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33 Does Comorbid Depression Impact Executive Functioning (EF) in Adults Diagnosed with ADHD?: A Comparison of EF Across Diagnoses in Clinically-Referred Individuals
- Haley V. Skymba, Gabriel P. Ovsiew, Nicole M. Durkin, Kyle J. Jennette, Zachary J. Resch, Jason R. Soble
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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. 640-641
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Objective:
Neurobiological and cognitive theories implicate deficits in executive function (EF) as a core facet of both depressive disorders and attention-deficit/hyperactivity disorder (ADHD), but empirical investigations inconsistently support this conclusion. Despite recognition of the likely bi-directional relationship of EF deficits to depression and ADHD, respectively, the extent to which comorbid depression might impact EF in adults remains unclear, considering more of the literature has examined children and adolescents. This study examined performance differences on EF measures in clinically-referred adults diagnosed with ADHD or a non-ADHD primary psychopathological condition in the presence/absence of comorbid depression.
Participants and Methods:This cross-sectional study included data from 404 adults referred for neuropsychological evaluation at a Midwestern academic medical center. In total, 343 met DSM-5 diagnostic criteria for ADHD (ADHD-all group:164 Predominantly Inattentive presentation [ADHD-I] and 179 Combined presentation [ADHD-C]) and 61 met criteria for a non-ADHD primary psychopathological condition (psychopathology group: 31 mood disorder, 17 anxiety disorder, and 13 posttraumatic stress disorder) when assessed via semi-structured clinical interview. All patients completed the Beck Depression Inventory-Second Edition (BDI-II) and five EF tests: Letter Fluency, Trail Making Test-Part B (Trails-B), Stroop Color and Word Test Color-Word trial (SCWT CW); and WAIS-IV Working Memory Index (WMI). Oneway MANOVAs assessed for significant EF differences between groups with high (BDI-II greater than or equal to 20) or low (BDI-II less than or equal to 19) depressive symptoms.
Results:When group diagnosis (ADHD-all vs. psychopathology) was examined in the context of high or low depression, a significant difference in EF performance emerged between groups, F(12, 1042.72)=2.44, p<.01, Wilk's A=.93, partial n2=.02, with univariate analyses indicating a significant difference in FAS-T between at least two of the groups (F(3, 397)=3.92 , p< .01, partial n2=.03). Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was significantly different between the ADHD-high depression and ADHD-low depression groups (p=.046 , 95% CI = [5.81, -.04]) as well as between the ADHD-low depression and psychopathology-high depression groups (p=.05, 95% CI = [-8.89, .00]). A one-way MANOVA examining differences between groups when distinguishing ADHD by subtype revealed a statistically significant difference in EF performance between groups, F(20, 1301)=1.85, p<.05, Wilk's A=.91, partial n2=.02, with univariate analyses indicating a statistically significant difference in FAS-T between at least two of the groups (F(5, 395) = 2.39 , p<.05, partial n2 = .03). However, Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was not significantly different between any of the groups.
Conclusions:Overall, results indicate that clinically-referred patients with ADHD perform comparably on tests of EF regardless of the presence or absence of comorbid depression. These findings have implications for conceptualizing EF weaknesses in neuropsychological profiles for individuals with ADHD and suggest examining factors beyond comorbid depression.
43 Comparison of Latent Structures for the Neuropsychiatric Inventory Questionnaire (NPI-Q)
- Nicholas R Amitrano, Maximillian A Obolsky, Zachary J Resch, Jason R Soble, David A Gonzälez
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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. 723-724
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Objective:
Existing research has demonstrated that neuropsychiatric/behavioral-psychological symptoms of dementia (BPSD) frequently contribute to worse prognosis in patients with neurodegenerative conditions (e.g., increased functional dependence, worse quality of life, greater caregiver burden, faster disease progression). BPSD are most commonly measured via the Neuropsychiatric Inventory (NPI), or its briefer, informant-rated questionnaire (NPI-Q). Despite the NPI-Q’s common use in research and practice, there is disarray in the literature concerning the NPI-Q’s latent structure and reliability, possibly related to differences in methods between studies. Also, hierarchical factor models have not been considered, even though such models are gaining favor in the psychopathology literature. Therefore, we aimed to compare different factor structures from the current literature using confirmatory factor analyses (CFAs) to help determine the best latent model of the NPI-Q.
Participants and Methods:This sample included 20,500 individuals (57% female; 80% White, 12% Black, 8% Hispanic), with a mean age of 71 (SD = 10.41) and 15 average years of education (SD = 3.43). Individuals were included if they had completed an NPI-Q during their first visit at one of 33 Alzheimer Disease Research Centers reporting to the National Alzheimer Coordinating Center (NACC). All CFA and reliability analyses were performed with lavaan and semTools R packages, using a diagonally weighted least squares (DWLS) estimator. Eight single-level models using full or modified versions of the NPI-Q were compared, and the top three were later tested in bifactor form.
Results:CFAs revealed all factor models of the full NPI-Q demonstrated goodness of fit across multiple indices (SRMR = 0.039-0.052, RMSEA = 0.025-0.029, CFI = 0.973-0.983, TLI = 0.9670.977). Modified forms of the NPI-Q also demonstrated goodness of fit across multiple indices (SRMR = 0.025-0.052, RMSEA = 0.0180.031, CFI = 0.976-0.993, TLI = 0.968-0.989). Top factor models later tested in bifactor form all demonstrated consistently stronger goodness of fit regardless of whether they were a full form (SRMR = 0.023-0.035, RMSEA = 0.015-0.02, CFI = 0.992-0.995, TLI = 0.985-0.991) or a modified form (SRMR = 0.023-0.042, RMSEA = 0.015-0.024, CFI = 0.985-0.995, TLI = 0.9770.992). Siafarikas and colleagues’ (2018) 3-factor model demonstrated the best fit among the full-form models, whereas Sayegh and Knight’s (2014) 4-factor model had the best fit among all single-level models, as well as among the bifactor models.
Conclusions:Although all factor models had adequate goodness of fit, the Sayegh & Knight 4-factor model had the strongest fit among both single-level and bifactor models. Furthermore, all bifactor models had consistently stronger fit than single-level models, suggesting that BPSD are best theoretically explained by a hierarchical, non-nested framework of general and specific contributors to symptoms. These findings also inform consistent use of NPI-Q subscales.
10 Performance between bilinguals and monolinguals: Anxiety as a moderating effect across executive functioning and processing speed in a multicultural cohort with ADHD symptoms
- Christopher Gonzalez, Demy Alfonso, Brian M Cerny, Karen S Basurto, John-Christopher A Finley, Gabriel P Ovsiew, Phoebe Ka Yin Tse, Zachary J Resch, Kyle J Jennette, Jason R Soble
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 425-426
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Objective:
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly associated with relative impairments on processing speed, working memory, and/or executive functioning. Anxiety commonly co-occurs with ADHD and may also adversely affect these cognitive functions. Additionally, language status (i.e., monolingualism vs bilingualism) has been shown to affect select cognitive domains across an individual’s lifespan. Yet, few studies have examined the potential effects of the interaction between anxiety and language status on various cognitive domains among people with ADHD. Thus, the current study investigated the effects of the interaction of anxiety and language status on processing speed, working memory, and executive functioning among monolingual and bilingual individuals with ADHD.
Participants and Methods:The sample comprised of 407 consecutive adult patients diagnosed with ADHD. When asked about their language status, 67% reported to be monolingual (English). The Mean age of individuals was 27.93 (SD = 6.83), mean education of 15.8 years (SD = 2.10), 60% female, racially diverse with 49% Non-Hispanic White, 22% Non-Hispanic Black, 13% Hispanic/Latinx, 9% Asian/Pacific Islander, and 6% other race/ethnicity. Processing speed, working memory, and executive function were measured via the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index, Working Memory Index, and Trail Making Test B, respectively. Anxiety was measured via the Beck Anxiety Inventory (BAI). Three separate linear regression models examined the interaction between anxiety (moderator) and cognition (processing speed, working memory, and executive function) on language. Models included sex/gender and education as covariates with Processing Speed Index and Working Memory Index as the outcomes. Age, sex/gender, and education were used as covariates when Trail Making Test B was the outcome.
Results:Monolingual and bilingual patients differed in mean age (p < .05) but did not differ in level of anxiety, education, or sex/gender. Overall, anxiety was not associated with processing speed, working memory, and executive function. However, the interaction between anxiety and language status was significantly associated with processing speed (ß = -0.37, p < .05), and executive functioning (ß = 0.82, p < .05). No associations were found when anxiety was added as a moderator for the associations between language and working memory.
Conclusions:This study found that anxiety moderated the relationship between language status and select cognitive domains (i.e., processing speed and executive functioning) among individuals with ADHD. Specifically, anxiety had a greater association on processing speed and executive functioning performance for bilinguals rather than monolinguals. Future detailed studies are needed to better understand how anxiety modifies the relationship between language and cognitive performance outcomes over time amongst a linguistically diverse sample.
42 Cognitive Impairment Stage and Dementia Syndromes Explain Latent Structure Variability on the Neuropsychiatric Inventory Questionnaire (NPI-Q)
- Nicholas R Amitrano, Maximillian A Obolsky, Zachary J Resch, Jason R Soble, David A Gonzälez
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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. 722-723
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Objective:
Neuropsychiatric/behavioral-psychological symptoms of dementia (BPSD) frequently contribute to worse prognosis of patients with neurodegenerative conditions. BPSD are commonly measured via a brief, informant-rated version of the Neuropsychiatric Inventory (NPI), the NPI-Q. Previously (see our other submission to this conference), we established optimal latent structures by comparing different factor models in the literature using confirmatory factor analyses (CFAs). However, questions remain as to why so many different models were found in the literature. One possibility is sampling differences, including different proportions of individuals across cognitive stages (e.g., mild cognitive impairment, moderate dementia) or syndromes (e.g., Alzheimer’s amnestic syndrome, Dementia with Lewy Bodies). We tested this hypothesis by subjecting candidate models to measurement invariance (MI) analyses stratified by cognitive stage and syndrome.
Participants and Methods:Individuals were included if they had completed an NPI-Q during their first visit at an Alzheimer Disease Research Center reporting to the National Alzheimer Coordinating Center (NACC). This resulted in 20,500 individuals (57% female; 80% White, 13% Black, 8% Hispanic), with a mean age of 71 (SD = 10.41) and 15 average years of education (SD = 3.43). Regarding staging, 75.9% of individuals did not meet criteria for all-cause dementia, whereas 24.1% individuals had all-cause dementia. Regarding syndromes, 35.6% had an Alzheimer’s presentation (“AD-type”) and 5.6% had either a behavioral variant frontotemporal dementia or Lewy-Body dementia presentation (“behavioral-type”). A 3-factor and 4-factor model were subject to MI across these groupings. We conducted MI analyses for equal forms, equal loadings, and equal intercepts using the lavaan R package with a diagonally weighted least squares (DWLS) estimator.
Results:The 3-factor model demonstrated good fit among individuals experiencing (CFI = 0.965, TLI = 0.955) and not experiencing (CFI = 0.984, TLI = 0.979) dementia, as well as among AD-type (CFI = 0.983, TLI = 0.978) presentations, but had borderline poor fit for behavioral-type (CFI = 0.932, TLI = 0.912) presentations. The 4-factor model had better fit among those experiencing (CFI = 0.985, TLI = 0.977) and not experiencing (CFI = 0.995, TLI = 0.992) dementia. Additionally, the 4-factor model demonstrated good of fit for AD-type (CFI = 0.993, TLI = 0.989) and poorer fit for behavioral-type (CFI = 0.949, TLI = 0.922) syndromes. Chi-square differences suggested that equal loading and equal intercept hypotheses should be rejected for both 3- and 4-factor models, for both staging and syndromal groupings. However, relative fit indices suggested that the equal form, equal loading, and equal intercept hypotheses could be adequate for only the 4-factor model.
Conclusions:The variability of factor structures in the BPSD literature appears, at least partially, explained by sampling variability among cognitive stages and dementia syndromes. The best models in the literature appear to have good fit in non-demented individuals and, among those who have dementia, in those with an AD syndrome. Only Sayegh & Knight’s 4-factor model had adequate (albeit, not optimal) fit among those with all-cause dementia and, more specifically, among those with a behavioral-type dementia syndrome. These findings inform BPSD theory and practical implementation of NPI-Q subscales.
70 The Effect of Executive Functioning on Predicting Health Literacy in a Memory Disorders Clinic
- Kyle J Jennette, Aya Haneda, Jason R Soble, Zachary J Resch
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 273-274
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Objective:
Health literacy is the degree to which an individual is able to attain, process, and understand information, skills, and services required to make informed decisions. Limited health literacy is a risk factor for problems understanding health information and adhering to medical instructions, underuse of preventive services, increased hospitalizations and associated medical costs, and higher mortality rates. Recognizing individuals with reduced health literacy can be difficult given demographic information such as age or years of education do not reliably reflect an individual’s health literacy level. Cross-sectional studies have identified limited health literacy as associated with lower scores on cognitive tests measuring memory, executive function (EF), and processing speed, independent from the influence of demographic variables (e.g., age, race, education). This study assessed the association of objective measures of executive functioning and health literacy when controlling for premorbid estimated intellectual functioning and relevant demographic variables.
Participants and Methods:A sample of 44 adult patients (20 Male; 24 Female) referred for neuropsychological evaluation for memory complaints who were administered the Test of Premorbid Functioning (TOPF), and multiple measures of EF including the Trail Making Test - Part B (TMT-B), Stroop Color and Word Test (SCWT), and Letter (FAS) and Semantic (Animals) Fluency as part of part of a larger standardized battery. Patients were also administered the Short Assessment of Health Literacy-English (SAHL-E). All included patients had <2 performance validity test failures. The sample was 50% non-Hispanic Black, 31.8% non-Hispanic White, 15.9% Hispanic, 2.3% Asian/Pacific Islander, and 54.5% female. Diagnostically, 50.9% of the sample were cognitively normal, 36.4% had mild cognitive impairment, and 15.9% had dementia. Two multiple regressions were conducted to evaluate (1) the predictive power of EF on the SAHL-E, and (2) the moderating impact of estimated premorbid IQ and demographics via the TOPF on the relationship between EF and SAHL-E.
Results:The first regression was not significant (p=.168) with FAS as the only independent predictor of SAHL-E performance (ß=.387, p<.05). The overall model was significant with the addition of the TOPF (p<.001). FAS accounted for 29% (ß=.336, p<.05) of the variance in SAHL-E when controlling for TOPF and other measures of EF.
Conclusions:These results indicate that novel generativity is a significant predictor of health literacy beyond the influence of estimated premorbid intelligence and demographic factors. Importantly, these findings suggest that broadly speaking EF abilities have minimal impact on health literacy, although reduced verbal generativity to letter cues is associated with reduced health literacy. Identification of at-risk populations such as individuals with limited health literacy is clinically important and can make way for early intervention. Health information targeted at this at-risk population should go beyond vocabulary and more specifically reduce the burden on verbal fluency.
12 The Effect of Adverse Childhood Experiences on Minnesota Multiphasic Personality Inventory-2-Restructured Form Symptom Reporting Among Adult Neuropsychological Referrals
- Demy Alfonso, Christopher Gonzalez, Gabriel P Ovsiew, Zachary J Resch, Jason R Soble
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 696-697
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Adverse childhood experiences (ACEs) is a broad construct that refers to negative events one may experience during childhood, including, but not limited to, childhood maltreatment, household dysfunction, and trauma. ACEs have consistently shown to be associated with negative physical and mental health outcomes. Although researchers have investigated the effects of trauma and abuse on personality measures, few studies have examined differences between those with high ACEs, low ACEs, and no ACEs on measures of personality in the context of neuropsychological evaluations.
Participants and Methods:The current study included 128 consecutive adult patients referred for outpatient neuropsychological evaluation of attention-deficit/hyperactivity disorder. The sample was 39.8% non-Hispanic White, 21.9% non-Hispanic Black, 16.4% Hispanic, 10.9% Asian/Pacific Islander, and 10.9% other race/ethnicity, with a mean age of 27.9 years (SD=6.3) and mean education of 16.1 years (SD=2.2). Multivariate analyses of variance were performed to evaluate differences on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) between individuals who experienced high levels of ACEs (>4/10 on the Adverse Childhood Experiences Questionnaire), low levels of ACEs (1-3/10), and no ACEs (0/10).
Results:When analyzing Higher-Order (H-O) scales, there was a significant group difference in mean elevation on the Behavioral/Externalizing Dysfunction (BXD) scale, F(2,113)=3.124, p < .05, such that individuals in the high ACEs group evidenced higher scores than those in the low ACEs group (p < .05). Additionally, there were significant differences on several Restructured Clinical (RC) scales. Specifically, there were group differences on the Low Positive Emotions (RC2) scale, F(2,113)=3.427, p < .05, such that those in the low ACEs group evidenced higher scores than those in the no ACEs group (p < .05). The Antisocial Behavior (RC4) scale also had significant differences, F(2,113)=13.703, p < .001, such that those in the high ACEs group had higher scores than those in the low and no ACEs groups (p < .001). Finally, the Ideas of Persecution (RC6) scale yielded significant group differences, F(2,113)=4.793, p < .05, such that those in the high ACEs group evidenced higher scores than those in the low and no ACEs groups (p < .05).
Conclusions:In sum, this study demonstrated that ACEs, particularly high levels of ACEs, are related to higher difficulties with problems with under-controlled and rule-breaking behaviors, low positive emotional responses, and beliefs that others pose a threat. As such, assessment of ACEs may serve an important role in characterizing patients’ psychological status as part of a comprehensive neuropsychological evaluation.
74 The Role of Executive Functioning in Predicting Health Numeracy in a Memory Disorders Clinic.
- Ayesha Arora, Matthew S Phillips, Veronica Koralewski, Neil H Pliskin, Jason R Soble, Zachary J Resch, Kyle J Jennette
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 276-277
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Objective:
Health numeracy is the understanding and application of information conveyed with numbers, tables and graphs, and probabilities in order to effectively manage one's own healthcare. Health numeracy is a vital aspect of communicating with healthcare providers and participating in one's own medical decision making, which is especially important in aging populations. Current literature indicates that assessing and establishing one's health numeracy abilities is among the first steps in providing necessary resources and accommodating patients' individual needs. Additionally, older adults with diffuse cognitive impairment often have issues with facets of executive functioning; however, the extant literature does not discuss the role of executive functioning in relation to health numeracy in this population. The purpose of this study was to explore the relationship between performance on tasks of executive functioning and objectively-measured health numeracy abilities in older adult patients.
Participants and Methods:This study included a sample of 42 older adult patients referred for neuropsychological evaluation for memory complaints who were administered the Test of Premorbid Functioning (TOPF), Trail Making Test - Part B (TMT-B), and Stroop Color and Word Test (SCWT Color Word Interference [CWI]) as part of a larger standardized battery. Patients were also administered the Numerical Understand in Medicine Instrument - Short Form (NUMI-SF). All included patients had <2 performance validity test failures. The sample was racially diverse (47.6% Black, 35.7% White, 14.3% Hispanic, 2.4% Asian) and 54.8% female. Average age was 62.95 (SD= 8.6) and average education was 14.1 (SD=2.7). Diagnostically, 47.6% of the sample were cognitively normal, 33.3% had mild cognitive impairment, and 19.0% had dementia. Average NUMI-SF score was 4.79 (SD= 1.7). Two multiple regressions were conducted to evaluate the extent to which executive functioning, as measured by the TMT-B and SCWT CWI predicted NUMI-SF, and the additive predictive power of premorbid IQ and demographics via the TOPF on the relationship between executive functioning and NUMI-SF.
Results:The first regression, which measured the relationship between the TMT-B and SCWT CWI upon NUMI-SF scores, was not significant (p=.616). The model was significant with the addition of the TOPF (ß=.595, p<.001) and TOPF alone predicted ∼60% of the variance in NUMI-SF score, while TMT-B and SCWT CWI remained non-significant.
Conclusions:These results indicate that common measures of executive functioning are not reliable predictors of health literacy with or without the moderating of premorbid intellectual functioning taken into consideration. This suggests that health numeracy is likely to be minimally affected by deficits in executive functioning and rather may be better accounted for by premorbid intellectual functioning and/or other sociodemographic factors (e.g. socioeconomic status, education quality, occupation). Future studies will benefit from elucidating the contributions of other social determinant factors on predicting health numeracy.
76 Differential Performance in Visual Learning and Retrieval in a Validity Controlled Chronic Pain Sample
- Phoebe Ka Yin Tse, Christopher Gonzalez, Karen S Basurto, Zachary J Resch, Jason R Soble, Kyle J Jennette
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 69-70
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Objective:
Individuals with chronic pain frequently report diminished cognitive functioning. Prior cross-sectional studies have demonstrated strong associations between chronic pain and neurocognitive impairment, most notably in memory, attention, processing speed, and executive functioning. However, there is a paucity of research evaluating visual learning and memory abilities in this population. Further, while current practice standards advocate for the use of performance validity tests (PVTs) to assess the credibility of neuropsychological test performance, they have infrequently been incorporated into studies examining chronic pain samples, despite a higher observed rate of noncredible performance in the literature. This study aimed to compare visual learning and memory performance between a mixed neuropsychiatric (MNP) group and a chronic pain group in a validity-controlled sample.
Participants and Methods:The study consisted of 371 adults referred for outpatient neuropsychological evaluation. Between groups, various PVTs were administered, which included, at minimum, one freestanding and four embedded PVTs. All patients were administered the Brief Visuospatial Memory Test-Revised (BVMT-R) as part of a comprehensive neuropsychological evaluation. Only patients classified as valid performers (<1 PVT fails; n=295) were included in the analyses (Pain: n=109; MNP: n=186). The overall sample was 69% female and racially diverse (22% non-Hispanic Black, 43% non-Hispanic White, 30% Hispanic, 3% Asian/Pacific Islander, and 2% other race/ethnicities), with a mean age of 46.8 (SD=14.8) and mean education of 13.7 years (SD=2.7). Independent samples t-tests were performed to investigate the differences in visual learning and memory abilities between the chronic pain and MNP groups.
Results:Chi-square analyses revealed significant differences between the pain and MNP groups on race, with more non-Hispanic White and Hispanic patients represented in the MNP group. There were also modest group differences in age and education. For the chronic pain group, patients scored lower on both BVMT-R Total T-Score (mean difference = 9.65T, p<.001) and BVMT Delayed Recall T-Score (mean difference = 8.97T, p<.001). The effect size was robust for both for Total T-Score (d = 0.682) and Delayed Recall T-Score (d = 0.632). In contrast, the difference in BVMT Recognition Discriminability was not statistically significant.
Conclusions:This study demonstrated significant differences in performance between mixed neuropsychiatric and chronic pain patients. Preliminary evidence indicated that chronic pain patients displayed lower visual mediated encoding and retrieval performance, although their recognition is comparable. Although the nature of this study was targeted toward visual learning and retrieval, it is likely that the known impact of chronic pain on attention, working memory, and processing speed accounts for this relationship. Future studies will benefit from further elucidating these potential mechanisms and better inform clinical decision-making and neuropsychological testing performance in patients with chronic pain.
15 The Role of Race and Adverse Childhood Experiences on Predicting Cognitive Ability on the Montreal Cognitive Assessment (MoCA).
- Veronica Koralewski, Matthew S. Phillips, Ayesha Arora, Woojin Song, Neil Pliskin, Jason R. Soble, Zachary J. Resch, Kyle Jennette
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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. 532-533
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Awareness of risk factors associated with any form of impairment is critical for formulating optimal prevention and treatment planning. Millions worldwide suffer from some form of cognitive impairment, with the highest rates amongst Black and Hispanic populations. The latter have also been found to achieve lower scores on standardized neurocognitive testing than other racial/ethnic groups. Understanding the socio-demographic risk factors that lead to this discrepancy in neurocognitive functioning across racial groups is crucial. Adverse childhood experiences (ACEs), are one aspect of social determinants of health. ACES have been linked to a greater risk of future memory impairment, such as dementia. Moreover, higher instances of ACEs have been found amongst racial minorities. Considering the current literature, the purpose of this exploratory research is to better understand how social determinants, more specifically, ACEs, may play a role in the development of cognitive impairment.
Participants and Methods:This cross-sectional study included data from an urban, public Midwestern academic medical center. There was a total of 64 adult clinical patients that were referred for a neuropsychological evaluation. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA) as well as a 10-item ACE questionnaire, which measures levels of adverse childhood experiences. The sample was 73% Black and 27% White. The average age was 66 (SD=8.6) and average education was 12.6 years (SD=3.4). A two-way ANOVA was conducted to evaluate the interaction of racial identity (White; Black) and ACE score on MoCA total score. An ACE score >4 was categorized as “high”; ACE <4 was categorized as “low.”
Results:There was not a significant interaction of race and ACE group on MoCA score (p=.929) nor a significant main effect of ACE score (p=.541). Interestingly, there was a significant main effect of Race on MoCA (p=.029). White patients had an average MoCA score of 21.82 (sd=4.77). Black patients had an average MoCA score of 17.54 (sd=5.91).
Conclusions:Overall, Black patients demonstrated statistically lower scores on the MoCA than White patients. There was no significant difference on MoCA score between races when also accounting for ACE scores. Given this study’s findings, one’s level of adverse childhood experiences does not appear to impact one’s cognitive ability later in life. There is a significant difference in cognitive ability between races, specifically Black and White people, which suggests there may be social determinants other than childhood experiences to be explored that influence cognitive impairment.
74 The Impact of Motoric Dysfunction on Neuropsychological Test Performance Within an Electrical Injury Sample
- Maximillian A Obolsky, Humza Khan, Zachary J Resch, Jessica L Paxton, Jason R Soble, Joseph W Fink, Neil H Pliskin
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 67-68
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Objective:
Victims of electrical injury (EI) often experience injuries to the peripheral nervous system and neuromuscular damage that may diminish motor function, such as flexibility/dexterity. These difficulties may continue after rehabilitation due to the reorganization of muscle afferent projections during peripheral nerve regeneration. Therefore, understanding how patients with a history of thermal burn injuries perform on motoric measures is necessary to explain the impact neuromuscular damage has on both motor and non-motor tests of cognition. However, no studies have examined the impact of motor functioning on cognition in patients who experienced thermal and electrical injuries compared to an electrical shock injury. This study explored the impact of motor dysfunction and psychiatric distress measured by depression severity on psychomotor speed and executive test performances among EI patients with and without thermal burn injuries.
Participants and Methods:This cross-sectional study consisted of EI patients undergoing an outpatient neuropsychological evaluation, including tests of motor dexterity (Grooved Pegboard [GP]), psychomotor speed (Wechsler Adult Intelligence Scale-IV Coding, Trail Making Test [TMT] Part A), and executive functioning (Stroop Color and Word Test [SCWT] Color-Word trial, TMT Part B). The sample was 83% male and 17% female, 88% White, 3% Black, 5% Hispanic, and 2% other race/ethnicity, with a mean age of 43.9 years (SD=11.36), mean education of 12.9 years (SD=2.05), and mean depression severity of 20.05 (SD=12.59) on the Beck Depression Inventory-II (BDI-II). Exclusion criteria were: 1) injury history of moderate-to-severe head trauma, 2) >2 performance validity test failures, and 3) any amputation of the upper extremity. Regression analyses included GP T-Scores for dominant hand and BDI-II total score as independent variables and neuropsychological normative test data as dependent variables.
Results:Among validly performing patients with EI (n=86), regression analyses revealed GP performance accounted for significant variance (R2 =.153-.169) on all neuropsychological measures. Among EI patients with burn injuries (n=50), regression analyses revealed GP performance accounted for significant variance (R2 =.197-.266) on all neuropsychological measures. Among EI patients without burn injuries (n=36), analyses revealed that neither GP performance nor BDI-II severity accounted for significant variance across the neurocognitive tests (R2=.056-.142). Furthermore, among EI patients with burn injuries and the total sample, regression analyses revealed depression severity negatively predicted GP performance (R2 =.099-.13), however, in patients without burn injuries, depression did not predict GP performance (R2 =.052).
Conclusions:Overall, results showed that GP performance is a significant predictor of neurocognitive performance on both motor and non-motor measures in EI patients with burn injuries. Therefore, among EI patients with burn injuries, GP performance may have potential utility as an early indicator of injury severity, considering that it predicts neuropsychological test performance on measures of psychomotor speed and executive functioning. Lastly, depression predicted GP performance within the burn injury sample illustrating that psychological distress may negatively impact motor functionality.
45 Relationship Between Degree of Cognitive Impairment and Performance on Measures of Health Numeracy and Literacy in a Memory Disorders Clinic
- Matthew S Phillips, Veronica Koralewski, Ayesha Arora, Woojin Song, Neil H Pliskin, Jason R Soble, Zachary J Resch, Kyle J Jennette
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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. 353-354
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Objective:
Understanding healthcare information is an important aspect in managing one’s own needs and navigating a complex healthcare system. Health numeracy and literacy reflect the ability to understand and apply information conveyed numerically (i.e., graphs, statistics, proportions, etc.) and written/verbally (i.e., treatment instructions, appointments, diagnostic results) to communicate with healthcare providers, understand one’s medical condition(s) and treatment plan, and participate in informed medical decision-making. Cognitive impairment has been shown to impact one’s ability to understand complex medical information. The purpose of this study is to explore the relationship between the degree of cognitive impairment and one’s ability to perform on measures of health numeracy and literacy.
Participants and Methods:This cross-sectional study included data from 38 adult clinical patients referred for neuropsychological evaluation for primary memory complaints at an urban, public Midwestern academic medical center. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA), as well as measures of both health numeracy (Numeracy Understanding of Medicine Instrument-Short Version [NUMI-SF]) and health literacy (Short Assessment of Health Literacy-English [SAHL-E]). The sample was 58% female and 60% Black/40% White. Mean age was 65 (SD=9.4) and mean education was 14.4 years (SD=2.5). The sample was further split into three groups based on cognitive diagnosis determined by comprehensive neuropsychological assessment (i.e., No Diagnosis [34%]; Mild Cognitive Impairment [MCI; 29%]; Dementia [34%]).Groups were well matched and did not statistically differ in premorbid intellectual functioning (F=1.96, p=.157; No Diagnosis, M=100, SD=7.92; MCI, M=99, SD=8.87; Dementia, M=94, SD=7.72) ANOVAs were conducted to evaluate differences between clinical groups on the MoCA, NUMI-SF, and SAHL-E. Multiple regressions were then conducted to determine the association of MoCA scores with NUMI-SF and SAHL-E performance.
Results:As expected, the Dementia group performed significantly below both the No Diagnosis and MCI groups on the MoCA (F=19.92, p<.001) with a large effect (ηp2=.540). Significant differences were also found on the NUM-SF (F=5.90, p>.05) and on the SAHL-E (F=6.20, p>.05) with large effects (ηp2=.258 and ηp2=.267, respectively). Regression found that MoCA performance did not predict performance on the NUMI-SF and SAHL-E in the No Diagnosis group (F=2.30, p=.809) or the MCI group (F=1.31, p=.321). Conversely, the MoCA significantly predicted performance on the NUMI-SF and SAHL-E for the Dementia (F=15.59, p=.001) group.
Conclusions:Degree of cognitive impairment is associated with understanding of health numeracy and literacy information, with patients diagnosed with dementia performing most poorly on these measures. Patients with normal cognitive functioning demonstrated a significantly better understanding of health numeracy and health literacy. This study supports the notion that as cognitive functioning diminishes, incremental support is necessary for patients to understand medical information pertaining to their continued care and medical decision-making, particularly as it relates to both numerical and written information.
21 A Comparison of the Memory and Non-Memory Based Performance Validity Measures for Detecting Invalid Neuropsychological Test Performance among Individuals with and without Memory Impairment
- Humza M Khan, Maximillian A Obolsky, Gabriel P Ovsiew, Jason R Soble, Zachary J Resch
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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. 703-704
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Objective:
Few to no studies have directly compared the relative classification accuracies of the memory-based (Brief Visuospatial Memory Test-Revised Recognition Discrimination [BVMT-R RD] and Rey Auditory Verbal Learning Test Forced Choice [RAVLT FC]) and non-memory based (Reliable Digit Span [RDS] and Stroop Color and Word Test Word Reading trial [SCWT WR]) embedded performance validity tests (PVTs). This study’s main objective was to evaluate their relative classification accuracies head-to-head, as well as examine how their psychometric properties may vary among subgroups with and without genuine memory impairment.
Participants and Methods:This cross-sectional study included 293 adult patients who were administered the BVMT-R, WAIS-IV Digit Span, RAVLT and SCWT during outpatient neuropsychological evaluation at a Midwestern academic medical center. The overall sample was 58.0% female, 36.2% non-Hispanic White, 41.3% non-Hispanic Black, 15.7% Hispanic, 4.8% Asian/Pacific Islander, and 2.0% other, with a mean age of 45.7 (SD=15.8) and a mean education of 13.9 years (SD=2.8). Three patients had missing data, resulting in a final sample size of 290. Two hundred thirty-three patients (80%) were classified as having valid neurocognitive performance and 57 (20%) as having invalid neurocognitive performance based on performance across four independent, criterion PVTs (i.e., Test of Malingering Memory Trial 1, Word Choice Test, Dot Counting Test, Medical Symptom Validity Test). Of those with valid neurocognitive performance, 76 (48%) patients were considered as having genuine memory impairment through a memory composite band score (T<37 for (RAVLT Delayed Recall T-score + BVMT-R Delay Recall T-score/2).
Results:The average memory composite band score for valid neurocognitive scores was T = 49.63 as compared to T = 27.57 for genuine memory impairment individuals. Receiver operating characteristic [ROC] curve analyses yielded significant areas under the curve (AUCs=.79-.87) for all four validity indices (p’s < .001). When maintaining acceptable specificity (91%-95%), all validity indices demonstrated acceptable yet varied sensitivities (35%-65%). Among the subgroup with genuine memory impairment, ROC curve analyses yielded significantly lower AUCs (.64-.69) for three validity indices (p’s < .001), except RDS (AUC=.644). At acceptable specificity (88%-93%), they yielded significantly lower sensitivities across indices (19%-39%). In the current sample, RAVLT FC and BVMT-R RD had the largest changes in sensitivities, with 19% and 26% sensitivity/90%-92% specificity at optimal cut-scores of <10 and <2, respectively, for individuals with memory impairment, compared to 65% and 61% sensitivity/94% specificity at optimal cut-scores of <13 and <4, respectively, for those without memory impairment.
Conclusions:Of the four validity scales, memory-based embedded PVTs yielded higher sensitivities while maintaining acceptable specificity compared to non-memory based embedded PVTs. However, they were also susceptible to the greatest declines in sensitivity among the subgroup with genuine memory impairment. As a result, careful consideration should be given to using memory-based embedded PVTs among individuals with clinically significant memory impairment based on other sources of information (e.g., clinical history, behavioral observation).
Pain Influences Neuropsychological Performance Following Electrical Injury: A Cross-Sectional Study
- Katherine E. Dorociak, Jason R. Soble, Patricia A. Rupert, Joseph W. Fink, Raphael C. Lee, Magdalena Anitescu, David Weiss, Gerald Cooke, Zachary J. Resch, Neil H. Pliskin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 18 January 2022, pp. 35-45
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Objective:
Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.
Method:This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; M age = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.
Results:Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.
Conclusions:Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.