of all test scores so that the latter are available when attempting to reach a formulation. In addition, it is argued that the current practice of expressing confidence limits on test scores on a standard score metric should be supplemented with confidence limits expressed as percentile ranks, because the latter provide a more direct and tangible indication of the uncertainty surrounding an observed score. Computer programs accompany this paper and can be used to obtain percentile rank confidence limits for Index scores (and FSIQs) on the WAIS-III or WISC-IV (these can be downloaded from the following web page: http://www.abdn.ac.uk/~psy086/dept/PRCLME.htm).
TL;DR: The use of medications for the treatment of PTSD, the neuropsychiatric sequelae of TBI, and the co-morbid condition is reviewed and general principles are suggested and particular attention is directed to situations where the use of medication for one condition might exacerbate symptoms of the other disorder.
Abstract: Recognition of the frequency of the co-occurrence of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) is a relatively recent development in both fields. As a result there has been little work on effective treatment strategies for those with both conditions. In fact studies of PTSD treatment often exclude those with a history of TBI, and studies of the treatment of TBI sequelae have often excluded participants with psychiatric disorders such as PTSD. Thus although evidence-based approaches for the treatment of PTSD and for the sequelae TBI are emerging, little is known about the use of psychotropic medications to treat individuals with co-morbid TBI/PTSD. The growing cohort of military personnel with high rates of exposure to TBI and concurrent PTSD calls attention to the need for improved treatment strategies, and for clarification of whether medications currently used to treat PTSD or the sequelae of TBI are effective in the co-morbid condition. In the absence of informative treatment studies, clinicians are faced with uncertainty about whether to use conventional approaches, alter these approaches in some way, or to shy away from these interventions for fear of exacerbating symptoms of the other condition. This situation is further complicated by the fact that many clinicians tend to be more familiar with medication approaches in one disorder or the other. This paper reviews the use of medications for the treatment of PTSD, the neuropsychiatric sequelae of TBI, and the co-morbid condition. General principles are suggested and particular attention is directed to situations where the use of medication for one condition might exacerbate symptoms of the other disorder. Directions for future research are suggested.
TL;DR: The VATAm is a questionnaire that compares a patient's self-evaluation with a caregivers’ evaluation of the patient's abilities on a series of motor tasks, which overcomes some of the limitations of the existing structured interviews and questionnaires and enabling assessment of patients with aphasia.
Abstract: There has been a growing interest in anosognosia in both clinical and research domains, yet relatively little attention has been paid to methods for evaluating it. Usually, the presence and severity of anosognosia is assessed by means of structured interviews or questionnaires. Both interviews and questionnaires can provide valuable information, but they rely heavily on self-evaluation and language, and are therefore prone to bias and pose more difficulty in the assessment of aphasic patients. The aim of this study was to develop a new tool, the VATAm (Visual-Analogue Test for Anosognosia for motor impairment), to assess explicit anosognosia for motor impairments. The VATAm is a questionnaire that compares a patient's self-evaluation with a caregivers' evaluation of the patient's abilities on a series of motor tasks. In addition, the test overcomes some of the limitations of the existing structured interviews and questionnaires, by enhancing reliability, improving data interpretation and diagnosis, and enabling assessment of patients with aphasia.
TL;DR: A 35-item, oral word-reading test with two equivalent forms designed to estimate premorbid abilities that accurately predict a broader range of IQs than Blair and Spreen's (1989) longer version.
Abstract: We describe the development of a 35-item, oral word-reading test with two equivalent forms (HART-A and HART-B) designed to estimate premorbid abilities. Both forms show excellent internal consistency (coefficients alpha>.91) and test-retest reliability (Pearson rs >.90). HART performance was combined with demographic variables to generate regression equations that predict IQ scores obtained concurrently and 4-8 years earlier. The resulting models explained 61% of full scale IQ (FSIQ) variability in 327 healthy adults. The FSIQs that can be estimated range from below 73 to above 131. Combined with demographic variables, these two brief word reading tests accurately predict a broader range of IQs than Blair and Spreen's (1989) longer version. Equivalent forms make it especially useful for longitudinal studies.
TL;DR: The occurrence of traumatic brain injury (TBI) and psychological health issues in the current theater of military operations has become a major factor in planning for the long-term healthcare of our wounded warriors.
Abstract: The occurrence of traumatic brain injury (TBI) and psychological health issues in the current theater of military operations has become a major factor in planning for the long-term healthcare of our wounded warriors. Post-traumatic stress disorder (PTSD) can co-exist with brain injury in military members who have been exposed to blasts. Specific areas of the brain may be more susceptible to damage from blasts. In particular, damage to the prefrontal cortex can lead to disinhibition of cerebral structures that control fear and anxiety. Reactive systemic inflammatory processes related to TBI may also impair psychological health. Impaired psychological health may lead to increased psychological distress that impedes brain repair due to the release of stress-related hormones. Since the external environment has been shown to exert a significant influence on the internal environment of the organism, enriching the external environment may well reduce anxiety and facilitate the neuroplasticity of brain cells, thu...
TL;DR: Findings indicate that a sizeable percentage of breast cancer survivors have clinically significant cognitive impairment.
Abstract: The cognitive function of breast cancer survivors (BC, n = 52) and individually matched healthy controls (n = 52) was compared on a battery of sensitive neuropsychological tests. The BC group endorsed significantly higher levels of subjective memory loss and scored significantly worse than controls on learning and delayed recall indices from the Rey Auditory Verbal Learning Test (AVLT). Defining clinically significant impairment as scores at or below the 7th percentile of the control group, the rate of cognitive impairment in the BC sample was 17% for total learning on the AVLT, 17% for delayed recall on the AVLT, and 25% for either measure. Findings indicate that a sizeable percentage of breast cancer survivors have clinically significant cognitive impairment.
TL;DR: Three neuropsychological symptom validity tests (SVTs) including the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) were compared in a private practice forensic sample of 1032 examinees with alleged mild traumatic brain injury.
Abstract: The rates of significantly below-chance results on three neuropsychological symptom validity tests (SVTs) including the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) were compared in a private practice forensic sample of 1032 examinees with alleged mild traumatic brain injury, moderate to severe traumatic brain injury, alleged toxic exposure, and reported chronic pain. The PDRT and WMT were equivalent to one another in the rates of below-chance results, with both yielding more frequent below-chance results than the TOMM. Seemingly more difficult sections of the PDRT and WMT had higher yields than seemingly easier sections. Multiple SVTs were more likely to yield below-chance results than a single test, supporting the use of multiple SVTs in forensic neuropsychological evaluations.
TL;DR: Data indicate that LA severity is an important marker for understanding list learning in dementia.
Abstract: In patients with dementia, leukoaraiosis (LA) was hypothesized to result in differential patterns of impairment on a verbal serial list-learning test. Using a visual rating scale, 144 dementia patients with ischemic scores <4 were re-categorized as having mild (n = 73), moderate (n = 44), or severe LA (n = 27). Mild LA was predicted to be associated with an amnestic list-learning profile, while severe LA was predicted to be associated with a dysexecutive profile. List-learning performances were standardized to a group of healthy older adults (n = 24). Analyses were conducted on a set of four factors derived from the list-learning paradigm, as well as error scores. Data indicate that LA severity is an important marker for understanding list learning in dementia.
TL;DR: This article summarizes current Department of Defense (DoD) initiatives related to TBI and PTSD.
Abstract: The current conflicts in the Middle East have yielded increasing awareness of the acute and chronic effect of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The increasing frequency of exposure to blast and multiple deployments potentially impact the probability that a service member may sustain one of these injuries. The 2008 International Conference on Behavioral Health and Traumatic Brain Injury united experts in the fields of behavioral health and traumatic brain injury to address these significant health concerns. This article summarizes current Department of Defense (DoD) initiatives related to TBI and PTSD.
TL;DR: Challenges in the Neuropsychological Assessment of Ethnic Minorities: Summit Proceedings Heather R. Romero, Sarah K. Lageman, Vidya (Vidyulata) Kamath, Anita Sim, and Anita Sim describe the challenges and opportunities for improvement in the assessment of ethnic minority mental health in the United States.
Abstract: These proceedings document the Multicultural Problem Solving Summit, which was held in Waikoloa Village, Hawaii in February 2008. Welcoming comments were followed by a brief review of the history o...
TL;DR: The most common records management problem confronting neuropsychologists is described and some practical solutions to the raw data problem are presented and evaluated.
Abstract: Psychologists must advocate for more stringent legal protection of psychological test materials because using standardized tests is the most distinguishing and exclusive feature of psychological evaluation practice. With the rapid growth in forensic consulting, unrestrained discovery of raw data and psychological test materials during litigation erodes the reliability and validity of the test procedures. Dissemination of test materials reduces the interpretive value of the tests and promotes cheating, turning our best methods into junk science in the courtroom. This article proposes to reform the law and to revise the professional ethics of psychologists consistent with the strong public policy of test security as described by the U.S. Supreme Court in Detroit Edison v. NLRB (1979). Currently, federal courts and about 20 states protect psychological tests as a unique methodology, with some states enacting a psychologist nondisclosure privilege/duty to safeguard test materials from wrongful disclosure. The record management practices of psychologists vary considerably and are vulnerable to legal attack unless psychologists are aware of legal arguments to protect test materials from wrongful release. Although this article does not offer legal advice, it describes the most common records management problem confronting neuropsychologists and some practical solutions to the raw data problem. Best practice for protecting psychological tests requires the psychologist to understand the law and to assert the psychologist nondisclosure privilege. Other strategies are presented and evaluated. Organized psychology and the legal community should advocate for a uniform rule to protect the objectivity, fairness, and integrity psychological methods in litigation.
TL;DR: The TOMM scores decreased and failure rates increased as a function of greater external evidence of intentional under-performance and higher cutoffs increased sensitivity without adversely affecting specificity in chronic pain patients undergoing psychological evaluation.
Abstract: This study used criterion groups validation to determine the accuracy of the Test of Memory Malingering (TOMM) in detecting malingered pain-related disability (MPRD) across a range of cutoffs in chronic pain patients undergoing psychological evaluation (n = 604). Data from patients with traumatic brain injury (n = 45) and dementia (n = 59) are presented for comparison. TOMM scores decreased and failure rates increased as a function of greater external evidence of intentional under-performance. The TOMM detected from 37.5% to 60.2% of MPRD patients, depending on the cutoff. False positive (FP) error rates ranged from 0% to 5.1%. Accuracy data for Trial 1 are also reported. In chronic pain the original cutoffs produced no FP errors but were associated with high false negative error rates. Higher cutoffs increased sensitivity without adversely affecting specificity. The relevance of these findings to research and clinical practice is discussed.
TL;DR: It is suggested that certain features of depression be considered in assessing depression in these populations and guidelines for distinguishing depression from medical, psychosocial, and physical complaints common in elderly people are provided.
Abstract: Prevalence rates of depression in medically ill elderly people are strikingly high. In particular, the prevalences of depression at any given time in Alzheimer's, Parkinson's, and stroke are as high as 87%, 75%, and 79%, respectively. Proper detection and management of depression in primary care is imperative. The present review examines the risk factors, peculiarities, and etiologies of depression in these populations. We suggest that certain features of depression be considered in assessing depression in these populations and provide guidelines for distinguishing depression from medical, psychosocial, and physical complaints common in elderly people. Additionally, we explore the use of self-report instruments of depression and provide guidelines regarding the specific measures and cutoffs most appropriate for use with these populations. To this end, we hope that readers acquire a greater appreciation for the experience of depression of those suffering from these neurological disorders to aid in their assessment.
TL;DR: The Open Trial Selective Reminding Test (OT-SRT) as mentioned in this paper is a modification of the SRT that also evaluates new learning abilities, where the examinee is asked to learn a list of 10 words over a maximum of 15 trials.
Abstract: The Open Trial Selective Reminding Test (OT-SRT) is a modification of the SRT that also evaluates new learning abilities. The examinee is asked to learn a list of 10 words over a maximum of 15 trials. Using a criterion-referenced approach, the list is repeatedly administered until a criterion of complete recall on two consecutive trials is achieved. Training to criterion provides a better assessment of learning ability than the traditional fixed trial list-learning paradigm. Recall and recognition is then tested 30 and 90 minutes following the learning trials. This paper presents normative data on the OT-SRT for 117 healthy controls (Study 1) and 151 participants with clinically definite multiple sclerosis (Study 2).