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16 Validation of the Pillbox Test in a Veteran Sample: A Replication Study.
- Frances M. Bozsik, Timothy J. Arentsen, Brad L. Roper, Jessica M. Fett, Marcy C. Adler, Jennifer L. Jacobson, Charlotte Bayer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 699-700
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Objective:
Assessment of medication management, an instrumental activity of daily living (IADL), is particularly important among Veterans, who are prescribed an average of 2540 prescriptions per year (Nguyen et al., 2017). The Pillbox Test (PT) is a brief, performance-based measure that was designed as an ecologically valid measure of executive functioning (EF; Zartman, Hilsabeck, Guarnaccia, & Houtz, 2013), the cognitive domain most predictive of successful medication schedule management (Suchy, Ziemnik, Niermeyer, & Brothers, 2020). However, a validation study by Logue, Marceaux, Balldin, and Hilsabeck (2015) found that EF predicted performance on the PT more so than processing speed (PS), but not the language, attention, visuospatial, and memory domains combined. Thus, this project sought to increase generalizability of the latter study by replicating and extending their investigation utilizing a larger set of neuropsychological tests.
Participants and Methods:Participants included 176 patients in a mixed clinical sample (5.1% female, 43.2% Black/African American, 55.7% white, Mage = 70.7 years, SDage = 9.3, Medu = 12.6 years, SDedu = 2.6) who completed a comprehensive neuropsychological evaluation in a VA medical center. All participants completed the PT where they had five minutes to organize five pill bottles using a seven-day pillbox according to standardized instructions on the labels. Participants also completed some combination of 26 neuropsychological tests (i.e., participants did not complete every test as evaluations were tailored to disparate referral questions). Correlations between completed tests and number of pillbox errors were evaluated. These tests were then combined into the following six domains: language, visuospatial, working memory (WM), psychomotor/PS, memory, and EF. Hierarchical multiple regression was completed using these domains to predict pillbox errors.
Results:Spearman’s correlation coefficients indicated that 25 tests had a weak to moderate relationship with PT total errors (rs = 0.23 -0.51); forward digit span was not significantly related (rs = 0.13). A forced-entry multiple regression was run to predict PT total errors from the six domains. The model accounted for 29% of the variance in PT performance, F(6, 169) = 11.56, p < .001. Of the domains, psychomotor/PS made the greatest contribution, f(169) = 2.73, p = .007, followed by language, f(169) = 2.41, p = .017, and WM, f(169) = 2.15, p = .033. Visuospatial performance and EF did not make significant contributions (ps>.05). Next, two hierarchical multiple regressions were run. Results indicated that EF predicted performance on the PT beyond measures of PS, AR2 = .02, p = .044, but not beyond the combination of all cognitive domains, AR2 = .00, p = .863.
Conclusions:Results of this study partially replicated the findings of Logue et al. (2015). Namely, EF predicted PT performance beyond PS, but not other cognitive domains. However, when all predictors were entered into the same model, visuospatial performance did not significantly contribute to the prediction of pillbox errors. These results suggest that providers may benefit from investigating medication management abilities when deficits in PS, WM, and/or language are identified. Further research is needed to better understand which domains best predict PT failure.
32 Prediction of Seizure Outcome with Presurgical IAT, MRI, and PET in Patients with Temporal Lobe Epilepsy Undergoing Surgery
- Grant G Moncrief, Stephen L Aita, Jennifer Lee, Bryce Jacobson, George P Thomas, Robert M Roth, Angeline S Andrew, Krzysztof A Bujarski, Vijay M Thadani, Erik J Kobylarz, Stephen J Guerin, David W Roberts, Barbara C Jobst
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 31-32
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Objective:
Anterior temporal lobectomy is a common surgical approach for medication-resistant temporal lobe epilepsy (TLE). Prior studies have shown inconsistent findings regarding the utility of presurgical intracarotid sodium amobarbital testing (IAT; also known as Wada test) and neuroimaging in predicting postoperative seizure control. In the present study, we evaluated the predictive utility of IAT, as well as structural magnetic resonance imaging (MRI) and positron emission tomography (PET), on long-term (3-years) seizure outcome following surgery for TLE.
Participants and Methods:Patients consisted of 107 adults (mean age=38.6, SD=12.2; mean education=13.3 years, SD=2.0; female=47.7%; White=100%) with TLE (mean epilepsy duration =23.0 years, SD=15.7; left TLE surgery=50.5%). We examined whether demographic, clinical (side of resection, resection type [selective vs. non-selective], hemisphere of language dominance, epilepsy duration), and presurgical studies (normal vs. abnormal MRI, normal vs. abnormal PET, correctly lateralizing vs. incorrectly lateralizing IAT) were associated with absolute (cross-sectional) seizure outcome (i.e., freedom vs. recurrence) with a series of chi-squared and t-tests. Additionally, we determined whether presurgical evaluations predicted time to seizure recurrence (longitudinal outcome) over a three-year period with univariate Cox regression models, and we compared survival curves with Mantel-Cox (log rank) tests.
Results:Demographic and clinical variables (including type [selective vs. whole lobectomy] and side of resection) were not associated with seizure outcome. No associations were found among the presurgical variables. Presurgical MRI was not associated with cross-sectional (OR=1.5, p=.557, 95% CI=0.4-5.7) or longitudinal (HR=1.2, p=.641, 95% CI=0.4-3.9) seizure outcome. Normal PET scan (OR= 4.8, p=.045, 95% CI=1.0-24.3) and IAT incorrectly lateralizing to seizure focus (OR=3.9, p=.018, 95% CI=1.2-12.9) were associated with higher odds of seizure recurrence. Furthermore, normal PET scan (HR=3.6, p=.028, 95% CI =1.0-13.5) and incorrectly lateralized IAT (HR= 2.8, p=.012, 95% CI=1.2-7.0) were presurgical predictors of earlier seizure recurrence within three years of TLE surgery. Log rank tests indicated that survival functions were significantly different between patients with normal vs. abnormal PET and incorrectly vs. correctly lateralizing IAT such that these had seizure relapse five and seven months earlier on average (respectively).
Conclusions:Presurgical normal PET scan and incorrectly lateralizing IAT were associated with increased risk of post-surgical seizure recurrence and shorter time-to-seizure relapse.
Assessing Laws and Legal Authorities for Obesity Prevention and Control
- Lawrence O. Gostin, Jennifer L. Pomeranz, Peter D. Jacobson, Richard N. Gottfried
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- Journal:
- Journal of Law, Medicine & Ethics / Volume 37 / Issue S1 / Summer 2009
- Published online by Cambridge University Press:
- 01 January 2021, pp. 28-36
- Print publication:
- Summer 2009
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Law is an essential tool for public health practice, and the use of a systematic legal framework can assist with preventing chronic diseases and addressing the growing epidemic of obesity.The action options available to government at the federal, state, local, and tribal levels and its partners can help make the population healthier by preventing obesity and decreasing the growing burden of associated chronic diseases such as cardiovascular disease and Type 2 diabetes. The Centers for Disease Control and Prevention (CDC) uses the four-part systematic legal framework commonly referred to as “public health legal preparedness” to demonstrate the essential role law can play for any public health issue. This paper uses the “laws and legal authorities” component of the framework and should be considered in combination with the competencies, coordination, and information-best practices components of the framework.