Grand Rounds - Oxford Academic

Abstracts

Grand Rounds

DIVERSITY GRAND ROUNDS

Moderator: Marc A. Norman

Discussants: Shelley Peery and Liza San Miguel

DGR1

Expressive Language Disorder, Attention-deficit/Hyperactivity Disorder, and Bilingualism: A Case PresentationEscabi Y, San Miguel L

The evaluation of bilingual children is a complicated endeavor because there are various views of how bilingualism

affects brain organization and functioning. Added to that is the challenge of determining language development of

Hispanic children living in a monolingual Spanish-speaking home in a Spanish-speaking country, but mostly exposed to

English language television programming and, in some cases, English language school curriculum. Our case will review

the evaluation process of a 14-year-old Puerto Rican boy with previous diagnoses of expressive language disorder and

Attention-deficit/Hyperactivity Disorder (ADHD). The neuropsychological evaluation revealed an IQ within the average

range, with significant differences between the perceptual reasoning, verbal comprehension, and processing speed. The

case will summarize performance in verbal, executive, and psycho-educational measures with a thorough review of his

developmental history and the interpretation of these neuropsychological achievement and behavioral measures in light

of other variables influencing his difficulties.

DGR2

Starting From Zero: Competence to Stand Trial in an Oromo (Ethiopian) Man with Unidentified Cognitive

LimitationsJudd T

Objective: Although competence to stand trial is the most common criminal forensic psychological assessment, there is no

significant literature regarding such assessments in non-English speakers in the United States. This case illustrates an

approach when the examiner has no pre-existing knowledge of the evaluee’s language or culture. Method: A 25-year-old

Oromo laborer with 4 years of education was referred for assessment of an unknown cognitive or psychiatric disorder

regarding adjudicative competence following eight previous such assessments. Evaluation techniques included an Internet

search regarding his culture of origin, records review, consultation with his brothers and the interpreter, interview,

limited physical examination, and selected neuropsychological testing. Results: History was congruent with a severe ado-

lescent traumatic brain injury (TBI) and intellectual deficiency due to TBI. The evaluee’s vague history was corroborated

via family, Internet information, interpreter consultation, physical examination, and neuropsychological testing. Cultural and

immigration considerations helped resolve incongruencies. Test of Memory Malingering (TOMM) was normal. Performance

Index on Wechsler Adult Intelligence Scale-4th Edition (WAIS-4) was in the 50s. Formal (Woodcock–Johnson

Achievement-III, Rey Figure) and informal language and drawing testing in English and Oromiffa were congruent with

his history. The Fuld Object Memory Evaluation and 5-Digit Test were congruent with TBI. The Revised Competency

Assessment Interview demonstrated little benefit from competency restoration classes. The judge accepted the report as

resolving previous conflicting results. Conclusions: When data sources are less than satisfactory, seeking congruence

across multiple information sources and types of information can improve confidence in the conclusions, especially

when directed to specific referral questions. Testing can play a critical, although limited, role even in unconventional

circumstances.

Archives of Clinical Neuropsychology 25 (2010): 475–583

# The Author 2010. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

doi:10.1093/arclin/acq056

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ADULT GRAND ROUNDS

Moderator: Richard Naugle

Discussants: Michael Schoenberg and Kevin Duff

AGR1

Attention Deficits Suspected to be Secondary to Postural Orthostatic Tachycardia Syndrome: Two Cases InvolvingSisters

Hertza J, Nicholson J, Schiff W, Bell C, Estes B

Objective: The objective of this study was to explore the possibility of attention and executive system deficits in two sisters

secondary to postural orthostatic tachycardia syndrome (POTS). POTS is a condition of orthostatic intolerance, where move-

ment from sitting to standing yields tachycardia; this can be accompanied by hypotension, although this is not necessary for

diagnosis. POTS may result in, but is not limited to, dizziness, fatigue, syncope, polydipsia, acute hypoperfusion of tissues and

organs with chest pain, disorientation, muscle weakness, tremulousness, and headache, and autonomic dysfunction with gas-

trointestinal problems. Research suggests that a person may experience a decline in cerebral blood flow which can result in

anxiety, depression, word-finding problems, and poor concentration. This case will describe two teenage sisters with POTS

with similar cognitive profiles. Method: Two Caucasian females of 19 and 22 years old were assessed in a hospital setting.

Both women described lifelong difficulties with POTS, syncopal episodes, Ehlers-Danlos Syndrome type III (hyper-reflexia),

headaches, GI symptoms, and cognitive deficits such as difficulty organizing thoughts, sustaining attention, impulsivity, and

slow processing speed. Archival neuropsychological data, de-identified history, physician report, and neuroimaging will be

presented in a case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive

quantitative and qualitative measures. Results: Assessment revealed several areas of mild relative impairment in executive

functioning including complex attention, processing speed, and verbal fluency. Conclusion: The patients presented with atten-

tion and executive system deficits which may be secondary to cerebral hypoperfusion related to POTS.

AGR2

Neuropsychological Assessment in Two Cases of Posterior Cortical Atrophy

Millikin C, Shelton P, Marotta P

Objective: Posterior cortical atrophy (PCA) is a rare focal dementia characterized by progressive impairment of visual/visual–

spatial functioning. Various neuropathological substrates, including Alzheimer’s disease, dementia with Lewy bodies, cortico-

basal degeneration, and prion disease, have been reported. Some patients may have relatively greater involvement of dorsal

(occipito-parietal) pathways involved in the visual control of action or ventral (occipito-temporal) pathways involved in

object identification. Method: Case 1 (a 64-year-old man) had a 2-year history of problems with vision. He did not have pro-

sopagnosia. His SPECT scan showed severe posterior parietal and occipital hypoperfusion. Case 2 (a 75-year-old woman) had

a 3-year history of visual problems, including prosopagnosia. Her SPECT showed bilateral posterior hypoperfusion extending

into the temporal lobes. Results: On neuropsychological assessment, both patients made perceptual errors on the Boston

Naming Test (BNT) short form and had difficulty with reading, writing, and all visual–constructional tasks. Tactile

naming was relatively better, but patients sometimes had difficulty identifying whole objects due to simultanagnosia.

Responsive naming was intact. Compared with Case 2, Case 1 had more difficulty with verbal attention and memory. Case

1 completed the Visual Object and Space Perception Battery (VOSP) and scored in the borderline or impaired range on all

subtests, although space perception was slightly better than object perception. Conclusion: Both patients had marked difficulty

with visual–perceptual ability. Case 2 appeared to have an occipitotemporal syndrome (alexia, visual agnosia, prosopagnosia)

involving disturbance of the ventral pathway. The profile of Case 1 was less clear. More research is needed to link symptom

presentations with underlying neuropathology in PCA and other atypical dementias.

AGR3

Neuropsychological Functioning in a 24-Year-Old Male Status after Multiple Improvised Explosive Device Blasts, One

with Brief Loss of Consciousness, 2 Years Post-Blast with Resolution of Posttraumatic Stress Disorder Symptoms: ACase Study

Wingler I, Barth J

Objective: Blast injuries are the most common cause of war trauma in Iraq and Afghanistan (DVBIC, 2009), but remain a

poorly understood form of Traumatic Brain Injury (Agoston et al., 2009). Military members exposed to blasts have demon-

strated post-concussive symptoms including headache, vertigo, short-term memory problems, and difficulty multitasking or

concentrating (Okie, 2005; Ropper & Gorson, 2007; Ryan & Warden, 2003), as well as increased aggression, impulsivity,

476 2010 Annual Meeting Abstracts / Archives of Clinical Neuropsychology 25 (2010): 475–583

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anxiety, impaired social interactions, and judgment (Agoston et al., 2009). Multiple mild blasts can also be cumulative, causing

long-term effects manifested by memory impairments and abnormal behavior (Taber et al., 2006; Warden, 2006). Whether or

not these symptoms are primarily related to the effects of the blast or posttraumatic stress disorder (PTSD) (Hoge et al., 2008) is

unclear. This case study hopes to expand on the current literature by describing the neuropsychological presentation in a

24-year-old male (M.G.) exposed to 50–60 improvised explosive device (IED) blasts, one involving brief loss of consciousness

(LOC), who also had PTSD that resolved with treatment. Method: M.G. was referred for neuropsychological testing to deter-

mine his current cognitive functioning due to persisting attention and memory problems 2 years post-blast. Neuropsychological

testing revealed mild residual deficits in speeded verbal fluency, sustained attention, speeded word reading, verbal recognition

memory, and left upper extremity motor speed, and weakness in delayed visual retention. Results: Current neuropsychological

testing reveals evidence of residual deficits 2 years post-blast despite cognitive rehabilitation and successful PTSD treatment.

Conclusion: These findings are consistent with other studies that suggest cognitive compromise due to the primary effects of

the blast, which appear to persist despite effective PTSD treatment.

FORENSIC GRAND ROUNDS

Moderator: Robert L. Denney

Discussants: Kyle Boone and James Youngjohn

FGR1

Neuropsychological Consultation in a Competency-To-Stand Trial Evaluation: Use of the Word “Malingering”Parmenter B

Objective: The patient is a 28-year-old, right-handed, Caucasian man admitted to the forensic unit at a large state hospital to

undergo a competency-to-stand trial evaluation. The forensic examiner referred the patient for neuropsychological assessment

because of self-reported attention and memory problems. Medical history is significant for a seizure disorder partially con-

trolled with medication, arachnoid cyst on the brainstem, and migraine headaches. Family medical history is significant for

seizures. Method: Available medical records were reviewed and neuropsychological testing, including symptom validity

testing and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), was administered to evaluate current functioning

and to compare performance to previous results. Results: The patient performed inconsistently on symptom validity measures

and appeared to be exaggerating cognitive and psychiatric symptoms. Conclusions: The patient has a complicated medical

history that could impact cognition. Use of symptom validity testing enabled the neuropsychologist to document magnification

of cognitive deficits. This, coupled with the history and current circumstances of the patient, led her to opine that the patient

was malingering cognitive symptoms. However, because of the medical history, the forensic evaluator was uncomfortable

stating the patient was volitionally exaggerating symptoms and did not use the word “malingering” in his report. After the

court found the patient competent to stand trial, he admitted that he had intentionally tried to appear cognitively impaired

on testing. This case highlights the conflict that can arise between practitioners, or even in an individual practitioner, about

using the word “malingering” in an evaluation.

FGR2

Forensic Neuropsychological Evaluation in Moderate-To-Severe Brain Injury: Failed Symptom Validity Measures in

the Presence of Credible Personality and Behavioral ChangesAndrews G

Objective: Referral for neuropsychological evaluation was made by subject’s attorney following significant traumatic brain

injury (TBI) in a motor vehicle accident. Subject was a 22-year-old, Caucasian male, with no history of prior neurologic, psy-

chiatric, or legal concerns. At the scene, he demonstrated initial (non-sedated) Glascow Coma Scale (GCS) of 4 and bilateral

decerebrate posturing. Neuroimaging revealed multiple intracranial bleeds, contusions, and diffuse edema, with midline shift

requiring right frontal-parietal craniotomy. Significant anger, irritability, interpersonal difficulties, and employment failure

were noted by subject and family. He experienced multiple arrests after rehabilitation. Method: After review of extensive back-

ground documents, a neuropsychological evaluation was completed which consisted of extended clinical interviews with

subject and family members, symptom validity testing, and standard neuropsychological tests. Results: Neuropsychological

data were inconclusive and could not be reliably reported due to inconsistent cognitive effort. Psychological assessment

revealed emotional, behavioral, and interpersonal dysfunction consistent with patient and family reports. Records and inter-

view revealed a change in behavior with increased impulsivity and disinhibition leading to arrest and prison. Conclusions:

Patient did not exert optimal effort on all tasks presented. No conclusions regarding the existence and severity of memory

2010 Annual Meeting Abstracts / Archives of Clinical Neuropsychology 25 (2010): 475–583 477

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and other cognitive problems could be made based on this evaluation, because exaggeration of cognitive problems can occur in

the presence as well as absence of genuine cognitive deficits. However, personality/behavior changes were consistent with

known consequences of TBI, particularly the demonstrable structural brain damage sustained in the accident. Given the

absence of information, to the contrary, it was determined that the patient was experiencing credible and significant psycho-

logical sequelae secondary to this TBI.

PEDIATRIC GRAND ROUNDSModerator: Philip S. Fastenau

Discussants: H. Gerry Taylor and T. Andrew Zabel

PGR1

Atypical Pattern of Cognitive Dysfunction in a Case of Left Temporal/Middle Cranial Fossa Arachnoid Cyst

Riordan P, Lipinski D, Sawyer J, Brewer V

Objective: Arachnoid cyst (AC) often presents as a functionally quiescent neurological anomaly. Most frequently found in

the left temporal/middle cranial fossa (LT/MCF), significant cognitive dysfunction is generally not associated with AC.

When cognitive symptoms are present in LT/MCF AC, existing literature suggests that they are generally associated

with impaired language and verbal functions. The case in question is a pediatric patient with LT/MCF AC displaying

an atypical pattern of neuropsychological impairment not previously described in the literature. Method: Patient is an

8-year-old female with an LT/MCF AC that was imaged clearly on multiple CT scans. She has a history of headache

and has been diagnosed with attention deficit/hyperactivity disorder. Results: In contrast to published reports on LT/

MCF AC, the patient displayed a pattern of prominent deficits in non-verbal functions with generally intact language func-

tions. Specifically, verbal intellectual functioning was stronger than non-verbal intellectual functioning at a statistically sig-

nificant level, and verbal memory was substantially stronger than non-verbal memory. Conclusions: Although a lack of

cognitive findings is relatively common in cases of AC, existing literature regarding LT/MCF AC cases suggests that,

when present, associated cognitive impairments are generally in the areas of language, verbal memory, and other prototy-

pical left temporal functions. This case showed the opposite pattern of dysfunction in spite of unambiguous left hemisphere

pathology. Such findings add an additional layer of complexity to the empirical understanding of the relationship between

AC and cognitive impairment. Additionally, this case continues to raise the question of whether AC may contribute to aty-

pical organization of cerebral function.

PGR2

Below Chance Performance on Symptom Validity Testing (SVT) in an 8-Year-Old Girl after Mild Traumatic Brain

Injury: A Case Highlighting the Importance of Objectively Evaluating Rsponse Bias in ChildrenKirk J, Green C, Kirkwood M

Objective: Limited research has focused on the base rates of suboptimal effort in pediatric populations. However, we recently

found that 17% of children presented to an outpatient concussion clinic with non-credible performance (Kirkwood & Kirk,

2010). The current case helps to illustrate why symptom validity tests (SVTs) should be incorporated routinely into neurop-

sychological batteries with children. Method: An 8-year-old female presented for clinical neuropsychological consultation

after she sustained a concussion 1 month earlier. The injury was not associated with unconsciousness, amnesia, or neuroima-

ging abnormalities. The patient had missed 2 weeks of school and presented with persistent symptoms including difficulty

reading, headaches, memory problems, attention difficulties, and increased irritability. Premorbid history was notable for diag-

noses of bipolar disorder and attention-deficit/hyperactivity disorder (ADHD). The patient was in the second grade and had a

history of school avoidance. No academic concerns had been apparent, and she had not received special education services.

Results: The patient’s objective test performance was generally poor. She never refused to complete tasks, but demonstrated

consistently suboptimal effort, with significantly worse-than-chance performance on the Test of Memory Malingering

(TOMM) (Trial 1 ¼ 8, Trial 2 ¼ 8, retention ¼ 9) and Medical Symptom Validity Test (MSVT) (IR ¼ 15%, DR ¼ 15%,

CNS ¼ 80%, PA ¼ 0%, FR ¼ 5%). The patient’s primary motivation for providing suboptimal effort was judged to be an

attempt to avoid school-related work. Follow-up consideration for special education services was recommended.

Conclusions: The case provides support to previous studies suggesting that the TOMM and Green’s MSVT have value in

detecting suboptimal effort in young children. The case also highlights the importance of incorporating SVTs into pediatric

neuropsychological evaluations, even in clinical cases when external incentives are not readily apparent.


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PGR3

Hashimoto’s Encephalopathy: A Pediatric Case Study with Pre- and Post-Treatment Neuropsychological Testing

Brooks B, Fay T, Barlow K

Hashimoto’s encephalopathy (HE) is a devastating but potentially treatable encephalopathy, which presents with cognitive

deterioration and seizures, and is often associated with elevation of anti-thyroid peroxidase antibodies or thyroid dysfunction.

In the absence of a gold-standard diagnostic test, improvement in cognitive impairment is an important clinical marker of

response to steroid treatment. The purpose of this case study was to demonstrate the utility of repeated neuropsychological

testing in the management of a child with HE. The patient is a 14-year-old female who presented with new-onset temporal

lobe seizures (recorded on video EEG), auditory hallucinations, mood and behavior changes, and cognitive impairment.

Comprehensive medical investigations were normal (including normal neuroimaging), except for elevated anti-thyroid peroxi-

dase antibodies. Premorbid functioning included strong academic achievement. Neuropsychological testing, including a com-

puterized screening battery (CNS Vital Signs), paper-and-pencil tests, and questionnaires, was done before steroid treatment

and at follow-up assessments over 6 months. Testing indicated that there was frank, global cognitive impairment at pre-

treatment (baseline). After 10 weeks of steroid treatment, there was improvement in some cognitive domains (i.e., visual

memory, visual set-switching, and impulse control), as well as improvement in psychological and behavioral functioning.

Gradual tapering of steroid medication began at this time. Assessment at 6 months indicated normal psychological, academic,

and behavioural functioning, as well as average to above-average cognitive abilities (except for a measure of verbal inhibition

and switching). This pediatric case study demonstrates cognitive impairment associated with HE, response to steroid treatment

as measured through cognitive functioning, and a viable methodology for tracking cognition over time.


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Poster Session A

AGING AND DEMENTIA: ALZHEIMER’S DISEASE

A-118FDG-PET Correlates of Semantic (SF) and Letter Fluency (LF) in Patients with Dementia

Chelune G, Duff K, Wang A, Franchow E, Card S, Zamrini E, Foster N

Objective: Both semantic (SF) and letter fluency (LF) deficits are common among patients with dementia. However, patients with

Alzheimer’s dementia (AD) are thought to have differentially greater SF deficits than patients with frontotemporal dementia

(FTD), suggesting that SF and LF may have different neuroanatomic substrates. We examined the relationship between18FDG-PET metabolism and SF and LF in patients seen for differential dementia evaluation. Methods: Ninety-two patients

(age: M ¼ 70.9 + 7.8) with mild-to-moderate dementia (Mini-mental State Examination; MMSE ≤ 18; M ¼ 24.7 + 3.2)

were evaluated for differential diagnosis of AD versus FTD. Mayo-Older-Adult-Normative-Studies’ (MOANS) demographically

corrected SF and LF scores were correlated with 24 regional patterns of 18FDG-PET metabolism. Neurostat warped 18FDG-PET

images to Talairach space, and averaged peak metabolic values within the 24 regions of interest were normalized to pons

and standardized against normal elderly controls. Results: LF showed significant modest correlations (.206–.374) with18FDG-PET in the bilateral mesial and lateral frontal regions, as well as amygdala. In contrast, SF had stronger and anatomically

more widespread 18FDG-PET associations in, predominantly, the left hemisphere. The strongest 18FDG-PET correlates with SF

were in the mesial and lateral left frontal (.419–.395), left lateral temporal (.450), and left anterior cingulate (.442) regions.

Conclusions: LF and SF appear to have differential patterns of 18FDG-PET metabolism in this clinical sample referred for differ-

ential diagnosis of dementia. Whereas LF showed modest bilateral correlates with 18FDG-PET metabolism in the amygdala and

frontal regions, and SF was more strongly associated with metabolism in multiple regions, predominantly in the left hemisphere.

A-218FDG-PET Correlates of Memory in a Sample of Patients with Dementia

Duff K, Chelune G, Wang A, Card S, Franchow E, Zamrini E, Foster N

Objective: As memory deficits are prominent in many dementias and assessment of memory is a core component of neurop-

sychological evaluations, the current study examined the associations between memory test scores and brain metabolism via18FDG-PET. Methods: Ninety-two patients (age: M ¼ 70.7 + 8.4) with mild-to-moderate dementia (Mini-mental State

Examination; MMSE ≤ 18; M ¼ 24.9 + 3.2) were evaluated for differential diagnosis of Alzheimer’s disease versus fronto-

temporal dementia. Regional patterns of 18FDG-PET metabolism were correlated with performance on four immediate and

delayed recall measures (Memory subscale of Dementia Rating Scale (DRS), Wechsler Memory Scale-III (WMS-III)

Logical Memory, Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised). Neurostat warped

FDG-PET images to Talairach space, and averaged peak metabolic values within 22 regions of interest were normalized to

pons and standardized against normal elderly controls. Results: Across delayed recall measures, statistically significant corre-

lations were observed in the following regions: left lateral temporal (.33 to .40), left lateral parietal (.25 to .42), medial parietal

(.23 to .42), left parahippocampal (.32 to .60), and left posterior cingulate (.38 to .47). Smaller correlations were observed

between these regions and immediate recall scores. A screening measure of memory (DRS) generated comparable correlations.

Few significant correlations were observed between memory scores and frontal brain regions. Conclusions: Despite outward

differences in the memory tests examined, they were related to very similar brain regions in this demented sample.

Temporal and parietal regions, especially on the left side, were modestly correlated with performance on tests of immediate

and delayed recall. Frontal region activity was less strongly related to learning and recall of verbal and visual information.

A-3

P50 Auditory Event-Related Potentials Differentiate Mild Alzheimer’s Disease from Healthy Older Controls

Green D, Polikar R, Clark C, Kounios J

Objective: Researchers have inconsistently shown that P50 auditory event-related potentials (ERPs) differentiate mild

Alzheimer’s (AD) patients from older controls. This study aimed to improve methodology by increasing participants and

signal-to-noise ratio to test the hypothesis that AD patients exhibit significantly larger P50 amplitude than controls. Methods:

Participants included 31 community-dwelling AD patients (17 males, 14 females) and 38 controls (20 males, 18 females)

recruited from an outpatient memory clinic. All participants underwent neurological exam; patients met NINCDS-ADRDA


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criteria for probable AD. Groups were not significantly different in gender, age, or education. Using an oddball paradigm, par-

ticipants pressed a button in response to infrequent (p ¼ .2) “target” tones (2000 Hz) but not for frequent “standard” tones

(2000 Hz). Post-stimulus ERPs were computed and averaged across trials. Amplitude at electrode CZ was analyzed, where

P50 amplitude is traditionally strongest. Results: Behaviorally, the controls significantly outperformed the AD group correctly

responding to targets and standard tones. A repeated-measures analysis of variance was not significant for stimulus effects that

varied by group. Independent sample t-tests revealed AD patients have significantly greater P50 amplitude than controls in

response to targets (t(67) ¼ 2.09, p ¼ .004) and standard tones (t(67) ¼ 3.11, p ¼ .003). Conclusions: Larger P50 amplitudes

in mild AD patients likely reflect impaired modulation of auditory cortical responses by fronto-central cortical areas responsible

for inhibition over auditory cortical responsiveness. Given that P50 amplitude differentiated AD patients early in the disease

process from healthy older controls, further research may help develop tests with greater diagnostic sensitivity.

A-4

The Alzheimer’s Questionnaire (AQ): A Pilot Study for a New Informant-Based Dementia Assessment

Malek-Ahmadi M, Kataria R, Belden C, Connor D, Pearson C, Jacobson S, Yaari R, Singh U, Sabbagh M

Objective: The aim of this pilot study was to determine the feasibility and clinical utility of a brief, informant-based screening

questionnaire for Alzheimer’s disease (AD) that can be administered in a busy clinical setting. Methods: The Alzheimer’s

questionnaire (AQ) was administered to 99 patient–informant dyads (20 cognitively normal, 38 mild cognitive impairment

(MCI), 41 AD) in 3 dementia clinics at the patients’ initial assessment. Total score for the AQ (0–26) is based on the sum

of clinical symptom items in which the informant responds as being present. Clinical symptoms which are known to be

highly predictive of the clinical AD diagnosis are given greater weight in the total AQ score. Results: The mean time of admin-

istration of the AQ was 2.6 + 0.6 min. analysis of variance (ANOVA) demonstrated statistically significant differences in AQ

scores between cognitively normal individuals and mild cognitive impairment (MCI) cases (F ¼ 65.40, [df ¼ 1, 39], p ,

.0001). A similar result was found when MCI cases were compared against AD cases (F ¼ 32.32, [df ¼ 1, 57], p , .0001).

ROC curves for MCI cases versus cognitively normal individuals and MCI versus AD cases yielded AUCs of .98 (.91,

1.00) and .85 (.73, .93), respectively. Conclusion: This pilot study indicates that the AQ is a sensitive measure for detecting

cognitive impairment associated with AD and is a short, easily administered tool. The AQ may be helpful to clinicians

who must obtain an accurate, informant-based assessment of possible dementia in a short amount of time.

A-5MRI, Cerebrospinal Fluid, and APOE Correlates of Fine Motor Speed in Mild Cognitive Impairment and Alzheimer’s

Disease

Manning K, Arnold S, Moelter S, Davatzikos C, Clark C, Moberg P, Singer R

Objective: Decline in speeded ability accompanies aging and neurodegenerative processes. However, the biological substrates

of speeded decline are not well understood. The present study investigated the relationship between fine motor speed and bio-

logical markers of neurodegeneration in three groups of older adults across the aging continuum: healthy controls (HC), adults

with mild cognitive impairment (MCI), and adults with Alzheimer’s disease (AD). Method: The study included 109 HC, 66

adults with MCI (30 “pure” amnestic [aMCI] and 36 multiple domain [mdMCI]), and 170 adults with AD. Fine motor speed

was measured with three finger tapping tests: (1) dominant hand only, (2) alternating bimanual, and (3) bimanual synchronous.

A subset of 96 AD/MCI patients and 45 HC completed biological makers of neurodegenration: volumetric MRI of multiple

brain regions, APOE genotyping, and cerebrospinal fluid analysis for amyloid beta 42 and total tau. Results: Controls per-

formed significantly better than the mdMCI and AD groups, but not the aMCI group, on all finger tapping tasks. Multiple

regression analyses controlling for age, handedness, and intracranial volume revealed different relationships between finger

tapping and biomarkers in AD/MCI patients when compared with HC. For example, in AD/MCI, amyloid beta 42, total

tau, and left frontal gray matter volume accounted for 19% of the variance in dominant hand tapping (F(10, 85) ¼ 2.51, p

, .05). There was no relationship between finger tapping tasks and any biomarkers in the HC group. Conclusions:

Neurodegeneration impacts basic psychomotor speed in MCI and AD.

A-6

Cueing Technologies for Assisting Persons with Mild Cognitive Impairment in Instrumental Activity of Daily Living

Completion in an Experimenter-Assisted Smart Apartment EnvironmentSeelye A, Smith A, Schmitter-Edgecombe M

This study examined “smart environment” cueing technologies to provide new intervention strategies for persons with mild

cognitive impairment (MCI). We were interested in whether individuals with MCI would benefit from the delivery of cues


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provided within a smart environment when errors were encountered during completion of instrumental activities of daily

living (IADLs). Participants were 11 community dwelling individuals with MCI and 22 controls recruited through a uni-

versity research project and matched on age, gender, and education. Participants completed eight IADLs within a smart

environment. Using a graded hierarchy, cues were generated for each step needed to complete the IADLs. Cues were pre-

programmed into a computer and delivered when an error in activity completion occured. The hierarchy of cues given

began with a verbal indirect cue followed by a verbal direct cue and then a multimodal cue. t-tests showed that MCI par-

ticipants received more total cues across the eight activities and required more total activity steps be cued than controls (p

, .05). There were no significant differences in the average cue level received across the eight activities between MCI and

control participants. MCI participants required more cues on activities that had more steps and/or were more cognitively

complex. MCI participants showed more errors than controls in IADL completion. Similar to controls, MCI participants

generally responded accurately to the indirect cues which helped orient the participant back to task. Individuals with

MCI might benefit from receiving cues to assist with IADL completion in a smart environment, particularly for activities

that are more cognitively complex.

A-7

Caregiver Burden and Costs Associated with Behavioral Disturbance in Alzheimer’s Disease

Viamonte S, Murman D

Objective: To evaluate how behavioral disturbance (BD) in patients with probable Alzheimer’s disease affects caregiver

burden and costs of care. The selected sample had similar characteristics as patients currently enrolled in clinical trials

investigating pharmacological management of BD. Method: Participants were recruited from nine clinical practices (N ¼

133). The sample was limited (n ¼ 70) to community-dwelling adults aged 60 years or greater with Mini-mental State

Examination (MMSE) scores ranging from 6 to 24 inclusive. Additional variables included: patient gender, marital

status, Cumulative Illness Rating Scale (CIRS), Clinical Dementia Rating (CDR) Scale, Caregiver Burden Scale, and

Neuropsychiatric Inventory (NPI-10). NPI score of 10 was used to create two groups. Results: Analysis of variance

revealed no group differences regarding gender, marital status, CDR score, and MMSE; however, medical burden

(CIRS) was positively associated with BD. Regardless, each of these variables was included in the following multiple

regression analyses. BD significantly predicted caregiver objective burden (b ¼ .407, t(63) ¼ 3.672, p , .001) and

explained a significant proportion of variance (R2 ¼ .319, F(6, 63) ¼ 6.391, p , .001). Similar results were observed

for caregiver subjective burden (b ¼ .382, t(63) ¼ 3.266, p ¼ .002) with R2 ¼ .243, F(6, 63) ¼ 4.693, p ¼ .001. Total

cost, including unpaid caregiver time, was associated with BD (b ¼ .390, t(63) ¼ 3.830, p , .001), with R2 ¼ .425,

F(6, 63) ¼ 9.504, p , .001. Conclusions: BD has a substantial impact on caregiver burden and caregiving costs.

Improved management of BD could provide benefit to the patient and caregiver and reduce the overall financial burden

of Alzheimer disease.

A-8Which Cognitive Factors Predict Functional Decline in Older Adults with Alzheimer’s Disease?

West S, Fonseca F, McCue R, Golden C

Objective: This study examined whether language, executive functioning (EF), attention, or visual–spatial skills could predict

deficits in financial management, medication management, driving, dressing, grooming, and feeding abilities in Alzheimer’s

clients. Methods: Participants were 54 older adults, ranging in age from 65 to 93 (M ¼ 78, SD ¼ 5.20); all identified as

Caucasian. In this group, 57% were female and 82% were right-handed. Language measures included the Boston Naming

Test (BNT). EF measures included the Controlled Oral Word Association test (COWAT) and Trails B; attention measures

included Digit Span (Wechsler Adult Intelligence Scale-Third Edition; WAIS-III), and visual–spatial measures included

the Rey Complex Figure Test (RCFT) copy. Results: Pearson correlations assessed the abilities of cognitive measures to

predict decline in self-care activities. The only measure to yield significant results was the visual–spatial measure. The

RCFT was significantly correlated with financial (r ¼ 2.39, p , .01), medication (r ¼ 2.42, p , .01), driving (r ¼ 2.39,

p , .01), and dressing (r ¼ 2.25, p , .05) abilities. None of the language, EF, or attention measures were significantly corre-

lated to measures of daily functioning. Discussion: Measures of visual–spatial skills appear to be the best predictors of func-

tional decline in individuals in the early stages of Alzheimer’s. Although past research has found EF, attention, and language

measures to predict declines in daily activities, this study only used individuals in the earlier stages of AD, many of whom have

not begun to exhibit deficits in attention, EF, or language. For neuropsychologists attempting to make recommendations for

individuals in the earlier stages of AD, it may be more prudent to consider scores on visual-spatial measures than EF, language,

or attention measures.


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AGING AND DEMENTIA: OTHER

A-9Rey-15 Performance in a Non-Litigating Canadian Geriatric Psychiatry Sample

Cox D, Crowell T

Objective: To examine the performance of the Rey-15 test in a typical Canadian non-litigating geriatric psychiatry sample.

Method: Following approval by the relevant Ethics Boards, chart review was conducted across three hospital-based geriatric

psychiatry clinics in Metro Vancouver. Inpatients and outpatients who had completed the Rey-15 test during typical clinical

cognitive evaluations were identified. Results: Eighty patients were identified. Patients were older adults (x ¼ 77.7 years,

range ¼ 65–92), mostly females (65%), with a secondary education (11.8 years, range ¼ 4–20). Sixty-six patients (82.5%)

completed the Mini-mental State Examination (MMSE) (x ¼ 24.4, range ¼ 15–30). The sample was mixed diagnostically

(Alzheimer’s disease, vascular dementia, fronto-temporal dementia, depression, anxiety, psychosis) and included healthy

patients (no diagnosis). None of the patients was involved in ongoing litigation. Additionally, findings of cognitive impairment

could lead to outcomes considered undesirable by some patients (e.g., loss of driving privileges). Five patients (6.25%)

obtained scores of 15 on the Rey-15 test. Of these, none had a dementia diagnosis. Four had a serious psychiatric diagnosis

and the fifth had no diagnosis. The majority of the sample (57%) scored below a score of 9 on the Rey-15 test. The mean

score on the Rey-15 test was 7.6 (SD ¼ 3.61, range ¼ 0–15). The median score on the Rey-15 test was 6. MMSE score

was not related to Rey-15 performance. Conclusions: In a clinical geriatric psychiatry sample, scores below 9 on the

Rey-15 test are typical and should not be considered to be indicators of poor effort during testing.

A-10Comparison of Older and Younger Adults With and Without HIV on Neuropsychological and Everyday Functioning

Fazeli P, Vance D, Ross L, Ackerman M

Objective: Despite the ability of anti-retroviral viral medications to extend life, those aging with HIV may be more vulnerable

to cognitive and functional deficits. In this study, we examined the cognitive and functional performance of younger (21–49

years) and older (50+ years) adults with and without HIV. Method: Participants (N ¼ 172) were administered a cognitive

battery and the Timed Instrumental Activities of Daily Living test. Analysis of covariance (ANCOVA)s were used to test

the main effects of age and HIV status and the interaction, after controlling for gender and education. Results: For psychomotor

speed, there was a significant effect of age, with those who are younger performing better. For speed of processing, there was a

significant main effect of both HIV status and age for three measures, with those who are older and HIV-positive performing

worse. Another speed of processing measure only yielded HIV status as a main effect, and age emerged as a trend (p ¼ .06).

For the memory and executive functioning domains, no statistically significant differences across groups were detected. In the

Timed Instrumental Activities of Daily Living test, there was an HIV × age interaction, as well as a main effect of HIV status,

with those who are older with HIV performing worse on such everyday tasks (e.g., looking up a phone number). Conclusions:

The results of this study indicate that those with HIV may be at a risk of poorer cognitive performance compared with their

HIV-negative counterparts and this deficit may transfer to performing everyday tasks.

A-11Are We Missing Vascular Cognitive Impairment (VCI)? Retrospective Identification of a Probable VCI Profile in a

Memory Clinic Database

Hill B, Tremont G, Davis J, Westervelt H, Alosco M, O’Connor K, Ahearn D, Pella R

Objective: To determine the percentage of patients meeting criteria for a probable VCI profile in a large clinical database and

whether a vascular etiology was a primary diagnostic consideration. Method: The initial sample was 345 patients (means: age

73, education 14 years, Mini-mental State Examination [MMSE] 26) presenting to a teaching hospital-based interdisciplinary

memory disorders clinic. Of this sample, 20 individuals met criteria for the probable VCI profile proposed by Selnes and

Vinters (2006). Probable VCI criteria were: impaired performance (T , 35) on Grooved Pegboard Test and a measure of

executive functioning (Digit Span, FAS, Animal Naming, Trails B, or Clock Drawing) and intact performance (T . 40) on

Boston Naming Test and Hopkins Verbal Learning Test (HVLT) Recognition Discriminability. The probable VCI group

largely mirrored the initial sample (means: age 74, education 14 years, MMSE 28). Results: Six percent of the clinical database

matched the proposed VCI profile. Record review of the VCI profile sample revealed the following diagnoses: 60% mild cog-

nitive impairment, 15% possible/probable Alzheimer’s disease, 15% vascular dementia, 5% corticobasal degeneration, and 5%

frontotemporal dementia. Vascular risk factors were present in 40% of both the overall and probable VCI groups. Conclusions:

Results suggest that the proposed probable VCI profile occurs at a low base rate in a memory clinic setting and is found in only


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a subset of individuals with vascular risk factors. Still, the comparatively low rate of diagnosis of a primary vascular etiology

demonstrates that VCI may be underappreciated as a clinical entity, possibly due to the relatively recent emergence and con-

tinued evolution of the VCI concept.

A-12Altering Factor Structures of the Repeatable Battery for the Assessment of Neuropsychological Status based on Cortical

or Subcortical Dementing Etiologies

Jain G, Noggle C, Sohi J, Jeetwani A, Thompson J, Barisa M

Objective: The current study investigated which component solution might arise on the Repeatable Battery for the Assessment

of Neuropsychological Status (RBANS) through exploratory factor analysis within populations of patients with cortical or sub-

cortical dementing presentations. Methods: An archival data set was utilized for the current study. Participants were chosen

based on their diagnosis of either a cortical-based (n ¼ 64) or subcortical-based (n ¼ 73) dementia and grouped accordingly.

Exploratory factor analysis was run to determine the solutions for the RBANS. Results: Exploratory factor analysis revealed

discrepancies between dementing etiologies. In regard to cortical-based dementias, analysis revealed only a two-factor sol-

ution. Principal component analysis with promax rotation revealed list learning, story memory, figure copy, coding, semantic

fluency, list recall, list recognition, story recall, figure and recall loaded together on Factor 1, whereas line orientation, picture

naming, and digit span loading together on Factor 2. In comparison, exploratory factor analysis in subcortical-based dementias

corresponded with a three-factor solution with list learning, story memory, semantic fluency, list recall, list recognition, and

story recall loading together on Factor 1; figure copy, line orientation, coding, and figure recall loading together on Factor

2; and, picture naming and digit span loading together on Factor 3. Conclusions: Discrepancies in factor solutions between

presentations may speak to a greater breakdown of a neurocognitive hierarchy in cortical-based presentations as opposed to

subcortical, which leads to aforementioned alterations to the compared component structures. Findings may also suggest a

need for differential approaches to RBANS interpretation in these populations that adheres to the altered component structure.

A-13

Predictability of Outcomes on the Independent Living Scale (ILS) based on Repeatable Battery for the Assessment ofNeuropsychological Status Subtest Performance in a Sample of Patients with Cortical-Based Dementing Disorders

Sohi J, Noggle C, Jeetwani A, Jain S, Thompson J, Barisa M

Objective: The current study investigated the extent to which outcomes on the Independent Living Scales (ILS) appear related

to and/or dependent upon performance measured by Repeatable Battery for the Assessment of Neuropsychological

Status (RBANS) subtests in a sample of patients diagnosed with cortical-based dementing presentations. Method: An archival

data set was used for the current study. Participants included 18 individuals diagnosed with a variety of cortical-based

dementias who were administered both ILS and RBANS as part of a comprehensive neuropsychological evaluation.

RBANS subtest scores and ILS outcome scores were analyzed. Results: Canonical correlation revealed isolated relationships

between ILS domains and individual subtest of the RBANS. Those noted included significant relationships between the

figure copy (r ¼ .566), line orientation (r ¼ .552), and semantic fluency (r ¼ .511) subtests of the RBANS and

ILS-Managing Home & Transportation. An additional significant relationship was noted between ILS-Health & Safety and

line orientation (r ¼ .543). No additional correlations met significance. Conclusions: Results are of importance as they

appear to contrast those findings of Noggle and Colleagues (2008), which demonstrated a stronger and more robust link

between RBANS indices and ILS outcomes. Thus, although current findings demonstrating isolated relationships are interest-

ing, current results are of greater importance in that they suggest that utilization of individual subtests may not be extended to

judgments of capacity, rather, as demonstrated by Noggle et al., a broader interpretation of RBANS indices may be more

reliable.

A-14

Do Frontal Systems Behavior Scale (FrSBe) Scores Differentiate Between Frontotemporal and Alzheimer’s Type

Dementias?Vanderslice-Barr J, Gillen R, Zimmerman E

Objective: Preliminary research (Malloy et al., 2007) suggested that the Frontal Systems Behavior Scale (FrSBe; Grace &

Malloy, 2001) and, in particular, the Disinhibition subscale could differentiate between patients diagnosed with

Alzheimer’s disease (AD) and Frontotemporal dementia (FTD). The current study attempted to replicate this finding by explor-

ing differences between patients with FTD and AD on this instrument. Method: Archival patient data collected as part of an

independent research study in a hospital-based dementia specialty clinic was reviewed. Sixteen FTD and 16 AD patients


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matched for level of cognitive functioning via Mini-Mental State Examination (MMSE) scores were compared on Family

FrSBe (Apathy, Disinhibition, Executive, Total Score) ratings. Results: Independent t-tests were calculated to determine

whether statistically significant differences existed between the FTD and AD patient FrSBe scores. There were no significant

differences (p , .05) between the FTD and AD patient groups on any of the three subscale or total scores either before or after

onset of dementia symptoms. Conclusions: There were no statistically significant differences between subscale and total scores

on the FrSBe between a matched sample of FTD and AD patients. Scores from the FrSBe may not be useful in differentiating

between a diagnosis of FTD or AD. Limitations include the small sample size, and the broad range of dementia severity rep-

resented. A larger sample of patients earlier in the disease process may reveal differences in FrSBe profiles which become

obscure with increasing illness severity.

DEVELOPMENTAL AND PEDIATRIC: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

A-15

Wechsler Adult Intelligence Scale-Third Edition Performances of Adult Attention-deficit/Hyperactivity Disorder andClinical Controls

Holdnack J, Creamer S

To gain a better understanding of the neuropsychological pattern of adult Attention-deficit/Hyperactivity Disorder (ADHD),

the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) performances of individuals presenting for ADHD evalu-

ations were analyzed. Based on clinical observations suggesting better performances on more challenging tests of attention,

we hypothesized that on the Digit Span subtest, the clinical controls would perform better on the Digit Span (DS) forward

subtest, while showing no difference on DS backward. As part of a comprehensive clinical ADHD evaluation conducted at a

University Psychology Clinic, clients were administered the WAIS-III. The scores of 30 individuals who met the Diagnostic

and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for ADHD were compared with 15 individuals who did

not meet diagnostic criteria. Groups were matched on the WAIS-III Verbal Intelligence Quotient (VIQ; M ¼ 110.56), and as

expected the processing speed index (PSI) between the controls (M ¼ 101.29) and ADHD group (M ¼ 92.43) differed at a

level approaching significance (t(41) ¼ 217.99, p ¼ .07). Despite the groups not significantly differing overall on the DS

subtest, the control group performed significantly better on DS forward (t(41) ¼ 22.73, p , .01), whereas both groups

performed similarly on DS backwards (t(41) ¼ .08). No group differences existed on the Letter Number Sequencing

(LNS) or the Arithmetic subtests (t , 2.47). Conclusions: The pattern of data suggests that the ADHD group is able to

perform as well on more challenging measures of attention and working memory (e.g., LNS, DS backwards,

Arithmetic), but may have more difficulty maintaining attention on simpler tasks (DS forward). Future research is

needed to explore this hypothesis.

A-16

Developmental Pattern of Inhibitory Control Deficits in Attention-deficit/Hyperactivity DisorderRice J, Paltin I, Dougherty Ma, Walsh K, West S, Rosenbaum K, Golden C, Copenheaver D, Zand D, Kardel P, Acosta M,

Packer R

Objective: The present study investigated whether children with Attention-deficit/Hyperactivity Disorder (ADHD) show differ-

ent patterns of deficits in inhibitory processes depending on age. Method: Participants were 318 ADHD and control childrens,

divided into five age groups (6–7, 8–9, 10–11, 12–13, and 14–16). Inhibitory processes were measured using Continuous

Performance Test-II (CPT-II), Wisconsin Card Sorting Test (WCST), and Stroop Color-Word. A 2(diagnosis) × 5(age) multi-

variate analysis of variance (MANOVA) and three 2(diagnosis) × 5(age) analysis of variance (ANOVA)s were implemented.

Results: For WCST, there was a main effect for age and diagnosis; the 8–9 group performed significantly better than the 6–7

group. ADHD children made significantly more perseverative errors than the control. For CPT-II, there was a main effect for

age; the 12–13 group performed better than the 10–11 group. ADHD children made significantly more commission errors than

the control. For Stroop, there was a main effect for diagnosis and Age × Diagnosis interaction. Control was significantly higher

than ADHD. For 6–7, controls performed significantly better on WCST and Stroop relative to ADHD. For 8–9, controls per-

formed better on Stroop than ADHD children. For 10–11, normal children performed better on Stroop than ADHD. For 14–16,

controls performed better on the Stroop than ADHD. Conclusions: Based on the results, both ADHD and age influence inhibi-

tory controls, suggesting a developmental pattern of inhibitory processes in children with ADHD, which may account for the

range of symptoms seen in ADHD. Results indicate that children with ADHD have significant deficits in stopping an ongoing

response until approximately age 8 and deficits in interference control through adolescence. Findings emphasize the impor-

tance of understanding the developmental changes in children with ADHD.


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A-17

Gender Differences in Processing Speed in Children with Attention-deficit/Hyperactivity Disorder

Trammell B, Mazur-Mosiewicz A, Dean R

Objectives: Differences in cognitive abilities between males and females have been a topic of interest for decades. Although

overall performance is similar, there have been variations noted in specific cognitive areas between males and females

(Baron-Cohen, 2003; Jarvik, 1975; Jensen, 1998). Processing speed is a narrow-band ability that is affected both by gender

(Camarata & Woodcock, 2006) and ADHD (Shanahan et al., 2006). The purpose of this study is to examine the gender differ-

ences in processing speed in children with ADHD. Furthermore, this study also examines the developmental effects of these

deficits by examining school-aged children and adolescents separately. Method: The school-aged sample consisted of 222

males and 73 females with a mean age of 9.1 years old (SD ¼ 1.6 years), whereas the teenage sample consisted of 172

males and 55 females with a mean age of 14.5 years old (SD ¼ 1.6 years). Both groups were matched based on non-significant

Levene’s test. Results: Results from independent sample t-tests suggest similar results to a previous gender difference study

using normals (Camarata & Woodcock, 2006). These results suggest that there is a significant gender differences in processing

speed among teenagers with ADHD (p ¼ .05). Although the school-aged group found boys performing slower than girls, no

significant results were found (p ¼ .128). Implications: This may suggest that with development, the gap widens between

males and females with ADHD, with females performing faster on visual processing tasks.

DEVELOPMENTAL AND PEDIATRIC: OTHER

A-18

Neuropsychological Evaluation of Symptomatic and Asymptomatic Adrenoleukodystrophy: Case Study ComparisonBarber B, Mucci G, Buchbinder D, Chang R, Wang R

Objective: Adrenoleukodystrophy (ALD) is an X-linked recessive metabolic disorder that results in progressive neurologic

deterioration based on cerebral white matter demylination and adrenal insufficiency. Research on the neuropsychological

impact is sparse, but individuals with childhood-onset ALD can experience progressive impairment of cognition, behavior,

sensory, memory, and motor function (Shapiro et al., 1995). The neuropsychological criteria that signals early neurological

deterioration is defined as decline of 1 SD in either IQ, visual processing or memory, or one domain of neuropsychological

functioning. Methods: Neuropsychological testing was conducted with two 9-year-old males diagnosed with ALD, both

within 3 months time. MRI revealed white matter abnormalities in the occipital and parietal lobes and corpus callosum in

one individual who was treated with a bone marrow transplant. The other was placed on corticosteroids, as MRI revealed

no white matter abnormalities. Results: Comparison of the data indicated that despite disparate neuroimaging results,

testing revealed average language, visuospatial processing, and adaptive skills, with low average Full Scale IQ and little var-

iance between Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI). Although both demonstrated similar

weaknesses in attention and executive functioning, the individual with observed demylination exhibited deficits to a greater

extent in visuomotor integration, visual perception, memory, and emotional regulation. Conclusion: Consistent with past

research of ALD, early signs of disease manifest in attention and executive dysfunction, with progressive disease displaying

more significant visual, memory, and emotional regulation deficits. These results support the importance of neurocognitive

assessment and close monitoring of asymptomatic patients with ALD.

A-19

Rare Parietal Opercular Morphology and Lowered Reading Abilities in Children with Average Intelliegence andDyslexia and/or Attention-deficit/Hyperactivity Disorder

Chakravarti P, Kibby M, Hynd G

Objective: Brain structure has been associated with underlying neural circuitry. The few small studies assessing parietal oper-

cular morphology all found Type II to be relatively rare and associated with dyslexia. Therefore, the goal of our study was to

determine whether Type II is associated with dyslexia in a larger sample. Method: Children, aged 8–12 years, with dyslexia

(n ¼ 27), ADHD (n ¼ 39), both (n ¼ 20), or controls (n ¼ 50) participated in NIH/NICHD funded projects in one of the two

laboratories (R03HD048752, R01HD26890). Neuropsychological testing utilized the Wechsler Intelligence Scale for Children

(WISC) or Wechsler Abbreviated Scale of Intelligence (WASI), Woodcock Johnson Test-III (WJ-III), Test of Non-verbal

Intelligence (TONI), Visual-Motor Integration (VMI), Comprehensive Test of Phonological Processing (CTOPP), and

Children’s Memory Scale (CMS). MRI scans were classified using the Steinmetz system [Type I: the typical morphology;

Type II: absence of the Posterior Ascending Ramus (PAR); Type III: an additional gyrus between the post-central sulcus

(POCS) and the PAR; Type IV: PAR merging with the POCS]. Results: Chi square revealed no group differences in the


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frequency of the typologies. However, Type II occurred in only 6% of the sample. It was found only in the left hemisphere and

only in the clinical groups. Type II had poor word identification (t(15.55) ¼ 2.42, p , .05), word attack (t(72) ¼ 2.04, p ,

.05), passage comprehension (t(71) ¼ 2.37, p , .05), and orthographic choice (t(71) ¼ 3.04, p , .01) compared with Type

I. They also had below-average phonological awareness and learning of rote word lists. Performance on the rest of the measures

was average. Conclusion: Absence of a PAR (Type II) is associated with poor reading abilities despite average intellect in chil-

dren with dyslexia and/or ADHD. Deficits appear limited to phonological awareness, orthographics, and rote verbal learning.

A-20Memory and Attention Constructs in Children with Attention Deficits

Dougherty M, Rice J, Golden C

Objective: The purpose of this study was to ascertain the relationship between measures of memory and attention in children

and adolescents with attention deficits. Method: Participants included 49 children and adolescents with a previous diagnosis of

Attention-deficit/Hyperactivity Disorder (ADHD), including 34 males and 15 females. The sample was primarily Caucasian.

The average age was 8.59 (SD ¼ 2.86) and the average years of education was 2.65 (SD ¼ 2.50). This study compared memory

measures from the Wide Range Assessment of Memory and Learning-2 (WRAML-2) (Picture Memory, Design Memory, Story

Memory, and Verbal Memory, the Screening Memory Index, Working Memory Index, Verbal Memory Index, Visual Memory

Index) with measures of attention. Results: The Continuous Performance Test (CPT) Commission score was correlated with the

Verbal Memory Index (r(34) ¼ 2.281, p ¼ .05), Screening Memory Index (r(22) ¼ 2.349, p ¼ .05), and Working Memory

Index (r(12) ¼ 2.5, p , .05). The correlation between Commission Errors and the Picture Memory subtest on the WRAML-2

yielded r(34) ¼ 2.292 and p , .05. Perseverative Errors were significantly correlated with the Verbal Memory Index

(r(33) ¼ 2.312, p , .05) and the Picture Memory subtest (r(26) ¼ .399, p , .05). Hit rate, omission errors, variability,

and the clinical ADHD percentage were not significantly correlated with any indices or individual subtests on the

WRAML-2. Conclusions: The most significant correlations were found between measures of commission and memory.

Commission errors appear to be more significant in their memory implications in children with known attentional problems.

These results indicate that neuropsychologists should use caution when interpreting low memory indices in children and ado-

lescents with attention deficits as these indices all appear to be impacted by attention.

A-21

A Complicated Case of Hypothalamic Neuropsychiatric SyndromeJones K, Armstrong C

Objective: Hypothalamic injury has well-documented effects on biological drives including hunger, thirst, and circadian

rhythms. However, little is known about the detrimental effects on emotional control and cognitive functioning associated

with this type of injury. Lesions of specific areas of the hypothalamus have been associated with severe behavioral disturbances

because of disrupted connections with frontal regions and amygdaloid structures (Zillmer, Spiers, & Culbertson, 2008).

Method: A 15-year-old boy was diagnosed with a hypothalamic chiasmatic pilocytic astrocytoma at 7 years of age. The

tumor was partially resected and after recurrence, 1 year of chemotherapy was administered. MRI clearly illustrates frontal

craniotomy with an anterior transcallosal approach to resection as well as pre- and post-treatment changes. Tumor remained

stable but psychiatric symptoms (e.g., hallucinations, aggression, impulsivity), narcolepsy with possible psychogenic com-

ponents, and memory problems emerged. Neuropsychological evaluations were completed 6-year and 8-year post-diagnosis.

Results: Neurocognitive impairments were observed in the areas of memory, visual perception, attention, and speed, and infer-

ential processing. Interestingly, narcoleptic/cataplexic incidents were observed during visually complex tasks that were

obviously difficult for the patient during both evaluations. Overall, the patient exhibited general improvements at re-evaluation.

Conclusions: Characteristics of this neuropsychological/psychiatric profile provide insight into the importance of the connec-

tiveness among the hypothalamic region and other associated brain structures such as the frontal cortices and the medial tem-

poral lobe.

A-22Predictive Discriminative Analysis of Diagnostic Factors in Pediatric Attention-deficit/Hyperactivity Disorder and

Pervasive Developmental Disorders

Mazur-Mosiewicz A, Holcomb M, Trammell B, Dean R

Objective: Clinical differentiation between pediatric ADHD and PDD is difficult due to similar symptoms and presentation on

cognitive tests. Both groups struggle academically, experience social communication problems, and display poor impulse

control. This study investigated the most optimal combination of neuropsychological tests using the predictive discriminative


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analysis. Method: The groups included 530 ADHD and 104 PDD patients. Patients were administered the Woodcock Johnson

Tests of Cognitive Abilities-III (WJ-III COG) and the Dean-Woodcock Neuropsychological Battery (DWNB), which is a stan-

dardized measure of sensory and motor functions. Three predictive discriminant analyses (PDAs) were conducted to gain an

estimation of predictive abilities of the sensory-motor tasks, cognitive tasks, and combined sensory-motor and cognitive tasks.

The validation method selected for the analysis was the jackknife technique. The goal was to examine how well the selected

tests predicted the group membership into the ADHD and PDD groups. Results: Cognitive tests correctly determined 49% of

group membership of ADHD and PDD. Sensory-motor tasks correctly classified 77.9% of cases. The combination of cognitive

and sensory-motor tests was able to correctly identify 97.8% of cases. Conclusions: The cognitive subtests poorly determined

group membership of ADHD and PDD. This does not come as a surprise as both clinical groups struggle academically and have

difficulty with information retention and communication. Considering the results of the first analysis, further investigation was

conducted. Results suggest that sensory–motor tasks are more effective than cognitive tests; however, the differential diagnosis

of PDD and ADHD is the most accurate when using the fixed battery of combined sensory–motor and cognitive tests.

A-23Neuropsychological Profile of Prenatal Exposure to Crack-Cocaine and Alcohol: A Case Presentation and a Proposed

Developmental Model for Parent-Friendly Feedback

Puente A, Whigham K

This study documents the expected deleterious effects of combined crack-cocaine and alcohol exposure in utero, presents a

clinical case, and proposes a developmental model for providing neuropsychological feedback. Currently in the extant litera-

ture there are few investigations that have reported the sequelae of crack-cocaine and alcohol together, which is labeled the

“Cocktail profile” in the current study. We present a case study that examines the neuropsychological effects of illicit substance

use in combination with absence of seizures. A statistically unique patient, “Jane” is a young African American female who had

numerous risk factors, but has displayed tremendous resiliency. Her outcome corroborates the theoretical perspective that the

overall intellectual functioning of individuals exposed to crack-cocaine prenatally is potentially mediated by post-birth

environment. Test results indicate that her overall intellectual ability, language, and memory functioning are greater than

expected given her prenatal and developmental history. However, her visual–spatial, executive functioning, and behavioral

and emotional functioning are consistent with the “Cocktail profile.” In addition to the presentation of this unique profile,

we provide a developmental model for ideographic feedback (Dennis, 2001). A superimposed table elucidates Jane’s neurop-

sychological performance relative to the expected profile encompassing the teratogenic effects of prenatal exposure to crack-

cocaine and alcohol. The proposed feedback approach provides an individualized and simplistic method to facilitate the

parents’ understanding of their child’s current functioning in comparison to a clinical disorder. Ultimately, it is hoped that

this proposed technique could foster optimism and hope for families struggling with children who suffer from neuropsycho-

logical dysfunction.

A-24Executive Functioning in Children Versus Adolescents with Major Depressive Disorder

Rodriguez M, West S, Golden C

Objective: Children with Major Depressive Disorder (MDD) have shown a deficit in executive functioning when compared

with normal controls. The purpose of this study was to determine if this deficit diminishes with age. Methods: Scores from

the Digit Span subtests of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Stroop Color-Word test,

Wisconsin Card Sorting Test preservative responses, and the omission and commission variables of Conner’s Continuous

Performance Test (CPT) were examined among 77 MDD and 96 normal participants. Age groups were created from 6–

11 (N ¼ 94, M ¼ 8.06, SD ¼ 1.62) and 12–17 (N ¼ 79, M ¼ 13.71, SD ¼ 1.24). The MDD group consisted of 60%

males, 71% right-handed, and 60% Caucasian participants. The normal group consisted of 67% males, 87% right-handed,

and 61% Caucasian participants. Results: A 2 × 2 factor analysis of variance (ANOVA) design was utilized to determine

diagnostic group differences as well as the interaction between diagnosis and age. The results revealed no significance in the

interaction between age and diagnosis across all variables. Significant differences were found between diagnostic groups in

the 6–11 age group in CPT omission errors (F(1, 30) ¼ 30.23, p ¼ .00) and commission errors (F(1, 30) ¼ 14.77, p ¼ .00).

In the 12–17 age group, significant differences were found in CPT omission errors (F(1, 30) ¼ 10.96, p ¼ .01] and Digit

Span (F(1, 32) ¼ 12.16, p ¼ .00). Conclusions: These results suggest that some executive functioning deficits are present in

children with MDD when compared with controls, although age is not a contributing factor. These results contribute to

limited research on understanding neuropsychological characteristics of MDD children, which can be applied to develop-

ment of effective treatment.


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NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: TRAUMATIC BRAIN INJURY

A-25Relation of Cognitive Impulsivity to Executive Functioning Following Moderate-To-Severe Traumatic Brain Injury

Kelley E, Poole J

Objective: Prior studies have related impulsive behavior to executive dysfunction, but the subjective experience of impulsivity

is less understood. This study examined the relationship between cognitive components of impulsivity and executive skills after

traumatic brain injury (TBI). Method: Eighty-nine veterans with moderate-to-severe TBI, who received acute inpatient reha-

bilitation, were re-assessed at 6-month follow-up. Measures: Barratt Impulsivity Scale (BIS-II), a self-report of impulsivity in

six domains (attention, motor, self-control, perseverance, cognitive complexity, cognitive instability); Wisconsin Card Sort

(WCST), phonemic and semantic verbal fluency, and Stroop inhibition. Results: Five BIS-II subscales correlated significantly

with two of the executive tasks (r ¼ .23–.26, p , .05). Poorer cognitive complexity and perseverance on BIS-II correlated with

WCST perseverative errors and fewer categories completed. Poorer BIS-II cognitive stability and complexity correlated with

lower phonemic fluency, whereas poorer BIS-II self-control correlated with semantic and paraphasic errors during verbal

fluency. Stroop inhibition and BIS-II impulsive attention showed no significant correlations in these analyses. Conclusion:

During recovery from TBI, multiple aspects of self-reported impulsivity are related to objective measures of executive func-

tioning. Subjective experiences of impulsivity are associated with measures of perseveration, linguistic errors, and reduced

cognitive flexibility. These analyses verify that patients who report greater cognitive complexity and perseverance are

better able to organize flexible responses and solve ambiguous problems. Likewise, individuals who experience better

impulse control show better suppression of incorrect responses. Additional studies are needed to identify neuropsychological

correlates of self-reported attention impulsivity. These findings may inform efforts to build insight into impulse regulation

during rehabilitation.

A-26The Comorbidity of Blast Traumatic Brain Injury and Posttraumatic Stress Disorder: A Continuing Obstacle to

Treatment

Larco C

Objective: The purpose of this study is to review the relevant literature on blast TBI (bTBI) and PTSD. It has been found that

95% of blast-injured patients admitted to Walter Reed Army Medical Center had some level of traumatic brain injury (TBI;

Stuhmiller, 2008). Ling, Bandak, Armonda, Grant, and Ecklund (2009) noted that explosive blasts account for more than 60%

of causalities in the wars in Iraq and Afghanistan. In addition, 25% of returning veterans were diagnosed with a minimum of

one psychiatric diagnosis and slightly over half of those were diagnosed with PTSD (Thompson & Gottesman, 2008). Further,

it has been found that 44% and 23% of reported TBI cases with loss of consciousness (LOC) also met criteria for PTSD and

depression, respectively. The numbers for TBI without LOC were 27% and 8%, respectively (Elder & Cristian, 2009). Method:

Review of the literature to explore the mechanisms of action and the biological effects of both pathologies. Additional inves-

tigation of the relationship between bTBI and PTSD, including overlapping and differential symptomatology. Results: PTSD

and TBI have many overlapping symptoms, such as complaints of fatigue, irritability, poor sleep, impaired concentration,

attention, and memory problems. However, a TBI has more organic symptoms, such as headaches, dizziness, visual com-

plaints, hearing loss, balance problems, and cognitive impairment (Elder & Cristian, 2009). Conclusion: Given the high comor-

bidity of bTBI and PTSD, health-care providers are exploring the similarities and differences between these two disorders in

order to provide accurate and effective treatment.

A-27

The Educational Impact of a Depressed Right Frontal Skull FractureMay N, Nemeth D, Olivier T, Whittington L, Hamilton J, Steger A

Objective: A 12-year-old Caucasian male experienced a depressed right frontal skull fracture at age 10, which required neu-

rosurgery. Reportedly, this child with Attention-deficit/Hyperactivity Disorder (ADHD) hit his head on a metal bar while

swinging. Reportedly, he suffered a brief loss of consciousness, could not remember all of the details, and was apparently con-

fused at the scene. A CT brain scan revealed a full-thickness depression of the right frontal skull fracture with the linear portion

of the fracture extending through the roof of the orbit. The decision to operate was based on the neurological status of the

patient, the exact location of the sinus involved, and the degree of venous flow compromise. Method: A neuropsychoeduca-

tional evaluation was conducted to develop a comprehensive intervention plan. Results: Neuropsychological evaluation

revealed significant brain behavior and executive functioning deficits. Psychological evaluation revealed behavioral and


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personality deficits. Academic difficulties were also noted. Conclusions: Shortly after surgery, this child was released to return

to school. The neurosurgeon expected that the surgery would leave the child with no residual effects; however, this was not the

case. Although a relatively good student pre-trauma, upon return to school, the child began experiencing difficulties with learn-

ing, memory, affect and behavior. Five hundred and four accommodations were offered, but IDEA assistance was not. Upon a 1

year neurological follow-up, the child reported having to repeat 5th grade, and continuing to exhibit headaches, nausea, noise

sensitivity, irritability, and frustration. Two years later, this child, now age 12 and in 6th grade, continues to struggle acade-

mically and emotionally.

A-28

Component Analysis of Verbal Fluency in Patients with Traumatic Brain Injury

McDonald K, Jeffay E, Gammada E, Zakzanis K

Objective: The current study examined whether component scores (i.e., switching and clustering) of phonemic and semantic

verbal fluency tests yields greater sensitivity to traumatic brain injury (TBI) than global scores (i.e., number of words gener-

ated). Method: Archival data were gathered from a random sample of personal injury litigants referred for a neuropsychological

examination due to subjective cognitive complaints secondary to TBI. Twenty mild TBI, 8 moderate TBI, and 12 severe TBI

patients along with 95 healthy normal community-dwelling adults were included into the study. Statistical analysis between

groups revealed no significant difference in age, or years of formal education completed between groups. Results:

Comparison of scores from each TBI group to healthy controls revealed larger effect sizes for component scores than for

global scores of verbal fluency. This was most evident in terms of component scores of semantic fluency (e.g., controls vs.

mild TBI: semantic switching d ¼ 1.07, semantic cluster size d ¼ 1.17, semantic global d ¼ .05). Comparison between TBI

severities revealed less robust results but effect sizes generally favoured component scores for both phonemic and semantic

fluency scores. Conclusion(s): Results of the current study illustrate the potential diagnostic utility of component scores of

verbal fluency to be advantageously sensitive to TBI.

A-29

Examining Psychological Distress, Cognitive Ability, and Functional Outcome Following Traumatic Brain InjuryRamanathan D, Wardecker B, Slocomb J, Hillary F

Objective: The consequences of traumatic brain injury (TBI) involve physical disability, emotional disturbances, cognitive

impairments, and behavioral problems (Arango-Lasprilla et al., 2007; Dikmen et al., 1995; Rao et al., 2000; Rassovsky et al.,

2006). Within the literature documenting outcomes following TBI, few studies have examined the relationships between psychia-

tric and cognitive factors on functional outcome (Ponsford et al., 2008). Therefore, the current study aimed to understand the

association between outcomes following TBI and examined if psychological distress and cognitive ability predict functional out-

comes following moderate and severe TBI. Method: Forty-five individuals who had sustained moderate-to-severe TBI were

included in the study. Participants completed a telephone interview and self-report measures on current psychological distress,

cognitive ability, and functional independence levels. Correlational and regression analyses were performed in PASW Statistics

18. Results: Cognitive ability and psychological distress were both significantly correlated with functional outcome. Partial cor-

relations demonstrated that cognitive ability and functional outcomes were significantly correlated when controlling for psycho-

logical distress but that the correlation between psychological distress and functional outcome, when controlling for cognitive

ability, was not significant. A post hoc mediation model was tested using regression and demonstrated that cognitive ability med-

iates the relationship between psychological distress and functional outcomes. Conclusions: The current study elucidated the

associations between outcomes following TBI and demonstrated that cognitive ability mediates the relationship between psycho-

logical distress and functional outcome. These data may have important clinical implications for intervention techniques due to

the results indicating that treatment of psychological distress following TBI could ultimately improve functional outcomes.

A-30

Meta-Analysis of the Neuropsychological Aspects of Mild Traumatic Brain Injury: Time Post-Injury and Cognitive

DomainsRohling M, Demakis G, Larrabee G, Binder L, Ploetz D

Objective: Three meta-analyses (Binder et al., 1997; Frencham et al., 2005; Pertab et al., 2009) have been conducted on the neu-

ropsychological effects of mild traumatic brain injury (TBI). None of these tracked how specific domains of the neuropsycho-

logical functioning recover post-injury. The purpose of this meta-analyses was to re-analyze studies included in prior analyses to

evaluate this issue. Data selection: Studies that compared individuals with mild TBI to controls without TBI were included.

Twenty-eight studies with 48 total samples were included with 2,834 participants with TBI and 2,057 controls. There were no


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demographic differences between groups. Studies were divided into three chronicity or time post-injury groups (e.g., ≤14 days,

15–92 days, and ≥3 months). Seven domains of cognitive functioning were assessed including, for example, processing speed

and perceptual reasoning. Data synthesis: Effect sizes (a negative number indicates that the mild TBI group performed worse than

the control group) across these groups for all neuropsychological domains were as follows: d ¼ 2.37 for ≤14 days, d ¼ 2.20 for

15–92 days, and d ¼ 2.07 for ≥3 months. Most cognitive domains demonstrated similar improvement in functioning, although

visual memory and learning domain had the greatest effect size difference (d ¼ 2.66) at ≤14 days. This diminished to d ¼ .03 at

≥3 months. Conclusions: Mild TBI results in relatively minor neuropsychological deficits immediately after injury, but essen-

tially no deficits after 3 months. The current data support the position that cognitive recovery after mild TBI is expected.

A-31

The Importance of Screening for Post-Concussion Motor SymptomsSchatz P, Smith A

Objective: To evaluate whether the presence of post-concussion motor symptoms affect recovery following sports-related con-

cussion. Methods: Two-hundred and one high school and collegiate athletes who sustained a concussion and endorsed motor

symptoms, balance problems, or dizziness, were compared to 197 high school and collegiate athletes who sustained a concus-

sion and did not endorse motor symptoms. Athletes were tested on ImPACT at both baseline and post-concussion. Results:

Groups showed no significant differences in baseline test scores. Multivariate analysis of variance (MANOVA) revealed multi-

variate effects of symptom group and time, with group × time interactions noted. Athletes endorsing motor symptoms within 1

week post-concussion scored significantly worse on verbal memory, visual memory, and reaction time, and also endorsed more

non-motor symptoms, when compared with athletes not endorsing motor symptoms post-concussion. These effects were not

present 7–10 days post-injury. A smaller sub-group of athletes presented with motor symptoms 7–10 days post-concussion,

and MANOVA revealed that these athletes return to baseline cognitive performance, but continue to endorse significantly more

non-motor symptoms than athletes not presenting with motor symptoms 7–10 days post-concussion. Conclusions: Athletes

presenting with balance problems or dizziness post-concussion score significantly worse than athletes not presenting with

motor symptoms, when compared with baseline. Athletes continuing to endorse motor symptoms over 1 week post-concussion

should be carefully evaluated with balance testing and also be screened for non-motor symptoms.

A-32

Achievement Test Profiles in Children with Traumatic Brain InjuryStolberg P, Thayer N, Mayfield J, Jones W, Allen D

Objective: Traumatic brain injury (TBI) results in heterogeneous patterns of neurocognitive deficits that have been well documen-

ted using tests of intelligence, learning and memory, and attention. Fewer studies have examined the effects of TBI on educational

achievement to determine whether heterogeneity also exists on measures that assess these domains. The current study examined

these issues in children and adolescents who sustained TBI. Method: Participants included 171 youth with TBI between 7 and

20 years of age who were administered the Woodcock–Johnson Test of Achievement Third Edition (WJ-III: Ach) reading,

math, writing, and fluency subtests. Hierarchical cluster analysis (Ward’s method) was run specifying three, four, and five clusters

using WJ-III: Ach subtests as attributes. Stability of the cluster solutions was examined using the K-means iterative partitioning

method. Results: Four clusters were extracted that did not differ on age, gender, ethnicity, or Glasgow Coma Scale scores.

Kappa between Ward’s and K-means methods was highest for the four-cluster solution (k ¼ .83), and Beale’s F-statistic indicated

that it accounted for more variance than the three-cluster solution. Clusters differed on both level and pattern of performance with

one cluster above average, a second average with low fluency scores, a third below average, and a fourth impaired. Discussion:

Results provide some of the first findings on heterogeneity in achievement test performance in children and adolescent with

TBI. Four achievement test profiles were identified that were differentiated by both level and pattern of performance. Results

may be useful in identifying those children who will have academic difficulties following TBI.

A-33

Combat Blast Exposure, Objective Cognitive Functioning, and Subjective Cognitive Complaints Predict EmploymentStatus of Blast-Exposed Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans

Storzbach D, Demadura T, Tun S

Objective: Many OEF/OIF veterans diagnosed with mild traumatic brain injury resulting from blast exposure continue to report

that cognitive problems adversely affect their post-deployment occupational functioning. The objective was to evaluate

whether blast exposure, subjective cognitive complaints, and objective cognitive performance are associated with employment

status in OEF/OIF veterans. Method: Thirty participants were drawn from an ongoing study of neuropsychological functioning


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in blast-exposed OEF/OIF veterans. Backward stepwise logistic regression was used to construct a logistic regression model

with employment status as the dependent variable. The potential independent variables included number of self-reported blast

exposures, subscale scores on the Ruff Neurobehavioral Inventory (RNBI), and measures of memory, attention, spatial, and

executive functioning from the Neuropsychological Assessment Battery (NAB). Results: Independent variables of the resulting

logistic regression model included self-reported blast exposure, RNBI executive functioning, RNBI employment functioning,

and NAB number and letter efficiency. The model classified veterans’ employment versus unemployment status with 96%

overall accuracy. Conclusions: Interim study findings suggest that number of self-reported blast exposures, subjective cognitive

complaints, and objective cognitive performance are significantly associated with blast-exposed veterans’ employment status.

A-34

Differences in Executive Function Profiles in Normal Children and those with Traumatic Brain InjurySutton G, Ringdahl E, Thaler N, Barney S, Mayfield J, Pinegar J, Allen D

Objective: Traumatic brain injury (TBI) results in heterogeneous neurocognitive deficits which vary depending on the nature,

mechanism, and severity of injury. Cluster analysis has been used to examine these deficits, although few studies have made

direct comparisons between clusters identified in TBI and normal control samples to determine whether clusters identified in

TBI differ from what would be expected due to normal variability in test performance among non-brain-injured individuals.

The purpose of this study was to identify homogenous subtypes of executive function impairment in pediatric TBI and to

compare these clusters to those identified in controls. Method: Participants included children who sustained TBI (n ¼ 143)

as well as a normal comparison sample (SS group; n ¼ 143) that were matched on age and sex, and administered the

Comprehensive Trail Making Test (CTMT). Hierarchical cluster analysis (Ward’s method) was used to analyze CTMT

scores for the two groups, with three, four, and five cluster solutions specified. Results: A three-cluster solution fit best for

both the TBI and SS groups. The TBI group exhibited lower performance on all clusters compared with controls. However,

there was little variability based on the pattern of subtest performance across groups. Conclusions: Results indicate that

individuals with TBI are differentiated from normal comparisons on executive functions assessed by the CTMT, although

differences are primarily characterized by the level of performance. The CTMT may therefore be most useful in differentiating

between individuals with and without TBI based on severity of impairment, rather than pattern of specific executive function-

ing deficits.

A-35Construct Validity of the Wechsler Intelligence Scale for Children-Fourth Edition in Pediatric Traumatic Brain Injury

Terranova J, Kazakov D, McMurray J, Mayfield J, Allen D

Objective: Wechsler Intelligence Scale for Children 4th edition (WISC-IV) is commonly used to evaluate intellectual function-

ing following traumatic brain injury (TBI). However, little information is available regarding its construct validity when used

to assess childhood TBI. The current study examined the construct validity of the WISC-IV Indices in children who had sus-

tained moderate-to-severe TBI. Method: Participants included 66 children with TBI (60% males; mean age: 144.46 months;

SD: 35 months) who had subsequently been assessed using the WISC-IV and other tests, including the Woodcock–Johnson

Test of Achievement, Third Edition (WJ-III), the Oral and Written Language Scale (OWLS), the Test of Visual Motor

Integration, the Test of Memory and Learning (TOMAL), the Wisconsin Card Sorting Test (WCST), the Continuous

Performance Test (CPT), Grooved Pegboard (GP), and Grip Strength (GS). Construct validity of the WISC-IV Index scores

was examined by calculating correlations with these other measures. Results: Significant association was present between

the WISC-IV Verbal Comprehension Index and language ability (r ¼ .807); the WISC-IV Perceptual Reasoning Index and

visuomotor integration (r ¼ .59); the Processing Speed Index and broad math skills (r ¼ .73); and the Working Memory

Index and (r ¼ .71), attention/concentration (r ¼ .68), and executive function (r ¼ .40). Discussion: Results of the current

study provide support for the construct validity of the WISC-IV when used to assess children with TBI. Future research

might evaluate other clinical populations to determine whether the results obtained here are generalizable.

A-36Post-Concussion Syndrome 3 months after a Mild Traumatic Brain Injury: Two Methods of Assessing Self-Reported

Symptoms in the Acute Phase

Villemure R, Nolin P, Le Sage N

Objective: To predict post-concussion syndrome (PCS) according to two methods of assessing self-reported symptoms in the

acute phase following mild traumatic brain injury (mTBI). Method: Sample consisted of 354 adults who were contacted by

telephone during the initial week, fourth week, and third month following their mTBI. They had to first report their symptoms


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freely (spontaneous method) and then, according to a standardized checklist (suggested method: Rivermead Post-Concussion

Symptoms Questionnaire; King et al., 1995). Logistic regression analyses were applied in order to predict PCS at 3 months

from symptoms reported in the first and fourth weeks according to both assessment methods, which controlled mTBI diagnostic

criteria. Results: Participants who reported at least three symptoms according to the spontaneous and suggested methods at the

first week post-mTBI had, respectively, twice as many chances (OR ¼ 2.24; 95% CI ¼ 1.21–4.12) and almost six times as

many chances (OR ¼ 5.82; 95% CI ¼ 2.97–11.41) of developing PCS at 3 months than those who presented fewer than

three symptoms. For those who reported at least three symptoms in the fourth week post-mTBI, chances of developing PCS

at 3 months were 3.48 for the spontaneous method and 15.69 for the suggested method. Conclusion: The risk of developing

PCS at 3 months is higher when the participants reported at least three symptoms at first and fourth week post-mTBI, and

the suggested method seems more sensitive at detecting PCS.

A-37

Base Rates of Post-Concussive Symptoms in a Non-Concussed Multi-Cultural Sample

Yeung E, Zakzanis K, Gammada E, Jeffay E

Objective: The purpose of this study was to investigate the base rates of symptomatology that characterizes Post-Concussion

Syndrome (PCS) in healthy individuals parcelled by cultural identity to examine differences. In this study, we sought to deter-

mine if cultural differences exist in terms of base rate endorsement of PCS symptomatology in healthy individuals and whether

culture-specific clusters of PCS symptomatology exist in healthy individuals. Methods: A total of 151 participants, consisting

of 33 Caucasians, 49 Chinese, Filipinos, and Southeast Asians, 43 Arabs, West Asians, and South Asians, and 8 Africans com-

pleted four questionnaires and two subtests of a test of verbal ability. Results: We found that the endorsement of PCS symptoms

did not differ by cultural groups in general, but that there were differences between cultures in the base rates of individual

symptom endorsement. Conclusions: Our findings suggest that cultural background may play a moderate role in PCS sympto-

matology and that false-positive conclusions may be reached disproportionally between cultural groups. Knowledge of such

symptom endorsement in healthy individuals is essential if we are to further understand PCS. Indeed, the practice of clinical

neuropsychology may be exceptionally prone to false-positive conclusions about the presence of PCS where the base rates of

symptom endorsement are high in non-brain-injured individuals.

A-38

Medical Symptom Validity Test Performance Following Moderate-To-Severe Traumatic Brain InjuryYi A, Small S, Macciocchi S, Barlow K, Seel R

This study assesses Medical Symptom Validity Test (MSVT) performance in participants with moderate-to-severe traumatic

brain injury (TBI) and identifies predictors of MSVT performance. Participants hospitalized at a rehabilitation hospital follow-

ing moderate-to-severe TBI (N ¼ 85) were assessed prior to discharge using a battery of neuropsychological tests.

Neuropsychological battery included the following measures: O-Log, Multilingual Aphasia Examination (MAE) Token

Test, Wechsler Memory Scale, Fourth Edition (WMS-IV) Visual Reproduction, Wechsler Adult Intelligence Scale-Third

Edition (WAIS-III) Letter Numbering Sequencing, California Verbal Learning Test, Second Edition (CVLT-2), Booklet

Category Test, Delis-Kaplan Executive Functioning Scales (D-KEFS) Trails, Beck Depression Inventory II, and MSVT.

Decision tree analysis using recursive partitioning was used to examine demographic and neuropsychological test predictors

of MSVT performance. The study sample had a mean age of 30.8, 12.5 years of education, and post-traumatic amnesia (PTA)

of 5.1 weeks. Neuropsychological test performance was uniformly impaired across all measures (Test Battery Mean/T Score ¼

31.5). Mean MSVT Immediate Recall (IR) was 94.5%. Mean MSVT Delayed Recall (DR) was 92.1%. Mean MSVT

Consistency Index (CI) was 90.1%. Neuropsychological test scores did not predict performance on the MSVT. Decision

tree analyses revealed participants who had an O-Log score .23 obtained 90% or greater performance on the MSVT IR.

Participants who had an O-Log score .24 obtained 90% or greater on the MSVT DR. Based on initial analyses, participants

who are fully oriented are able to score .90% correct on the MSVT. Finding intact orientation to be a predictor of MSVT

performance should assist clinicians in making determinations of optimal and suboptimal effort in clinical cases where exam-

inees do not evidence disorientation. Effort assessment and application of findings are discussed.

A-39

Premorbid IQ Estimates and Current Functioning: Discrepancies in a Collegiate Athlete SampleRabinowitz A, Arnett P

Objective: Premorbid IQ estimation is often used as a comparison standard when interpreting neuropsychological (NP) test

results. Word-reading tests such as the Wechsler Test of Adult Reading (WTAR) are objective and valid methods for estimating


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premorbid IQ. The current study aimed to evaluate the WTAR IQ estimate as a predictor of current cognitive functioning in a

sample of non-injured college athletes. Methods: A battery of NP tests, including the WTAR, was administered to 509 non-

injured college athletes. Test scores were converted to standard score (SS) units, using the athletes at baseline as a reference.

Discrepancy scores were calculated by subtracting the SS-converted NP test scores from the WTAR IQ estimate. Results: The

WTAR IQ estimate was significantly discrepant from athletes’ mean NP test performance by an average of 11 SS points (t ¼

64.5, p , .001). IQ estimate was related to WTAR performance discrepancies (r ¼ .42, p,.001): for lower IQ athletes (,98),

the WTAR underestimated NP test performance by an average of 3.3 SS points; for higher IQ athletes (.105), the WTAR

overestimated NP test performance by an average of 5.0 SS points. For all NP tests, the WTAR overestimated NP test perform-

ance for higher-IQ athletes and underestimated NP test performance for lower-IQ athletes. Conclusions: As a comparison stan-

dard for estimating premorbid functioning, the WTAR introduces a systematic bias—overestimating the performance of

higher-IQ individuals and underestimating the performance of lower-IQ individuals. The implications of these findings for

post-concussion management will be discussed.

NEUROPSYCHOLOGICAL DOMAINS: ATTENTION

A-40

Intraindividual Variability in Response Time: Implications for Sustained AttentionRabinowitz A, Barwick F, Arnett P

Objective: Intraindividual variability in response time characterizes attentional performance in healthy individuals, yet

relationships between performance and performance variability remain poorly understood. The present study sought to

examine the relationship between response time (RT) and RT variability in a sample of non-injured college athletes.

Methods: The Vigil Continuous Performance Test (CPT) was administered to 443 college athletes participating in a

sports-concussion program at baseline. The Vigil has four consecutive blocks of 78 stimuli. Structural equation model-

ing was used to examine the time-dependent relationships between the average RT and RT standard deviations (SD) for

the Vigil’s four blocks. Separate models were established for the RT and SD data, and these models were then inte-

grated. Modification indices were consulted, and plausible beta paths were estimated. Results: The final model provided

an excellent fit to the data (x2(14) ¼ 21.92; p ¼ .08). All autoregressive paths for RT and SD were significant. RT and

SD were significantly correlated within each block. Modification indices suggested opening paths from RT1 to RT3 (b ¼

.21; t ¼ 8.65), SD1 to RT2 (b ¼ .33; t ¼ 5.53), and SD1 to RT3 (b ¼ .21; t ¼ 2.91). Mean values for RT and SD

increased over time. Conclusions: These results suggest that speeded attention degrades over the course of a CPT—

evidenced by both slowed RT and increased RT variability. RT variability early in the task predicted slower

responding for later blocks. In athletes at baseline, RT variability serves as an early marker of sustained attention

problems later in a task.

A-41Attention and Executive Functioning in Post-Traumatic Stress Disorder Clients

Bailey T, Brown M, Whiteside D, Waters D

Objective: Individuals diagnosed with post-traumatic stress disorder (PTSD) often report difficulties with attention, concen-

tration, memory, and executive functioning (EF; Briere & Spinazzola, 2005; Leskin & White, 2008). Few studies have demon-

strated these complaints on neuropsychological measures, thus the current research is designed to address this issue. Method:

The current study explores the relationship between PTSD and performance on EF measures utilizing 186 participants diag-

nosed with PTSD, all of who completed an outpatient neuropsychological evaluation. The PTSD (n ¼ 45) group was compared

with a neurological disorder group (ND; n ¼ 80) and anxiety disorder group (ANX; n ¼ 61). Participants were consecutive

referrals for a neuropsychological evaluation who met the diagnostic criteria. The ND group consisted of diagnoses such as

multiple sclerosis and normal pressure hydrocephalus. Results: A significant difference was found between groups on

various measures of attention including the Brief Test of Attention (BTA; F(2, 122) ¼ 4.971, p ¼ .01) and Working

Memory Index (WMI) of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III; F(2, 143) ¼ 7.433, p ¼ .001).

However, no differences were found on the Wisconsin Card Sorting Test (WCST) perseverative responses. Post hoc analysis

indicated that sustained attention in the PTSD group was similar to the ND group, but significantly poorer than the ANX group.

Conclusions: Findings indicate individuals diagnosed with PTSD appeared to have difficulty maintaining attention similar to

individuals diagnosed with a neurological disorder. The results suggest that these attentional problems could adversely affect

their ability to participate in psychotherapy. Implications of this research include the need to develop treatment strategies that

compensate for these attention issues.


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A-42

Evaluating the Effectiveness of Drivers to Perform a Secondary Task While Driving

Golden C

Objective: The purpose of this study was to evaluate how a standard measure of inattention was related to drivers’ ability to

attend to discriminant stimuli while completing a simulated driving task. Method: Participants consisted of 52 adults aged 18–

59 (M ¼ 29.85, SD ¼ 10.84) from a normal population. The sample was 55.8% females, 60.0% Caucasian, and 92.3% right-

handed, with an average education level of 15.88 (SD ¼ 2.46) years. Variables from the Conners Continuous Performance Test,

Second Edition (CPT-II), and STISIM Drivew were used in analyses. Results: Results were considered significant at the p ,

.05 level. CPT-II hit reaction time was positively correlated with STISIM incorrect responses (r(52) ¼ .45) and total mistakes

(r(52) ¼ .33), and negatively correlated with STISIM correct responses (r(52) ¼ 2.33). CPT-II detectability demonstrated a

significant positive linear relationship with STISIM correct responses (r(52) ¼ .31) and significant negative linear relationships

with both STISIM incorrect responses (r(52) ¼ 2.36) and total mistakes (r(52) ¼ 2.31). CPT-II response style was positively

correlated with mean response time (r(52) ¼ .43), incorrect responses (r(52) ¼ .28), missed responses (r(52) ¼ .44), and total

mistakes (r(52) ¼ .47), and negatively correlated with correct responses (r(52) ¼ 2.47). Conclusion: It appears that individ-

uals who took longer to respond and demonstrated a more cautious response style are more likely to demonstrate difficulty

responding to a secondary task while driving. Recommendations are discussed.

A-43Prismatic Adaptation in the Therapy of Spatial and Object Neglect: A Case Study

Grzybkowska A, Wyczesany M

Objective: Many researchers report positive effects of prismatic adaptation in elimination of hemispatial neglect symptoms in

visuo-motor, perceptual, and imagination tasks. The usefulness of this method in rehabilitation of two variants of neglect—

space versus object in perceived and imagined space is determinated. Method: A 71-year-old man, 11 years after right hemi-

sphere stroke, participated in the study. Standard paper–pencil tests (drawing, Ota’s tests) were used in the diagnosis.

Additionally, the computer version of Ota’s tests, which can diagnose spatial and object neglect, was applied. The patient

was asked to compare angles between clock hands of two clocks presented on either the left or the right side of the computer

screen and also had to imagine these clocks. The patient’s performance after the administration of prismatic adaptation was

compared with the initial performance level. Symptoms of neglect were not observed in the traditional paper–pencil tests

but only in the computer-perceptual task (spatial version). The patient showed no signs of spatial neglect in the computer-

imagination task and no signs of object neglect in the perceptual and imagination computer tasks. Results: Symptoms of

space neglect in the perceived space declined after prismatic adaptation. There were also no signs of spatial neglect 1 hr, 1

week, and 1 month after the rehabilitation session. Conclusion: The prismatic adaptation may be an useful method in rehabilita-

tion of spatial neglect. The computer version of Ota’s test seems to be more sensitive in detection of space neglect. More

detailed studies on a group of patients with object and space neglect symptoms are necessary.

A-44

Adults with Attention-deficit/Hyperactivity Disorder Demonstrate an Isolated Impairment in Rotated Memory for

Location on the Brown Location TestKatz L, Brown F, Roth R

Objective: To explore a clinical observation that adults with ADHD seem to have relative difficulty recalling dot locations

when they are rotated from the original presentation on the Brown Location Test (BLT), despite otherwise intact performance

on this test. Method: Fourteen individuals (11 males, 3 females) with ADHD were compared with 14 (10 males, 4 females) age,

IQ, and gender-matched healthy controls from the BLT standardization sample. Participants were adults (M ¼ 23.4, SD ¼ 6.7

years) with mostly higher-than-average intelligence (M ¼ 109.3, SD ¼ 14.23) and had attended some college (M ¼ 13.96,

SD ¼ 2.2 years of education). IQ was estimated with the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) for

clinical participants and the Wechsler Abbreviated Scale of Intelligence (WASI) for controls. The Brown Location Test is a

dot memory test with learning trials, interference, short, long, rotated, and recognition delays with published psychometric

support and clinical validity. Results: On a multivariate analysis of variance (MANOVA), individuals with ADHD had signifi-

cantly (F(1, 26) ¼ 14.37, h2 ¼ .356) lower scores on the BLT rotated long delay (M ¼ 3.71, SE ¼ .68) than healthy controls

(M ¼ 5.96, SE ¼ .68). There were no significant differences on any other BLT subtests. Conclusions: These results suggest that

individuals with ADHD score consistently lower on the rotated delay subtest than controls, despite otherwise intact scores

visual memory scores. This may be the result of paying less attention to environmental than egocentric cues, weakness in

mental rotation, or other difficulties to which this subtest score seems particularly sensitive.


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A-45

Process Training in the Early Rehabilitation of Attention Deficits in Acquired Brain Injury: A Pilot Study

McNeil K

Background: Process training is a rehabilitation treatment that involves the use of repetitive mental exercises believed to help in

the restoration of a cognitive function, presumably through the development of new neural pathways (i.e., neuroplasticity).

There is little and inconsistent evidence to support the effectiveness of process training in the delayed treatment of attention

deficits resulting from acquired brain damage (i.e., stroke or traumatic brain injury; TBI), and no studies have applied process

training early in the rehabilitation process. Method: CogniPlus software was the type of process training used in this pilot study.

CogniPlus uses computerized multimedia interactive simulations of real-life situations. Participants: Three inpatients on the

Rehabilitation Unit of the Saint John Regional Hospital who had suffered either a stroke or TBI approximately 1 month

earlier received 20 sessions of CogniPlus process training 1 hr per day, 5 days a week for 4 weeks (i.e., the “treatment” con-

dition). Three other patients did not receive process training (the “control” condition). All patients in both conditions received

standard in-patient rehabilitation therapies for 4 weeks. Results: All patients’ scores on the Test of Everyday Attention in both

the treatment and control conditions unexpectedly deteriorated over the 1 month period of this study (M scaled difference score

(post–pre) ¼ 21.36) with the treatment patients deteriorating 63% less on average than the control patients. Conclusion:

Attentional abilities in patients with acquired brain damage may continue to deteriorate during their second month post-injury.

However, computerized process training early in the rehabilitation process may reduce this deterioration by as much as 63%.

A-46

Neuropsychological Outcomes from Cerebral Malaria in Malawi

Vroman L, Semrud-Clikeman T, Terrie , Seydel K

Objective: Close to 1 million children die each year in sub-Saharan Africa due to cerebral malaria. Unfortunately, neuroimaging

and neuropsychological research is sorely lacking in this field. The purpose of this study was to examine the research in order to

determine the neuropsychological effects following long-term survival from cerebral malaria. This poster will critically examine

the extant research to determine the sequelae present in these children. Method: A review of the neuropsychological and neuroima-

ging literature from the years 1990 to 2009 was conducted using research studies that assessed individuals with cerebral malaria

resulting in 10 neuropsychological studies and 5 neuroimaging studies. Results: The diagnostic criteria for cerebral malaria were

found to be highly inconsistent across studies. The inclusion of retinopathy and coma are emerging as the gold standard for diag-

nosis of cerebral malaria. In the studies of neuropsychological function, data indicated that cerebral malaria is associated with

cognitive deficits in children and behavioral symptoms present upon recovery strongly resemble Attention-deficit/

Hyperactivity Disorder (ADHD). The studies reported approximately one-quarter of children diagnosed with cerebral malaria

suffer from long-term cognitive, attentional, and working memory deficits as demonstrated at follow-up visits 6 months to 9

years later. The neuroimaging studies consistently identified brain swelling, cortical infarcts, and white matter lesions, particularly

in the splenium of the corpus callosum during and following recovery from cerebral malaria. Conclusion: Neuropsychological and

neuroimaging data suggest that long-term cognitive deficits are common in a significant portion of patients with many of these

presenting with ADHD and executive function deficits. Treatment issues in sub-Saharan Africa will be discussed.

A-47Evaluating the Relationship between a Neurological Measure of Inattention and Driving Performance

Holster J, Corsun-Ascher C, Golden C

Objective: The purpose of this study was to evaluate how a standard measure of inattention was related to driving errors on a simu-

lated driving task. It was predicted that inattention would be positively associated with collisions, tickets, and road deviations.

Method: Participants consisted of 52 adults aged 18–59 (M ¼ 29.85, SD ¼ 10.84) from a normal population. The sample was

55.8% females, 60.0% Caucasian, and 92.3% right-handed, with an average education level of 15.88 (SD ¼ 2.46) years.

Variables from the Conners Continuous Performance Test, Second Edition (CPT-II), and STISIM Drivew were used in analyses.

Results: Results were considered significant at the p , .05 level. STISIM Total Tickets/Violations on the STISM driving program

demonstrated a positive linear relationship with CPT-II Hit Reaction Time Standard Error (r ¼ .46) and Variability (r ¼ .43).

STISIM Total Adverse Events also was positively correlated with CPT-II Hit Reaction Time Standard Error (r ¼ .42) and

Variability (r ¼ .33), and STISIM Total Lane Excursions was positively correlated with CPT-II Omissions (r ¼ .34) and

Variability (r ¼ .28). No significant relationships were found regarding STISIM Total Collisions and CPT-II measures.

Conclusion: The tendency to obtain tickets, incur adverse events, and deviate from road lanes on a driving simulator task

appears to be related to CPT-II measures of inattention and consistency. Measures of inattention were not predictive of accident

risk using the CPT-II. The CPT-II is indicated as being useful in the assessment of driving abilities.


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NEUROPSYCHOLOGICAL DOMAINS: MEMORY AND AMNESIA

A-48Working Memory: A Comparison Study between the Third and Fourth Editions of the Wechsler Tests of Intelligence

and Memory

Holster J, Corsun-Ascher C, Golden C

Objective: It was hypothesized that the working memory measures of the fourth edition Wechsler Memory Scale (WMS) and

Wechsler Adult Intelligence Scale (WAIS) would be less related in the third edition because the Wechsler Adult Intelligence

Scale-Fourth Edition (WAIS-IV) index involves auditory demands, whereas the WAIS-IV index is designed as a visual

measure. Method: Participants consisted of 20 adults with average age 34.20 (SD ¼ 13.87) from a clinically referred popu-

lation. The sample was 65.0% females, 60.0% Caucasian, and had an average education level of 13.38 (SD ¼ 2.06).

Standard scores from the Working Memory Indexes on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III),

WAIS-IV, WMS-III, and WMS-IV were utilized. Results: The Working Memory Index on the WAIS-III demonstrated a

strong positive linear relationship with the Working Memory Index on the WAIS-IV (r(20) ¼ .88). The Working Memory

Index Score on the WMS-III demonstrated a moderate positive correlation with the Visual Working Memory Index on the

WMS-IV (r(20) ¼ .59). A moderate positive linear relationship was noted between the WAIS-III and WMS-III Working

Memory Indices (r(20) ¼ .56), whereas a strong positive correlation was found between the WAIS-IV Working Memory

Index and WMS-IV Visual Working Memory Index (r(20) ¼ .74). Conclusion: The WAIS-IV Working Memory Index is

more highly correlated to the WAIS-IV Visual Working Memory Index than in the third edition of both tests. This was unex-

pected because the WMS-IV Visual Working Memory Index was designed to be more a visual measure of attentional control

and manipulation. The current tests may offer a purer measure of working memory, more independent of modality.

A-49

Predicting General Memory Performance using Various Assessments of DepressionBolanos J, Bergman B, Rodriguez M, Patel F, Frisch D, Golden C

Objective: The purpose of this study was to determine the strongest predictor of general memory using different assessments of

clinical depression. Method: The study utilized samples of varying sizes (N ranged from 99 to 612). Predictor variables

included the individual’s ethnicity, age, level of education, and level of depression via one of the following measurements:

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; Minnesota Multiphasic

Personality Inventory (MMPI) Scales (2, DEP, D1, D2, D3, D4, D5); MCMI-III scales (Depressive Personality, Dysthymic

Disorder, and Major Depression); and a positive Rorschach Depression Index (DEPI). The outcome variable was general

memory as measured by the Wechsler Memory Scale, Third Edition (WMS-III). Results: A series of multiple regression ana-

lyses were used to determine the measure of depression accounting for the greatest proportion of variance in memory function-

ing. With the exception of the Rorschach DEPI, MCMI-III Depressive Personality, and MMPI-2 Content Depression models,

all were significant at the .05 level. The MCMI-III measures of depression appeared to be the strongest predictors, accounting

for the largest, Major Depression (rs2 ¼ .051), and second largest, Dysthymic Disorder (rs2 ¼ .050) proportion of general

memory variance in their respective models. On the other hand, DSM-IV diagnosis (rs2 ¼ .0006) and the Rorschach DEPI

(rs2 ¼ .004) were the weakest and second weakest predictors, respectively. Discussion: Results indicated that the MCMI-III

Clinical Syndrome Scales would be best employed to determine the potential effects of depression on memory impairment

in comparison to similar constructs (e.g., DSM-IV criteria, MMPI-2, or the Rorschach).

A-50

Refining the Clinical Interpretation of Memory Assessment on the Wechsler Memory Scale-Fourth Edition: Base Rates

of Low Age-Adjusted Memory ScoresBrooks B, Holdnack J, Iverson G

Similar to multivariate statistical analyses, increasing the number of test scores being analyzed in clinical practice will increase

Type I errors (false-positives). As a result, there is an increased chance of false-positive diagnoses or clinical inferences of

memory impairment when a battery of tests is interpreted. The purpose of this study is to present the prevalence of low

scores on the Wechsler Memory Scale-Fourth Edition (WMS-IV; Wechsler, 2009) for healthy adults. Participants included

900 healthy adults (16–69 years of age) who were part of the WMS-IV standardization sample. The WMS-IV contains

four tests of learning and memory (Logical Memory, Verbal Paired Associates, Designs, and Visual Reproduction) that

provide eight age-adjusted scaled scores. Base rate analyses involved consideration of these subtest scores simultaneously, stra-

tified by Test of Premorbid Functioning (TOPF)-demographic predicted intelligence and years of education. Considering below


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the 10th percentile as a cutoff (SS ≤ 6), one or more low WMS-IV scores occurs in 90.9% with unusually low, 63.2% with low

average, 44.1% with average, 24.8% with high average, and 18.2% with superior/very superior predicted intelligence. When

stratified by years of education, one or more WMS-IV scores ,10th percentile is found in 70.7% with ≤8, 70.5% with 9–11,

52.9% with 12, 39.1% with 13–15, and 25.9% with 16+ years. Appreciation of the prevalence of low scores is necessary for

reducing false-positive rates. It is important for clinicians to know that some low scores are common on the WMS-IV, particu-

larly in those adults with lesser intelligence or education.

A-51Immediate and Delayed Verbal Recall in Post-Traumatic Stress Disorder Clients

Brown M, Lowry N, Whiteside D, Bailey T

Objective: Neuropsychology research has demonstrated that traumatized individuals have problems with memory functioning

(Van der Kolk, 2006). Specifically, studies have demonstrated an inverse relationship between severity of Post-traumatic Stress

Disorder (PTSD) symptoms and memory functioning (El-Hage, Gaillard, Isingrini, & Belzung, 2006; Jelinek et al., 2006;

Vasterling, Brailey, Constans, & Sutker, 1998). Although several studies have shown negative correlations between specific

subtests of the Wechsler Memory Scale-Third Edition (WMS-III) and PTSD (e.g., Logical Memory; Bremner et al., 1993;

Burriss et al., 2008), few studies have explored both immediate and delayed verbal recall in PTSD clients. Methods: The

current study further explored the relationship between individuals diagnosed with PTSD and auditory immediate memory uti-

lizing 186 participants who were consecutive referrals for outpatient neuropsychological evaluations. One-way analysis of var-

iance (ANOVA) was used to compare groups diagnosed with either PTSD (n ¼ 45), a neurological disorder such as multiple

sclerosis or hydrocephalus (ND; n ¼ 80), or an anxiety disorder not otherwise specified (ANX; n ¼ 61). Results: Statistically

significant differences were found between groups on measures of immediate (F(2, 135) ¼ 3.117; p , .05) and delayed (F(2,

136) ¼ 3.124; p , .05) verbal memory, with medium effect sizes. Post hoc analyses indicated that PTSD clients performed

more similarly to those with ND than with ANX. Conclusion: The results suggested that PTSD clients have difficulties

with encoding and retention of verbal information similar to those with neurological disorders and more severe than individuals

with anxiety disorders. The results indicate evidence that psychotherapy for PTSD needs to address compensatory strategies for

these difficulties to improve effectiveness.

A-52

Correlations between Measures of Intelligence and Attention in AdultsDougherty M, West S, Golden C

Objective: The purpose of this study was to ascertain the relationship between measures of intelligence and attention in adults

with no known psychological or neurological deficits. Method: Participants included 83 adults with no history of psychological

or neurological diagnosis, including 32 males and 51 females. The sample was primarily Caucasians. The average age was

28.10 (SD ¼ 7.18); the average education was 15.95 (SD ¼ 2.25). This study used Pearson correlations between vocabulary,

picture completion, block design, digit symbol, and symbol search from the Wechsler Adult Intelligence Scale-Third Edition

(WAIS-III) and omission errors, commission errors, variability, hit rate, and perseveration scores from the Continuous

Performance Test (CPT). Results: The CPT commission score was significantly correlated with the symbol search subtest

(r(82) ¼ 2.350, p , .01) and the FSIQ (r(82) ¼ 2.309, p , .05). The omission score was significantly correlated with

the picture completion subtest (r(81) ¼ 2.241, p , .05) and the PIQ (r(82) ¼ 2.219, p , .05). Variability was significantly

correlated to the digit symbol subtest (r(81) ¼ 2.268, p , .05). Hit Rate and Perseveration scores were not significantly cor-

related with any indices or individual subtests on the WAIS-III. Conclusions: Omission errors are more strongly correlated with

tasks requiring the identification of a missing part within a timeframe, whereas commission errors are more correlated with

tasks requiring the participant to decide if one of two target shapes is in a group of four shapes. These results indicate that

neuropsychologists should use caution when interpreting low processing speed, PIQ, and FSIQ scores in adults with attention

difficulties as these indices all appear to be impacted by attention.

A-53Myoclonus and Retrieval Deficits Following Anoxic Event

Estes B, Bell C, Hertza J, Dennison A

Objective: The objective of this study is to explore the processing disturbances underlying the anterograde amnesia following an

anoxic event. Anoxia tends to result in anterograde amnesia as the hippocampus and basal ganglia are particularly vulnerable to the

effects of anoxia. Frontal regions can also suffer with a more extensive loss of oxygen. The following study presents the cognitive

profile of one who suffered an anoxic event via choking, including demonstrating the presence of retrieval deficits and


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confabulations despite a relatively intact ability to consolidate new memories. Other noteworthy factors include the presence of

verbal apraxia and myclonus. Method: A 59-year-old female who choked at a restaurant resulting in respiratory failure with anoxia.

She had been high functioning prior to the event. Evaluation procedures included administration, scoring, and interpretation of

comprehensive quantitative and qualitative measures. Results: Neuropsychological testing revealed retrieval deficits with a

high number of intrusive responses along with tendencies to confabulate. Furthermore, the individual experienced myolconic

movements and had verbal apraxia. Memory consolidation appeared relatively intact when considering her performance on

delayed memory measures relative to immediate memory measures. Conclusion: Anoxia may result in anterograde amnesia

through processing and executive disturbances outside the expected disturbances in memory consolidation.

A-54

A Comparison Study on the Wechsler Memory Scale-Third Edition and Wechsler Memory Scale-Fourth EditionVerbal Paired Associates Subtests

Jones K, Holster J, Caorsun-Ascher C, Armstrong C, Golden C

Objective: The purpose of this study was to evaluate how the WMS-III and WMS-IV VPA subtests equate. The item number,

content, and semantic association distinguish the WMS-IV from its predecessor. Method: Participants consisted of 20 adults

aged 19–68 years (M ¼ 34.20, SD ¼ 13.87) from a clinically referred population. The sample was 65.0% females, 60.0%

Caucasian, and had an average education level of M ¼ 13.38 years (SD ¼ 2.06). Scaled scores from the VPA I and II subtests

on the WMS-III and WMS-IV were utilized. Results: Results indicated that categorized scores did not differ significantly from

their hypothesized values for WMS-III VPA I (x2(3, N ¼ 20) ¼ 1.84) and VPA II (x2(3, N ¼ 20) ¼ 3.53), and WMS-IV VPA I

(x2(4, N ¼ 20) ¼ 8.50), and VPA II (x2(3, N ¼ 20) ¼ 4.80, p . .05). A strong positive linear relationship was found between

the WMS-III and WMS-IV VPA I (r(20) ¼ .70) and VPA II (r(20) ¼ .72). Paired sample t-tests indicated no significant differ-

ences between the WMS-III and WMS-IV on VPA I (t(19) ¼ 2.91) and VPA II (t(19) ¼ 21.73, p . .10). Conclusion:

Although the updates made to the VPA subtests on the WMS-IV may appear to alter the memory task, making it more of

an associative process, it appears that individuals can be expected to perform similarly on both the WMS-III and WMS-IV

VPA subtests among a clinical population.

A-55

Intellectual Functioning and Auditory Memory among Homeless Adults at an Outpatient Clinic

Mackelprang J, Karle J, Najmabadi S, Valley-Gray S, Cash R, Gonzalez E

Objective: The aim of this study was to determine whether auditory memory and intelligence in a sample of homeless adults sig-

nificantly differed from those of a normative sample. Method: Participants were 45 homeless, predominantly right-handed (88.9%)

adults, most of whom were 45–54 years old (48.9%). This sample was recruited at an outpatient clinic in Miami, FL. The majority

were men (77.8%) who identified as Black, African American, or Afrocaribbean (57.8%). Fewer participants were White (20%),

Hispanic or Latino (11.1%), or Other (11.1%). Approximately 40% did not complete high school. Auditory memory was measured

by three indices of the Wechsler Memory Scale-Third Edition (WMS-III). A prorated Full Scale IQ (FSIQ) was derived from the

six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult Intelligence Scale-Third Edition

(WAIS-III). Results: Results of a series of one-sample t-tests indicated that this sample differed significantly from the

WMS-III normative sample on Auditory Immediate Memory (t(41) ¼ 26.538, p , .001), Auditory Delayed Memory

(t(42) ¼ 24.496, p , .001), and Auditory Recognition Delayed (t(41) ¼ 26.246, p , .001), with all indices approximately 1

SD below reported norms. The prorated FSIQ of the studied sample was also found to be significantly lower than the mean

FSIQ in the normative sample (t(42) ¼ 6.033, p , .001). Conclusions: As hypothesized, auditory memory and intellectual func-

tioning were significantly impaired in the sample. Demographics as well as physical and psychological conditions will be analyzed

to determine potential correlates for such impairment.

A-56

Gender Differences in Working Memory Tasks which Include Verbal or Visual Material

Metoyer K, Holster J, Golden C

Objective: The purpose of the study was to examine gender differences in working memory involving verbal and visual

material using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) digit span subtest and the Wechsler

Memory Scale-Third Edition (WMS-III) spatial span subtest, respectively. Method: Participants consisted of 576 adults

aged 16–81 (M ¼ 33.12, SD ¼ 13.77) from a normal population. The sample was 50.0% males, 67.3% Caucasian, and

86.6% right-handed, with an average education level of 13.50 (SD ¼ 2.73) years. Results: Results were considered significant

at the p , .05 level. One sample t-tests indicated gender effects on WAIS-III digit span subtest (t(575) ¼ 73.56) and WMS-III


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symbol span subtest (t(575) ¼ 64.35). On average, males (M ¼ 9.58, SD ¼ 2.96) outperformed females (M ¼ 8.98, SD ¼

3.07) on the WAIS-III digit span subtest. Also, males (M ¼ 9.26, SD ¼ 3.43) outperformed females (M ¼ 8.20, SD ¼ 3.52)

on the WMS-III symbol span subtest. Conclusion: The outcome suggests that males perform better than females on

working memory tasks that involve material that is either verbal or visual. These results are consistent with past research

that has shown that males perform better on both visual and verbal tasks of memory. However, recent research has yielded

inconsistent results; females have been demonstrated to perform better on visual working memory tasks and equally with

males on verbal working memory tasks. Further research is recommended.

A-57

Melancholic Depression and Reduced Verbal Learning Ability on the California Verbal Learning Test

Natta L, Gomez R, Trettin L, Tennakoon L, Schatzberg A, Keller J

Objective: Melancholic depression (MCD) is a subtype of major depressive disorder (MDD) characterized by pervasive anhe-

donia. The effect of MDD subtypes on learning is not well understood, but depression subtypes may account for discrepant

neuropsychological findings in the depression literature. This study examined relationships between melancholic and verbal

learning on the California Verbal Learning Test (CVLT). Methods: Performance of MCD (N ¼ 18) and non-MCD (no

MDD subtype; N ¼ 16) participants on the CVLT was examined. Depression subtype was assessed using the SCID.

Participants were recruited at Stanford University Medical Center. Analysis of variance (ANOVA)s were conducted with

depression subtype as the between-subjects factor and CVLT scores as the dependent variables. Results: MCD patients

showed reduced recall on total word learning, short- and long-cued recall, and short- and long-free recall (all p , .05).

MCD showed deficits in the number of words learned per trial (learning slope F(1, 30) ¼ 4.74, p , .04). There was a

trend for poorer recognition (p ¼ .08), but no difference in retention or clustering strategies between the groups.

Conclusions: MCD participants remembered fewer words overall and had reduced new learning across trials. However, learn-

ing strategies, retention, and number of words recall at first presentation did not differ between groups. These results indicate

that MCD may be associated with a reduced sustained motivation/effort during the CVLT. If accurate, this may be important in

a therapy context, with effort and motivation need to be continually monitored. Furthermore, these findings suggest that

depression subtype may play a key role in understanding the sometimes inconsistent neuropsychological deficits in depression.

PROFESSIONAL ISSUES: EFFORT AND MOTIVATION

A-58

Item Difficulty-Based Effort Measures on the North American Adult Reading Test

Davis J, Sherer C, Wall J, Ramos C, Patterson C, Shaneyfelt K

Objective: This study examined embedded effort measures based on the North American Adult Reading Test (NAART).

Method: Data were collected as part of a post-test only experimental study conducted at a Midwestern University during

2007. Ninety-nine undergraduates without reported neurological injury were randomized to control (n ¼ 31), naıve simulator

(n ¼ 34), and coached simulator (n ¼ 34) groups. The sample was 86% females, 86% Caucasian, and 92% right-handed.

Average age was 21 years, and average education was 13. Instructions varied by group. Outcome measures included the

NAART and Word Memory Test (WMT). Accuracy of embedded effort measures based on low difficulty items

(NAART-E1 and NAART-E2) and low–high difficulty difference (NAART-D) were examined in comparison to the WMT.

Results: Groups were not different in terms of NAART total errors (p ¼ .093) nor in performance on more difficult

NAART items (p ¼ .453). Performance on easier items, however, was significantly different (p ¼ .016), and simulators

who failed the WMT made more NAART errors than control participants (p ¼ .011). The WMT correctly classified 100%

of control participants and 71% of simulators. NAART-E1 correctly classified 94% of control participants and 21%–29%

of simulators. NAART-E2 correctly classified 94% of control participants and 27%–32% of simulators. NAART-D correctly

classified 97% of control participants and 9%–12% of simulators. Conclusions: Embedded indices using low difficulty

NAART items showed promise as effort measures. NAART-D was less sensitive. Cross-validation of these measures in a clini-

cal sample may be beneficial. It may also be useful to examine these measures across a wider range of educational level.

A-59

Successful Malingering: What, Where, And WhyDenBoer J, Hall S

Malingering is the “intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by

external incentives . . .” (DSM-IV TR, APA, 2000). This poster will review the neuropsychological profiles of successful brain


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injury simulators (SBIS) on three popular symptom validity tests (SVTs): The Test of Memory Malingering (TOMM), Word

Memory Test (WMT), and Computerized Assessment of Response Bias (CARB). Study 1 examined the ability of simulated

malingerers to effectively escape detection against the most frequently used SVT, the Test of Memory Malingering (TOMM).

Study 2 examined the ability of simluated malingerers to effectively escape detection against all three frequently used SVTs,

the TOMM, WMT, and CARB. Successful brain injury simulators were coached (n ¼ 22; 76%) or uncoached participants who

performed at or above specified TOMM cutoff levels for adequate effort (Trial 2 ≥ 45). Using Tombaugh’s criteria, 32% of

malingerers were misclassified as controls. SBISs scored significantly better than unsuccessful simulators on all standard neu-

ropsychological measures, although notably they suppressed their scores relative to controls on the WCST. In Study 2, SBIS

was observed on all three SVTs. Successful simulation occurred whether these measures were used alone or in combination

with one another. Successful brain injury simulation has serious clinical implications for the validity and future role of neu-

ropsychological assessment. The results from the current studies emphasize the challenging nature of malingering detection

and emphasize the use of multiple malingering detection measures.

A-60The Incremental Utility of a Novel Test of Memory Malingering Consistency Index in Assessing Effort among Litigants

Gunner J, Miele A, Lynch J, McCaffrey R

Objective: A subset of examinees who pass the Test of Memory Malingering (TOMM) fail the Word Memory Test (WMT).

This study examined response consistency patterns on the TOMM as a novel consistency index (CI). Method: An archival of

analysis was conducted on 56 forensic files. Responses were coded to determine whether examinees responded incorrectly con-

sistent, inconsistently, or correctly consistent for each of the 50 items across Trial 1, Trial 2, and the Retention Trial. These

patterns were examined to assess any differences in the consistency of responses between examinees who passed both the

TOMM and the WMT compared with examinees who failed the WMT but passed the TOMM. The frequency of either incor-

rectly or correctly consistent responses and inconsistent responses (one or two inconsistent responses) for each examinee within

the two groups was examined. A cutoff score of 10 inconsistent responses was selected as the CI for insufficient effort. No

examinees who passed both the TOMM and the WMT had .10 inconsistent responses; 9 of the 16 (56%) examinees who

passed the TOMM but failed the WMT had .10 inconsistent responses. This index was then used to compare examinees’

performance on the Global Memory Index of the Memory Assessment Scale (GMI). Results: Examinees whose CI was

,10 performed significantly better on the GMI compared with those with CI .10. Conclusions: The TOMM CI provided

a substantial degree of incremental utility to the three traditional TOMM Index scores in identifying insufficient effort as

well as poorer GMI scores in a group of brain-injured litigants.

A-61Stroop Color-Word Test as a Symptom Validity Test for Processing Speed: Sensitivity and Specificity

Lo T, Cottingham M, Aretsen T, Boone K, Goldberg H

Objective: A number of embedded symptom validity tests are derived from existing neuropsychological tests. Previous

studies investigating the use of the Stroop Color-Word Test as a measure of response bias have either used simulators (and

thus the results may not generalize to “real world” contexts) or failed to identify cutoffs associated with adequate specificity

(.90%). Method: We examined sensitivity and specificity values for each condition of the Comalli Stroop Test in an archival

sample comprised 80 non-credible (i.e., motive to feign, failure on .2 unrelated measures of cognitive response bias, and

clinician deemed non-credible), and 176 credible (i.e., no motive to feign, ,2 failures on unrelated effort indicators,

FSIQ .70, no dementia, and no documented verbal learning disability) participants. Results: When selecting cutoffs with

.90% specificity, the sensitivity rate for a cutoff of 63 s for Stroop A (word reading) was 64%, for a cut-off of 87 s for

Stroop B (color naming) was 61%, and for a cutoff of 166 s for Stroop C (color interference) was 42%. Conclusion:

Results suggest that the Comalli Stroop, particularly word reading and color naming, shows good sensitivity as a measure

of response bias.

A-62The Significance of the Test of Memory Malingering Retention Trial among Litigants: Is it Really Optional?

Miele A, Gunner J, Lynch J, McCaffrey R

Objective: The Test of Memory Malingering (TOMM) is a frequently administered freestanding symptom validity measure.

Given a failure on Trial 2 (a score less than 45 correct responses), the examiner has the option of administering a retention

trial. According to the manual, “malingerers” typically perform lower on the retention trial than on Trial 2, but this is rare

(p18). Greve and Bianchini (2006) reported that 3% of their litigating sample would have been incorrectly classified


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without administration of the retention trial. To the best of our knowledge, this finding has not been replicated in a similar

sample. Method: An archival analysis was conducted on 164 examinees referred for neuropsychological testing due to litigat-

ing reasons. We used scores on the three TOMM trials to identify individuals who failed the retention trial but passed either

Trial 1 or Trial 2. Results: In our sample, 51 out of 164 examinees (approximately 31%) failed the retention trial. Of these 51

examinees, only 2 passed either Trial 1 or Trial 2 (approximately 4%). These two examinees passed Trial 2. Conclusion:

According to the TOMM manual, administration of the retention trial is optional given a pass on Trial 2. Consistent with

Greve and Bianchini (2006), our results indicate that while infrequent, examinees passing Trial 2 may fail the retention

trial. Not administering this trial may therefore result in inaccurate evaluation of effort due to the presence of false-negatives.

Clinicians should exercise caution in choosing to discontinue the test after administration of Trial 2, especially in forensic

evaluations.

A-63

Sensitivity, Specificity, Positive Predictive Power, and Negative Predictive Power of 15 Embedded Symptom Validity

Measures among Litigants: Caution, Dangerous Curve Ahead!Miele A, Benigno A, Gunner J, Leigh K, Lynch J, Drexler M, McCaffrey R, Weiss E

Objective: Effort assessment is critical for accurate evaluation of neuropsychological test performance. Given recent concerns

of test security surrounding well-established freestanding symptom validity tests (SVTs), there is currently much interest in the

clinical utility of “embedded” symptom validity indices to supplement or perhaps even replace standard instruments of effort

assessment. Method: An archival analysis was carried out on 55 examinees referred for neuropsychological testing for litigat-

ing reasons. Using four well-known and frequently administered freestanding symptom validity measures as criteria (the Word

Memory Test, the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Rey-15 Item Test), we calculated

sensitivity and specificity as well as positive and negative predictive power for 15 embedded measures. Results: Sensitivity,

specificity, positive predictive power, and negative predictive power varied considerably depending on which of the freestand-

ing SVTs was selected as a criterion. Four embedded measures (Digit Span RDS, Category Test Total Errors on Subtest 7,

Errors on Tactile Finger Recognition, and Errors on Finger Tip Number Writing) had the highest sensitivity and specificity.

These four embedded measures also showed similar ranges of positive and negative predictive power. Conclusions: Some

embedded measures do appear to consistently predict insufficient effort better than others. The sensitivity of the embedded

measures examined in this study tended to be low. Clinicians are cautioned regarding the use of embedded symptom validity

tests to assess effort either alone or in combination.

A-64

You Can’t Hide Your Lyin’ Eyes: Eye-Tracking Measures and FeigningPloetz D, Rohling M, Lankey M, Womble M

Objective: The goal of the study was to determine if eye movements might aid in the causal determination of cognitive impair-

ment versus feigning while taking the Word Memory Test (WMT; Green, 2003). Method: Participants were 30 undergraduates

who received course credit for volunteering. We used a within-subjects design (i.e., counter-balanced feigned vs. genuine con-

ditions). Participants wore an EyeLink II head piece to record eye movements. The WMT was administered via computer as

described in the user manual. In the feigned condition, participants were given a scenario in which they were asked to pretend

that they were in a law suit after a car accident. They were to “trick” the examiner into believing they were memory-impaired.

Results: The number of saccades and fixations were less for the genuine compared with the feigned condition (p ¼ .0002 and

.0003, respectively). Time duration per word set was significantly less (p , .0001) for the genuine condition. Fixation duration

was significantly longer in the feigned condition (p ¼ .0024). With eye measurements alone, participants’ performance was

correctly classified at 76% (sense. ¼ .80, spec. ¼ .81, PPV ¼ .69, NPV ¼ .83). Conclusion: Eye movements during perform-

ance on the WMT significantly predicted feigned versus genuine performance. Future eye tracking research involving partici-

pants in real-world conditions with documented disorders, such as TBI or PTSD, may help to ascertain if patients’ are

performing to the best of their ability.

A-65

The Word Memory Test is Resilient to Functionally Disabling Amnesia in Acquired Brain Injury

Yeung S, Silverberg N

Objective: Concerns persist that neuropsychological symptom validity tests such as the Word Memory Test (WMT) may

mistake genuine memory impairment for insufficient effort. We investigated the WMT’s resiliency to profound amnesia.

Method: The WMT was administered to a consecutive cohort at a rehabilitation center (n ¼ 55), using a discontinue rule


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derived from Bauer et al. (2007). Of those with no independent evidence of insufficient effort (n ¼ 47), three patients (aged

25–44) presented with (a) objectively documented brain injury (hypoglycemic coma, anoxia, severe traumatic brain injury),

(b) profound anterograde amnesia established through rehabilitation team/family observations, (c) inability to work or live

independently primarily due to amnesia, and (d) no external incentive to malinger. The remaining sample (n ¼ 44) was

used as a clinical control group (68% traumatic brain injury, 18% stroke, 14% other). Results: The amnestic patients performed

worse than the clinical control group on the WMT Immediate Recognition trial (z-scores , 23.5) and at/near floor levels on

other standardized memory tests, confirming their amnesia severity. Although one amnestic patient scored below the rec-

ommended cutoff for insufficient effort on the WMT, all three scored more than 30 points higher (M ¼ 54 + 1.1) on the

easy versus hard subtests, consistent with the WMT “dementia profile.” Thus, profound amnesia lowered WMT performance,

but was not associated with a profile, suggesting insufficient effort. Conclusion: Even patients with profound and functionally

disabling amnesia can produce valid WMT profiles. This small case series uniquely adds to the evidence base for the WMT’s

resiliency to genuine memory impairment.

A-66The Contributory Role of Pre-Injury Income on Cognitive and Psychological Feigning Following Traumatic

BrainInjury

Zakzanis K, Amirthavasagam S, Jeffay E, Gammada E, Yeung E, McDonald K

Objective: We set out to determine if pre-injury average hourly wage in patients with traumatic brain injury (TBI) would

predict feigning in litigating individuals. Method: Archival data were obtained from a random sample of personal injury litigat-

ing examinees referred for a neuropsychological examination. We examined test scores of feigning (n ¼ 62) and non-feigning

(n ¼ 37) litigants matched in terms of TBI severity. Both groups were administered the Rey 15-Item Test (Rey-15), Test of

Memory Malingering (TOMM), and Personality Assessment Inventory (PAI). Results: Pre-injury average hourly wage of

both feigning and non-feigning litigants was found to differ between groups and correlate with scores on the TOMM Trial

1, TOMM Trial 2, Rey-15, and the negative impression management scale of the PAI. Furthermore, feigning and non-feigning

litigants were found to differ significantly with respect to years of education. Conclusions: Our findings should alert the practi-

cing neuropsychologist that the probability of malingering may be greater in the instance of a low pre-injury salary in litigating

patients. Additional research regarding pre-injury income and symptom validity and personality test scores should be under-

taken to better understand the relationship.

PROFESSIONAL ISSUES: FORENSIC PRACTICE

A-67Suboptimal Motivation and Psychopathology Profiles in Neuropsychological Evaluations

Constantinou M, DenBoer J, Hall S

Objective: The detection, or suspicion, of suboptimal motivation in children could be based on an erratic and unexplained per-

formance during testing, performance on motivation assessments, behavioral observations, knowledge of past history, etc.

Constantinou (2010) found that conduct disorder, oppositional defiant disorder, and children diagnosed with

Attention-deficit/Hyperactivity Disorder (ADHD) were more likely to be suspected of lowered motivation and score low on

motivation assessments. Method: The current study expanded to include larger samples and more diverse diagnoses.

Children were matched and divided into diagnostic categories, with 40 children (aged between 6 and 8) in each diagnostic

category (conduct disorder, oppositional defiant disorder, learning disorders, ADHD, pervasive developmental disorders,

anxiety disorders, and mood disorders). Results: Data from regression analyses and discriminant analysis revealed that only

children diagnosed with conduct disorder, oppositional defiant disorder, and mixed type or primarily hyperactive ADHD

were more likely to present with suboptimal motivation. A combination of these diagnoses increased this likelihood of sub-

optimal motivation twofold. Conclusion: Certain childhood psychopathology increases the likelihood of suboptimal motiv-

ation. Such findings could help clinicians become more precise in the detection of childhood suboptimal motivation during

neuropsychological assessments.


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Poster Session B

DEVELOPMENT AND PEDIATRIC: LEARNING DISABILITY

B-1An Investigation of Memory Functioning as a Source of Comorbidity between Attention-deficit/Hyperactivity Disorder

and Developmental Dyslexia

Lee S, Klaver J, Kibby M

Objective: Limited research has examined long-term memory functioning in ADHD subtypes when compared with developmental

dyslexia and controls. Thus, the aim of our study was to assess memory functioning in children with ADHD-PI (n ¼ 28), ADHD-C

(n ¼ 21), dyslexia (n ¼ 36), and comorbid dyslexia/ADHD (n ¼ 18) in relation to controls (n ¼ 47). Method: Participants included

150 children as noted above, aged 8–12 years. They performed several measures as part of a university-based, NIH/NICHD-funded

project (R03 HD048752), including the Children’s Memory Scale (Dot Locations, Stories, Word Lists, Numbers, Sequences, and

Picture Locations). The groups were equated on Test of Nonverbal Intelligence-Third Edition (TONI-3) IQ, age, race/ethnicity, and

gender. Results: A multivariate analysis of variance (MANOVA) for the working memory measures revealed children with dyslexia

performed worse than controls on Sequences (F(4, 136) ¼ 11.51, p , .001), Numbers Forward (F(4, 136) ¼ 3.20, p , .05), and

Picture Locations (F(4, 136)¼ 2.68, p , .05). A MANOVA for immediate memory measures revealed differences on Word Lists

(F(4, 144)¼ 7.18, p , .001) and Dot Locations (F(4, 144) ¼ 2.61, p , .05) but not Stories (F(4, 144) ¼ 1.24, ns). Specifically,

controls performed better than ADHD-C, dyslexia, and dyslexia/ADHD on Word Lists. Both ADHD groups tended to perform

worse than controls on Dot Locations (p , .10). Moreover, after combining the two ADHD groups, this difference was significant

(p ¼ .01). Similar results were found on the delayed recall trials for these measures. Further analysis using repeated-measures

MANOVA revealed that delayed recall was not substantially worse than immediate recall in ADHD or dyslexia, indicating that

reduced memory performance was due to poor encoding of the material. Conclusions: Deficits in selective reminding were

found across clinical groups, suggesting a potential source of comorbidity between dyslexia and ADHD.

B-2The Double Deficit Hypothesis in Reading Disabled College Students

Stern S, Morris M, Morris R

The double deficit hypothesis (Wolf & Bowers, 1999) proposes that four subgroups may emerge in a reading disabled (RD) group

based on linguistic profiles: phonological awareness (PA) deficit only, visual naming speed (VNS) deficit only, double deficit (DD),

or no deficit (ND). These subgroups show different patterns of performance on reading achievement measures. The current study

investigates the performance of these RD subgroups on other academic achievement (AA) and neuropsychological (NP) measures.

Two hundred and twenty-six college students, who met regression-based discrepancy and/or low achievement criteria for RD, were

selected from a larger sample of students evaluated for academic difficulties. Measures of PA, VNS, math and spelling achievement,

and neuropsychological function were collected as part of a larger assessment battery. Subgroups based on performance on PA and

VNS tasks were identified and compared on AA and NP tasks using multivariate analysis of covariance (MANCOVA). Significant

univariate differences were observed on all AA measures (p , .05), however post hoc pairwise comparisons were not significant for

a math fluency measure. Significant univariate differences were also observed on verbal (p , .001), visuospatial (p , .001), and

processing speed and motor measures (p , .001). Results suggest that PA and VNS deficits are associated with different AA and NP

profiles. Patterns of linguistic ability affect the profiles of AA and NP performance that characterize adults with RD. These findings

have implications for evaluations and academic accommodations in a university setting.

B-3Neuropsychological Characteristics of Asperger’s Disorder

Whittington L, Nemeth D, Olivier T, May N, Hamilton J, Steger A

Objective: According to Stewart (2002), Asperger’s disorder (AD) is characterized “by normal or accelerated language devel-

opment in infancy and childhood and a desire to form relationships,” yet AD individuals often fail in their attempts to socialize.

AD children usually have areas of special interest that often develop into obsessions; they also show a great degree of social

ineptitude (Stewart, 2002). Case histories will show how AD neuropsychological characteristics change throughout develop-

ment and how appropriate interventions can significantly improve adaptive abilities. Method: Comprehensive neuro/psychoe-

ducational evaluations of three children, two adolescents, and two adults consisted of an assessment of intellectual,


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educational, attentional, executive and behavioral, affective, and personality functioning. Results: Results from these compre-

hensive neuro/psychoeducational evaluations revealed attentional, learning, and adaptive problems in all AD examinees.

Conclusions: These case histories demonstrate the importance of early evaluation and intervention. As time passes, without

an appropriate understanding of children’s weaknesses, learning and adaptive abilities can become increasingly problematic

and can result in the emergence of significant emotional, social, and behavioral problems.


B-4

Executive and Non-Executive Factors and their Correlates with Intelligence in Children with Attention-deficit

Hyperactivity DisorderChan R, West S, Golden C

Objective: Research shows that individuals with Attention-deficit/Hyperactivity Disorder (ADHD) have impairment in general

intelligence and executive functioning. This study examined the associations between the two. In particular, executive factors

(EFs) assessed were inhibition, working memory, and sustained attention, whereas non-executive factors (non-EFs) assessed

were short-term memory and processing speed. Methods: Participants were 294 children, aged 4–17 (M ¼ 9.08, SD ¼ 2.83)

with 72% males, 58% Caucasian, and 89% right-handed. For executive functions, Category, Conner’s Continuous Performance

Test (CPT), Trails B, Stroop and Wisconsin Card Sort Task were used. For non-executive functions, Wechsler Intellligence

Scale for Children-Fourth Edition (WISC-IV) subtests used were Digit Span, Coding, and Symbol Search. WISC-IV

Composite scores for Perceptual Reasoning Index (PRI), Verbal Comprehension Index (VCI), and Full Scale Intelligence

(FSIQ) were calculated. Results: Pearson correlations were calculated for EF and non-EF factors with the three indices.

Only Category Number of Errors showed a weak negative relationship with PRI (r ¼ 2.436, p , .033). Conclusions:

Children with ADHD did not show strong associations between general intelligence and EF or non-EF factors. Neither

verbal intelligence nor perceptual intelligence was significantly associated with any EF or non-EF factors. In general,

neither EF nor non-EF factors strongly correlate with intelligence. These results suggest that these cognitive functions may

not play a role in determining intellectual abilities in children with ADHD. Therefore, these factors cannot be expected to

mediate crystallized or fluid intelligence, which is in direct contradiction to recent research.

B-5Diagnostic Accuracy of the Personality Inventory for Children-2 in Children with Attention-Deficit/Hyperactivity

Disorder

Landstrom M, Dodzik P, Boneff T, Williams T

Objective: The aim of this study was to investigate the clinical utility of the Personality Inventory for Children-2 (PIC-2) for the

classification of Attention-deficit/Hyperactivity Disorder (ADHD). Specifically, the authors were concerned with the sensi-

tivity of PIC-2 to the various subtypes of ADHD (inattentive, hyperactive, or combined). Methods: The sample consisted

of 80 (24 females) children diagnosed with ADHD (mean age ¼ 8.9). Half of the sample (40) had comorbid mood disorder

or LD. Diagnosis of ADHD (inattentive ¼ 27, hyperactive ¼ 8, combined ¼ 45) was made with DSM-IV/ICD-9 criteria by

two board-certified pediatric neuropsychologists. Participants were administered a battery of neuropsychological tests and

broad personality measures appropriate for their age. Results: As expected, the ADHD participants had an elevated PIC-2

(ADH) scale (mean ¼ 65.8, SD ¼ 10.93). No significant differences were found between those with (mean ¼ 67.8, SD ¼

10.09) and those without (mean ¼ 63.78, SD ¼ 11.49) comorbid mental health issues. However, the PIC-2 correctly classified

only 50% of the participants as having ADHD based on the recommended cutoff score (65T) as compared to ADHD rating

scales, which correctly classified 90% of participants. Based on the subtype, the PIC-2 was insensitve to inattentive (26% sen-

sitivity; mean ¼ 58.93, SD ¼ 7.526%) and hyperactive (25% sensitivity; mean ¼ 64.13, SD ¼ 10.8) subtypes. The PIC-2 cor-

rectly classified 69% of the combined type (mean ¼ 70.16, SD ¼ 10.7). Conclusions: The PIC-2 is relatively insensitive to

ADHD in children based on established cutoff scores. Modest sensitivity was seen in the ADHD-combined subtype.

B-6

How Accurate are Parent and Teacher Attention-deficit/Hyperactivity Disorder Rating Scales when Compared to

Neuropsychological Measures of Executive Function and Attention?Robbins J, Martin P, Prinzi L, Golden C

Objective: Previous research shows contradictory evidence of impairment in Executive Functioning (EF) in attention-deficit

hyperactivity disorder (ADHD) and of a correlation between parent and teacher ADHD rating scales and neuropsychological


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measures of attention and EF. This study examined this issue. Method: Sixty-one children presenting for a neuropsychological

evaluation participated in the study with a parent and teacher completing the forms. The sample consisted of 61% males and

39% females aged 7–16 (M ¼ 10.69, SD ¼ 2.47). The Wisconsin Card Sorting Task and the Conners’ Continuous

Performance Test (CPT) were used as neuropsychological measures of EF and attention. The Conners’ Parent and Teacher

ADHD Rating Scales were used to assess the parent and teacher ratings of ADHD symptoms. Results: A multiple regression

revealed that only CPT Omission scores were able to predict how children would be evaluated by their parent and/or teacher on

the ADHD rating scales (Teacher Hyperactive-Impulsive, R ¼ .363, F(3, 57) ¼ 2.891, p ¼ .008, Teacher Inattentive, R ¼ .341,

F(3, 57) ¼ 2.504, p ¼ .015, and Parent Hyperactive-Impulsive, R ¼ .355, F(3, 57) ¼ 2.734, p ¼ .008) except for the Parent

Inattentive (R ¼ .142, F(3, 57) ¼ .390, p ¼ .317). Conclusion(s): The findings suggest that neuropsychological measures of

EF are not sensitive to the ADHD symptoms reported by parents and teachers. The Omission scores assess sustained attention

over time and may be a better way to examine the symptoms that are focused on by parents.


B-7

Neurocognitive Late Effects Associated with the Treatment of Pediatric Right Posterior Thalamic Tumor: A Case

Report with Early Childhood OnsetBarber B, Mucci G

Objective: Consideration of several factors regarding treatment of pediatric thalamic tumors is crucial, and includes: (1) age,

(2) presence of neurofibromatosis type 1, (3) tumor size/location, and (4) the toxicity of chemotherapy and radiation, as treat-

ment may result in significant tumor reduction and disease control (Packer, 2000). In pediatric thalamic tumors, chemotherapy

has been shown to be more effective in younger patients, whereas delayed radiation may prevent growth deficiencies. However,

the literature on neuropsychological effects is sparse. Method: Neuropsychological testing was conducted on a 7-year-old

Hispanic female with a high-grade glioma of the right posterior thalamus. The individual was diagnosed at age 2 and given

a poor prognosis. She has since undergone two resections of a right thalamic and brainstem tumor and chemotherapy, initially

presenting with no social, emotional, or behavioral difficulties. Results: The individual’s Full Scale IQ fell into the low average

range with significantly lower non-verbal than verbal skills, with weaknesses in reading and mathematics. Neuropsychological

testing revealed difficulties in visuospatial skills, motor, and short-term visual memory, consistent with deficits found with

right thalamic lesions (De Witte et al., 2008). Strengths included attention, executive functioning, expressive and receptive

language, verbal memory, long-term visual recall, and behavioral regulation. Conclusion: Given the dearth of available

research on pediatric thalamic tumors, discussion focuses on the importance of careful treatment selection and potential treat-

ment risks and benefits in young children with thalamic tumors. The role of the neuropsychologist in longitudinal monitoring of

neurocognitive late effects is also discussed.

B-8The Impact of Posttraumatic Stress Disorder (PTSD) on Visual and Verbal Memory in Children

Brzinski B, Frish D, Rosen S, Golden C

Objective: Research shows that when using neutral stimuli, adult individuals with posttraumatic stress disorder (PTSD) have

greater impairments in verbal memory than visual memory. The present study examined whether these impairments follow a

similar pattern in children diagnosed with PTSD. Method: The sample consisted of 26 children diagnosed with PTSD.

Sixty-five percent of the sample were males (n ¼ 17). Participant’s ages ranged from 5 to 15 (M ¼ 8.9, SD ¼ 2.93) and

their education levels ranged from 1st to 9th grade (M ¼ 3.28, SD ¼ 2.67). The Verbal Comprehension and Perceptual

Reasoning Index scores of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) were used as a control

in the sample. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-II) Verbal and Visual

Memory Indices were used as measures of verbal and visual memory. Results: Two paired-sample t-tests were conducted

using SPSS 17. Results from the first revealed no significant difference between Verbal Comprehension Index and

Perceptual Reasoning Index scores in children with PTSD (t(25) ¼ 2.78, p ¼ .45). The second t-test indicated that there

was no significant difference between Verbal Memory and Visual Memory Index scores (t(25) ¼ 21.57, p ¼ .13).

Conclusion: There was no difference found in children with PTSD when verbal memory was compared with visual

memory. These results contradict previous findings in adults with PTSD that verbal memory is significantly more impaired

than visual memory. The results of this study could indicate that PTSD and its cognitive effects manifest differently in children

compared with their adult counterparts. Future research should use a larger sample to examine memory deficits and other cog-

nitive sequelae of PTSD in children.


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B-9

The Developmental Relationship Between Children’s Emotion Perception and Intellectual Skills

Hamilton J, Nemeth D

Objective: As children grow and mature, so do their cognitive, social, and emotional capabilities. Marked improvements in

emotion recognition have been found in children between the ages of 5 and 10. The Comprehensive Affect Testing System

(CATS) is an assessment tool that was designed to improve neuropsychological understanding and awareness of emotion. It

has been used effectively to assess emotion processing in various adult psychiatric and neuropsychological populations as

well as in healthy adults, but has not been used extensively with children. The CATS and its 13 unique subtests assess

emotion perception across basic emotional communication channels: facial (expression), prosodic (tone of voice), and

lexical (meaning of language). Method: The Vocabulary and Matrix Reasoning subtests from the Wechsler Abbreviated

Scales of Intelligence (WASI) were used to estimate general intellectual functioning. An abbreviated version of the

Comprehensive Affect Testing System (CATS-A) was used to assess emotion perception. Results: Significant correlations

existed (p ¼ .05) for Full Scale IQ and several Prosody Subscales and the Prosody Composite Scale. When examining the

differential influence of the Verbal and Performance IQ subtests on CATS performance, no significant findings existed for

Vocabulary T-scores and CATS performance. Numerous significant correlations, however, were found between Matrix

Reasoning T-scores and many CATS subtests and composite scales across communication channels at the p ¼ .05 level.

Conclusion: Intelligence is related to emotion recognition. Non-verbal cognitive abilities appear to be most related to

emotion perception. This relationship changes over the course of development.

B-10

Behavioral Profiles of Children with EpilepsyMartinez A, Kirk J, Exalona A, Wicker N, Green C, Broshek D, Kao G, Kirkwood M, Quigg M, Cohen M, Riccio C

Objective: There is considerable research regarding the link between epilepsy and children’s mental health problems and diffi-

culties in daily functioning. The purpose of this study is to determine whether differing types of epilepsy contribute to specific

mental health problems or patterns of functioning, as measured by the Behavioral Assessment System for Children (BASC).

Methods: Participants were 163 children and adolescents aged 4–18 seen in an outpatient (tertiary care) setting in Georgia with

a diagnosis of epilepsy. Children had a mean age of 10.6 (SD ¼ 2.87). The sample included predominantly males (61.3%) and

was predominantly white (73.6%). Based on the sample availability, main seizure types examined are complex-partial (n ¼

101) and complex-partial-secondary (n ¼ 33). Descriptive statistics, one-way analysis of variance (ANOVA) tests, and multi-

variate analysis of variance (MANOVA) tests were conducted to examine differences among children with seizures and same

aged peers. Between-group analyses was conducted categorized by seizure type. Differences compared between parent and

teacher ratings and specific behavioral indices were identified as being statistically different between group types. Results:

Descriptive statistics did not reveal any clinically significant internalizing or externalizing problems. MANOVA analyses

showed specific behavioral indices evidenced notable differences between seizure types and between raters. Parent-rated

aggression differed significantly between group types. Teacher-rated social and study skills also showed moderate differences.

Based on these findings, previous study results suggest that children with epilepsy showing a high rate of behavioral and aca-

demic concerns were partially confirmed. Results provide information that may be beneficial to clinicians and school psychol-

ogists who provide behavioral support to children who have seizures.

B-11

Sex Differences in Neuropsychological Functioning Following Treatment for Pediatric Brain TumorOlson K

Objective: The primary objective of this review is to compare the data examining sex as a risk factor for post-treatment neu-

rocognitive deficits in survivors of childhood brain tumors to what is known regarding sex differences in neuropsychological

functioning. The benefits of using this knowledge to create tailored cognitive remediation interventions are also examined.

Data selection: A literature review was conducted using five of the most authoritative information search engines (e.g.,

PsycINFO). Studies of interest identified sex differences in neuropsychological functioning in general and as a result of treat-

ment for childhood cancer more specifically. Search terms included pediatric, gender, male, female, sex, differences, brain

tumor, CNS tumor, neuropsychological functioning, and late effects. Outcome data were reviewed. Data synthesis: From

the studies reviewed, the neuropsychological domains most affected by brain tumor treatment are attention, executive function-

ing, processing speed, working memory, visual processing, visual-motor functioning, perceptual reasoning, and the ability to

learn. Although data are less prevalent than in the field of acute lymphoblastic leukemia (ALL), findings appear similar in the

pediatric brain tumor population—females are more at risk than males for poorer cognitive outcomes. Although there are no


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unequivocal conclusions regarding sex differences in neuropsychological functioning, males and females often exhibit hemi-

spheric specialization in certain tasks. Conclusions: Based on published research, females appear to be more at risk than males

for increased neuropsychological deficits following treatment for a brain tumor. By identifying the differences in male and

female neuropsychological functioning, interventions might be more targeted to specific needs of each population.

B-12

Behavioral Inhibition in Disruptive Behavior Disorders

Rice J, Dougherty M, Golden C

Objective: The current study examined three previously identified processes of behavioral inhibition in children with disruptive

behavior disorders: inhibition of prepotent responses, stopping of ongoing response given feedback on errors, and interference

control. Method: Participants were 138 children diagnosed with a disruptive behavior disorder (46% Conduct Disorder, 54%

Oppositional Defiant Disorder) by doctoral level students and 31 children as a normal control group. The disruptive behavior

disorders group was 79% males and included participants aged 6–17 (M ¼ 10.75, SD ¼ 3.35); the normal control group was

participants aged 6–15 (M ¼ 10.0, SD ¼ 2.74), 55% of which were males. To control for intellectual differences between

groups, the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Vocabulary subtest was included in the analy-

sis as a covariate. Inhibition of prepotent responses was measured through Continuous Performance Test (CPT) commission

errors; stopping an ongoing response with perseverative errors on the Wisconsin Card Sorting Test (WCST); and interference

control with the Stroop. Three analysis of covariance (ANCOVA)s with alpha set at .05 were performed. Results: Results

revealed significant differences between the two groups after controlling for intellectual functioning on CPT-II (F(1, 69) ¼

14.78, p , .01), WCST (F(1, 97) ¼ 17.01, p , .01), and Stroop (F(1, 108) ¼ 4.93, p ¼ .028). The normal control performed

better on all measures (CPT-II: M ¼ 48.49; WCST: M ¼ 12.41; Stroop: M ¼ 24.13) compared with those with disruptive be-

havior disorders (CPT-II: M ¼ 71.6; WCST: M ¼ 28.22; Stroop: M ¼ 19.9). Conclusions: The results of this research offer

further evidence for a deficit in behavioral inhibition in disruptive behavior disorders. It suggests that deficiencies in inhibiting

prepotent responses, stopping ongoing responses, and interference control extend beyond just ADHD and are also associated

with other disruptive behavior disorders.

B-13

Is the Stroop a More Appropriate Measure of Executive Functioning for Children with Perceptual Reasoning Deficits?

Sharma V, Rodriguez M, Golden C

Objective: Measures of executive functioning such as the Wisconsin Card Sorting Test (WCST) and the Trails Making Test

require the use of perceptual reasoning skills, which makes isolation of executive functioning deficits difficult. This study

examines the potential utility of the Stroop test in differentiating executive functioning in children with perceptual reasoning

deficits. Methods: Results on the WCST, Trails, and the Stroop test were compared between 42 children aged 7–15 (M ¼

11.36, SD ¼ 2.21). The sample consisted of 62% males, 48% Caucasian, and 90% right-handed participants. Range of edu-

cation was 1–10 (M ¼ 5.12, SD ¼ 2.41). For measures of executive functioning, the WCST, Trails B, and Stroop Color

Word Score were used. Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Composite scores for Full

Scale Intelligence (FSIQ), Verbal Comprehension Index (VCI), and Perceptual Reasoning Index (PRI) were used. Results:

Pearson correlations indicated that the Stroop Color Word test was significantly correlated with the VCI (r ¼ .310, p ¼

.046), but not with the FSIQ or the PRI. In contrast, both the WCST number correct and Trails B were significantly correlated

with both the VCI and the PRI at the .05 level. Conclusions: Performance on the Stroop Color Word test is not significantly

altered in children with PRI deficits, making it more suitable than the WCST or Trails B as a test of executive functioning for

populations suspected to have issues with perceptual reasoning. However, it may not be appropriate for individuals with varied

educational backgrounds that prevent optimal language development.

B-14

Developmental Trends in Individuals with NF1 and Noona phenotype (NFNS) Compared with Matched NF1 and

ControlsPaltin I, Walsh K, Rosenbaum K, Copenheaver D, Zand D, Kardel P, Acosta M, Packer R

Objectives: Recognition of a distinct population of children with NF1 and Noonan phenotype (NFNS) has become more pro-

minent. There have been no studies of neurocognitive functioning in this group compared with NF1. Our primary objective is to

compare the developmental trajectories of these clinical groups using a case time-series approach. Methods: Three sets of chil-

dren were selected from a larger series, matched on age and gender. Two of the sets paired an NFNS, NF1, and control par-

ticipant, whereas the other set paired an NFNS and control participant, comparing cognitive and behavioral development at two


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time points (15–21 months, 30–40 months, or 40 months to 5 years). Results: Developmental trends were variable, although

generally participants across groups demonstrated gains in cognitive skills with age. However, NFNS participants consistently

exhibited greater cognitive, adaptive, and self-regulatory impairments compared with the other participants. Specifically,

although control and NF participants performed in the average cognitive range, NFNS participants were low average to

impaired. The NFNS participants were also reported to receive more interventions than the NF1 and control participants,

with an increase in intervention services over time. Conclusions: These findings suggest that although children with NFNS

exhibit a similar trend in development, their functioning is more significantly impaired than children with NF1 or controls,

with a higher level of intervention services needed. This suggests more extensive evaluation and treatment approaches in

the NFNS population, as they appear to represent a distinct clinical group with unique needs.

B-15A Case Study of a Child with Partial Trisomy 14 Mosaicism and Normal Cognitive Functioning

Vasserman M

Objective: Trisomy 14 is a rare genetic condition associated with growth retardation, facial anomalies, congenital heart defects,

and, in most cases, mental retardation. This case presents a 13-year-old girl with partial trisomy 14 mosaicism, history of failure to

thrive, growth retardation, facial dysmorphism, Pervasive Developmental Disorder, Not Otherwise Specified (PDD, NOS) fea-

tures, and average intelligence. This is the second documented case of average cognitive development in the context of

trisomy 14 and reflects that mental retardation and cognitive delays are not necessary features of partial trisomy 14. Method:

Jennifer is a 13-year-old, left-handed girl who was diagnosed with partial trisomy 14 in utero. Jennifer’s initial postnatal

period was complicated by decreased heart rate and lethargy. Infant development was further complicated by failure to thrive,

hypotonia, and feeding problems. Motor development was normal, whereas language development was severely delayed, in

part due to oromotor hypotonia. She received early intervention services from 6 months until pre-school. Results: Jennifer’s neu-

ropsychological profile revealed average cognitive and academic functioning (FSIQ ¼ 99). Deficits were noted in the areas of

learning and memory (2nd–16th percentile), dominant side motor coordination, speed and dexterity (5–8th percentile), mental

flexibility (16th percentile), decreased response accuracy on cognitively demanding tasks (1st percentile), theory of mind (11–

25th percentile), and reading comprehension (23rd percentile). Multiple symptoms of PDD NOS were evident in early childhood

but less so at present. Conclusions: This case reflects that partial trisomy 14 mosaicism does not necessarily result in mental retar-

dation, reflecting the relatively minimal genetic contribution of the tripled partial chromosome on cognitive development.

DIVERSITY

B-16Interference from Second Language to First Language in Bilinguals

Fonseca F, Tourgeman I, Stack M, Demsky Y, Golden C

Objective: Previous studies have evaluated verbal learning of the second language in bilinguals. However, interference from

the second language to the first language is rarely mentioned in bilingualism literature. The goal of this study was to examine

whether verbal learning in the first language (Spanish) is affected by the number of years of exposure to the second language

(English). Method: Participants were 28 bilingual speakers, with a mean age of 29.32 (SD ¼ 1.00). There were 14 male and 14

female participants in the sample. The average education level of the sample was 15.43 (SD ¼ 2.43). Participants were admi-

nistered the Categorical Fluency and Verbal Learning subtests from the Nova Multilingual Neuropsychological Battery in

Spanish. Results: Verbal Learning was significantly correlated to the Time in the United States (r ¼ 25.24) and Education

(r ¼ .413) at the .5 level. All of the trials of Verbal Learning had a negative correlation with Time in the United States and

a positive correlation with Education. Age was shown to not have a significant relationship with performance on the Verbal

Learning Task (r ¼ 2.066). Conclusions: Because time of exposure to the second language affected performance on the

Verbal Learning subtest, it can be concluded that working memory as expressed by the ability to memorize words in the

first language is affected by the amount of years the bilingual participant has been exposed to the second language. This

effect was shown to be independent of the participant’s age, which had no effect on performance.

B-17

The Boston Naming Test “Noose” Item: What Is it Good For?Horwitz J, McCaffey R

Objective: Recent discussion has questioned the appropriateness of the Boston Naming Test (BNT) noose item, given its cul-

turally inflammatory symbolism. Therefore, the present study investigated performance and emotional responses to BNT


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stimuli among Black and White cognitively intact college students and assessed for potential differential item functioning

(DIF). Method: Data from 50 undergraduate students, including 19 Blacks and 31 Whites (self-identified), were included.

Participants were administered all 60 BNT items, followed by an experimental, computer-based test assessing emotional

responses to BNT stimuli. Results: Performance differences were found on two items (wreath, p ¼ .05; sphinx, p ¼ .01),

with higher mean scores among Whites for both items. Follow-up logistic regressions performed on individual items, using

ethnoracial group, overall BNT score, and the interaction term as predictors, revealed a significant interaction on one item

(noose, p ¼ .015). Inspection of corresponding mean scores suggested that overall naming ability reliably predicts performance

on this item among Whites but not among Black participants. Emotional response to the noose item did not differ between

groups; however, ethnoracial group accounted for 7% of the variance in reaction time for emotional responding, with

Blacks responding more quickly than Whites. This difference, however, was not statistically significant (p ¼ .07).

Conclusion: Results from this study suggest that performance on certain BNT stimuli may be impacted by ethnoracial

factors and that the noose item may test different constructs in Blacks when compared with White young adults. These findings,

together with the APA ethical principles and multicultural guidelines, suggest that the noose may be an inappropriate item for

continued inclusion in the BNT.

B-18

Neuropsychological Testing Spanish Speakers: The Challenge of Accurately Assessing Linguistically and CulturallyDiverse Individuals

Ojeda C, Kadushin F, Wingler I, Lazarus G, Green J, Barth J, Puente A

Objective: To address the current state of neuropsychological assessment of Spanish speakers, a three-phase study was

designed to: (a) develop a current and comprehensive list of neuropsychological and psychological tests available in

Spanish, (b) determine which Spanish tests are being used by Spanish-speaking neuropsychologists, and (c) determine if

the Spanish tests used meet the criteria from the testing Standards for Educational and Psychological Tests. Method: Phase

1: the list of Spanish tests was developed by reviewing these sources: (a) previously published studies on tests in Spanish,

(b) Buros Mental Measurements Yearbook (Online database), (c) Hispanic Neuropsychological Society List of Spanish

Tests, (d) databases (PsychInfo & WorldCat), and (e) Spanish test publishers (e.g., Manual Moderno & TEA). Phase 2:

Online survey was administered using Hispanic Neuropsychological Society members. Survey included questions regarding

demographics and Spanish test usage with 56 out of 83 responding. Phase 3: tests reported were matched to the Standards

for Educational and Psychological Tests to determine whether these tests met the criteria required for tests in English.

Results: Findings showed that there are few Spanish tests (555 from 3,500). Of these, relatively fewer tests are being used

(216) for neuropsychological testing. Of the 216, there are approximately 25–40 tests that are used frequently and a much

larger number of tests that are used infrequently. Finally, almost none of the tests meet the testing standards criteria.

Conclusions: Results indicate that the current status of available and useful neuropsychological testing for Spanish speakers

is inadequate. Specific suggestions are provided to attempt to remedy this situation.

B-19

Neurocognitive Assessment in American Indian Elders

Parikh M, Graham L, Hynan L, Grosch M, Weiner M, Cullum C

Objective: Little neuropsychological research exists with respect to American Indians. Previous findings with the CERAD

battery suggested similar results among older American Indian and Caucasian groups. The purpose of this investigation

was to examine the performance of healthy American Indian and Caucasian elders on a brief battery of neurocognitive

measures. Methods: Thirty-eight American Indian participants (AI) and 28 Caucasians (C) were administered the

Mini-Mental State Examination (MMSE), Digit Span Forward and Backward (DSF, DSB), and Hopkins Verbal Learning

Test-Revised (HVLT-R). All participants were primarily English-speaking. Groups were similar in mean years of education

(M(AI) ¼ 13.4, M(C) ¼ 14.0), but the Caucasian sample was significantly older (M(AI) ¼ 62.2, M(C) ¼ 71.1, p , .001).

analysis of covariance (ANCOVA)s were performed with age, education, gender, and depression scores as covariates.

Covariates significant at p , .15 were included in an adjusted model ANCOVA. Results: Scores on the MMSE did not

differ significantly (M(AI) ¼ 28.9, M(C) ¼ 29.3, p ¼ .084). Scores on DSF (M(AI) ¼ 5.5, M(C) ¼ 6.8, p , .001), DSB

(M(AI) ¼ 4.5, M(C) ¼ 5.5, p , .001), and HVLT-R total (M(AI) ¼ 25.1, M(C) ¼ 29.6, p , .001) were significantly different

between groups, with the Caucasian sample obtaining higher scores after adjusting the analyses for significant covariates.

Conclusions: Performance on the MMSE was comparable between groups, whereas American Indians obtained slightly

lower scores on Digit Span and HVLT-R. These results differ to some extent from previous findings utilizing the CERAD

battery. Although further investigation is necessary in larger samples with additional tests, these findings suggest that some


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measures, possibly those with heavier language components, may require different norms or score adjustments to allow appro-

priate interpretation.

B-20

Performance on the Demsky Golden Interference Task Using a Hispanic SampleTourgeman I, Bure-Reyes A, Stewart J, Stack M, Demsky Y, Golden C

Objective: The present study was conducted to determine whether bilingual participants perform differently on an interference

task when it is administered in English or Spanish. Method: Analyses were performed on data collected from non-patient vol-

unteers, who participated in the Nova Multilingual Neuropsychological Battery Pilot Study (NMNB). The study analyzed data

from 41 Spanish–English Bilingual participants (whose first language was Spanish) who were administered the Demsky

Golden Interference Task (DGIT) as part of the NMNB. Twenty-one of the participants were administered the English

version of the Interference Task and 20 participants were administered the Spanish version. The mean age was 28.24

(SD ¼ 8.36). There were 22 females and the average education was 15.83 (SD ¼ 2.09). The DGIT consists of three trials pre-

sented to the client at 30-s intervals. Trial 1 measures reading ability. Trial 2 is administered to individuals who are unable to

read the words in Trial 1. Trial 3 measures number reading ability. Trial 4 asks the participant to state the number of digits

present in each set rather than the numbers written. Results: Overall performance was significantly slower for those adminis-

tered the Spanish version of the interference task (F(39) ¼ 4.96, p ≤ .05). No other significant differences were observed.

Conclusions: The trial that presented competing stimuli for the participant to attend to (Trial 4) yielded a significant lower

score. The significant difference between the group administered the English version of the task and the group administered

the Spanish version suggests that those receiving the English version may have a higher aptitude for inhibition.

B-21

Factors Influencing Performance on Anomia Task among Monolingual and Bilingual SamplesZhang J, Tourgeman I, Demsky Y, Stack M, Golden C

Objective: The goal of this study was to determine factors influencing performance on an anomia task to determine the extent

of an individual’s visual confrontation naming abilities in monolingual and bilingual samples. Method: The sample consisted

of 124 participants including 78 females, average level of education of 16.20 (SD ¼ 2.02), 63 monolingual English speakers,

61 bilingual speakers, and were primarily Caucasian or Hispanic. Participants were administered the anomia subtest of the

NOVA Multilingual Neurological Battery (NMNB). The English version of the NMNB was administered to 96 participants,

and the Spanish version of the NMNB was administered to 28 participants. The subtest consisted of 11 visual stimuli; partici-

pants were directed to verbally identify each of objects. Results: One-way analysis of variance (ANOVA)s were run to measure

differences between performance on the Anomia subtest and each measure. At the .05 level, there was a significant difference

between performance for language of administration (F ¼ 4.06) and monolingual versus bilingual (F ¼ 8.75). A correlation

was run between Acculturation and performance on anomia showed a significant correlation (r ¼ .24). No significant effect

was found for ethnic identity. Conclusion: The participants receiving the English version had higher performance for visual

naming abilities. Monolingual English speakers did better than the bilinguals. Language proficiency could be a factor as par-

ticipants may have chosen a version in a language that they are not as proficient in. The significant correlation with accultura-

tion suggested that those with higher acculturation had a higher aptitude for visual naming abilities. Another explanation could

be that higher acculturation is associated with higher language proficiency.

B-22Performance of English Monolinguals and Spanish/English Bilinguals on Verbal Tests

Bures-Reye A, Stewart J, Tourgeman I, Demsky Y, Stack M, Golden C

Objective: The present study compared the performance of monolingual English speakers and Spanish/English bilinguals on

verbal tests. Method: The sample, non-patient volunteers, who participated in the Nova Multilingual Neuropsychological

Battery Pilot Study (NMLB), included 63 monolingual English and 33 bilinguals (Spanish and English). The mean age was

27 (SD ¼ 7.6) and mean education was 16.4 (SD ¼ 1.8). Tests were administered in English including the following:

Verbal Commands, which asks the participant to demonstrate how they would perform a number of common tasks such as

how they would sweep; Categorical Fluency, in which the person must name as many things that fall into that category;

Verbal Learning and Verbal Delayed, the ability to learn a list of words when presented several times; Word Recognition, rec-

ognition task from verbal learning; Anomia, naming objects; Phonetic Discrimination, assesses ability to differentiate and

articulate different words; Spelling, writing words and sentences read aloud; Reading Comprehension, completing sentences

with an appropriate word; and Vocabulary, defining words. Results: Analysis revealed significant differences in Verbal


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Commands (t(93) ¼ 22.146) and Oral Word Recognition (t(93) ¼ 22.03). Bilinguals obtained higher scores than monolin-

guals on Verbal Commands. Bilinguals recognized more words than monolinguals. No other significant differences were

found. Conclusion(s): The results showed that only 2 out of the 11 verbal tasks resulted in a significant difference between

bilingual and monolingual participants. Bilingual participants performed better on tasks that measured verbal recognition

and were more adept at following verbal instructions to execute motor movements. The test appears to work equally well

in bilinguals and monolinguals.

B-23Effects of English as a Second Language (ESL) on Verbal Memory Scores

Finlay L, Goldberg H, Arentsen T, Lo T, Moriarti T

Objective: Previous research examining the impact of English as a second language (ESL) on neuropsychological test scores

did not find effects on verbal memory (Boone, Victor, Wen, Razani, & Ponton, 2007). The purpose of the current study was to

further examine this finding. Method: Participants were 32 native English-speaking and 13 ESL clinical patients from a large

county hospital who were deemed credible, had no dementia diagnosis, and had an FSIQ .70. Current English use was greater

than 50% for 12 of the 13 ESL patients (range 20%–100%). Between-groups differences on the Wechsler Memory Scale-III

(WMS-III) Logical Memory I and II and on all Rey Auditory Verbal Learning Test (RAVLT) trials were analyzed with analysis

of covariance (ANCOVA)s controlling for years of education. Results: The ESL group had significantly lower scores on

RAVLT Trial 1 (hp2 ¼ .14, F(1, 42) ¼ 6.80, p , .02), Total of Trials 1–5 (hp2 ¼ .10, F(1, 42) ¼ 4.79, p , .04), and

Trial 8 Delayed Recall (hp2 ¼ .10, F(1, 42) ¼ 4.56, p , .04). Conclusions: ESL status impacted initial and total learning,

and delayed recall for rote material. The effect was attenuated by Trial 5, by which time no significant difference on

number of words learned was found.

B-24Does Ethnicity Impact the Relationship between Depression and Intelligence among the Homeless?

Mackelprang J, Karle J, Aragon P, Gonzalez E, Valley-Gray S, Cash R

Objective: This research aimed to investigate the moderating effect of ethnicity on the association between depression and

intelligence in a sample of homeless adults. Method: Participants were 45 homeless or formerly homeless, predominantly right-

handed (88.9%) adults, most of whom were 45–54 years old (48.9%). This sample was recruited at an outpatient clinic in

Miami, FL. The majority of participants were men (77.8%) and approximately 40% did not complete high school. The pre-

ponderance of participants identified as Black, African American, or Afrocaribbean (57.8%). Fewer participants were

White (20%), Hispanic or Latino (11.1%), or Other (11.1%). These participants were grouped into one category to be compared

with the majority. Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Prorated Full

Scale IQ was derived from the six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult

Intelligence Scale-Third Edition (WAIS-III). Results: A significant interaction was not observed (F(1, 39) ¼ 3.437, p ¼

071), indicating that the effect of depression on intelligence does not vary as a function of ethnicity in this sample. The

main effect of ethnicity, however, was significant (p ¼ .005), explaining 15.8% of the total variance of intelligence.

Conclusions: Results did not support the hypothesis that ethnicity acts as a moderator in the relationship between depression

and FSIQ. The interaction was in the predicted direction, however, suggesting that small sample size may be limiting the

results. Potential differences in subtest scores that may be influenced by ethnicity and clinical implications will be discussed.

NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: PSYCHIATRIC ILLNESS

B-25

A Mediation Model of Post-Traumatic Stress Disorder, Intellectual Functioning, and Depression in a Sample ofHomeless Adults

Mackelprang J, Karle J, Hardie R, Cash R, Gonzalez E, Valley-Gray S

Objective: This study attempted to determine whether depression mediated the relationship between symptoms of post-

traumatic stress disorder (PTSD) and intelligence in a homeless sample. Method: Participants were 45 homeless or formerly

homeless, predominantly right-handed (88.9%) adults, most of whom were 45–54 years old (48.9%). This sample was

recruited at an outpatient clinic in Miami, FL. The majority of participants were males (77.8%), and most identified as

Black, African American, or Afrocaribbean (57.8%). Fewer participants were White (20%), Hispanic or Latino (11.1%), or

Other (11.1%). Approximately 40% did not complete high school. Baron and Kenny’s (1986) three-step method for determin-

ing the presence of mediation was utilized. Depression and symptoms of PTSD were measured by the Center for Epidemiologic


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Studies Depression Scale (CES-D) and the PTSD Checklist-Civilian Version (PCL-C), respectively. A prorated Full Scale IQ

was derived from the six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult Intelligence

Scale-Third Edition (WAIS-III). Results: Intellectual functioning when regressed on depression yielded significant results (F(1,

40) ¼ 4.634, p ¼ .037). Collinearity between the predictor and proposed mediator were deemed tenable; therefore, the hypoth-

esized mediator (CES-D) was regressed on PCL-C, with significance (F(1, 40) ¼ 22.869, p , .001). Finally, intellectual func-

tioning was regressed on both depression and PTSD, again with significant results (F(2, 39) ¼ 4.34, p ¼ .02), indicating partial

mediation. Conclusions: The presence of a statistically significant mediator indicates that the inverse relationship between

PTSD and intellectual functioning appears to be made stronger by the presence of depression.

B-26

Neuropsychological Correlates of Schizoaffective Disorder and Psychotic Major Depression: A Comparison StudyUsing a Three-Factor Model

Mason J, Keller J, Gomez R, Trettin L, Schatzberg A

Objective: Cognitive function is impaired in patients with schizoaffective disorder (SAD) and psychotic major depression

(PMD). Few studies have examined these two patient groups simultaneously. Here we compared cognitive function in

PMD and SAD patients. Follow-up analyses examined the specific role of positive symptoms, negative symptoms, and affec-

tive symptoms on cognition. Method: Forty PMD and 18 SAD patients participated. Participants were rated on the Brief

Psychiatric Rating Scale (BPRS) and completed a comprehensive neuropsychological assessment including attention,

working memory, executive functioning, and verbal memory. Results: Analysis of covariance (ANCOVA) analyses were

run with each main neuropsychological test with group as the independent factor and age as the covariate. In all domains,

PMD and SAD patients did not differ on their cognitive performance (p . .27). Follow-up regression analyses with the

PMD and SAD patients combined utilized positive, negative, and affective symptoms as independent factors to predict cog-

nitive performance. This three-factor model contributed a significant amount of variance in verbal memory, attention, and

executive functioning (p , .05). In all cases, negative symptoms played a significant role once the other two factors were cov-

aried. Conclusion: These findings may have important therapeutic implications as residual negative symptoms often remain

even after generally successful treatment of these disorders. Given that PMD patients tend to experience more acute sympto-

matology and SAD patients have more chronic problems, additional studies with larger samples are needed to better understand

how these factors may distinctly affect cognitive functioning in these two groups.

B-27

Assessing Cognitive Impairment and Functional Ability in Schizophrenia

Moore R, Mausbach B, Viglione D, Patterson T

Objective: Cognitive impairment is a leading cause of disability in people with schizophrenia. Many individuals with this dis-

order have major impairments in adaptive life skills and the performance of social roles, which lead to a limited capacity to

function independently in the community. We hypothesized that patients with greater thought disorder and less complexity, in

addition to neuropsychological deficits, would exhibit greater functional impairments. Methods: Participants were 28-year-old

schizophrenic outpatients (mean age 50.57 + 5.26 years) reasonably controlled on medication. All participants completed the

UCSD Performance-Based Skills Assessment (UPSA), Repeatable Battery for the Assessment of Neuropsychological Status

(RBANS), and the Rorschach Performance Assessment System (RPAS). The UPSA was used to assess functional ability and

the RBANS was used to assess neuropsychological impairment. The Ego-Impairment Index-II (EII-2) and Overall Complexity

(Complex) variable of the RPAS were used to assess thought disorder and psychological complexity, respectively. Results: The

magnitude of the effect size between the RBANS and the UPSA was large (r ¼ .69, p , .001, R2 ¼ .48). Using a multiple

regression model, the EII-2 (t ¼ 21.10, p ¼ .21) and Complex (t ¼ 1.90, p ¼ .07) variables accounted for an additional

7.3% (R2 ¼ .55) of the variance beyond that accounted for by RBANS scores. Conclusion: These preliminary results

suggest that the constructs of thought disorder and psychological complexity play a role in the functional limitations seen

in schizophrenics above and beyond neuropsychological impairment. Further research should examine how these variables

are related to real-world behavior in this population.

B-28

Neuropsychological Deficits in Elderly Schizophrenia and Schizoaffective DisordersMorrow J, Barber B, Restrepo L, Mucci G, Golden C, Buchbinder D, Chang R, Wang R

Objective: The purpose of this research was to measure cognitive processing deficits in elderly participants with psychotic

disorders compared with normal participants using Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and Trail


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Making B. Method: Participants were outpatients diagnosed with schizophrenia or schizoaffective disorder (N ¼ 38) com-

pared with participants with no history of neuropsychological or psychiatric disorders (N ¼ 4). The participants were

75.0% Caucasian and 57.3% females with a mean age of 64. Participants’ Full Scale IQ (FSIQ) on the WAIS-III was uti-

lized as a measure of general intelligence and Trail Making B T-score was utilized as a measure of executive functioning.

Results: All analyses were conducted at the .01 level of significance. There was a significant difference on FSIQ between

schizophrenics/schizoaffective (M ¼ 80.79) and normal participants (M ¼ 104.09, F(1, 70) ¼ 29.865, p , .001). For this

reason, FSIQ was utilized as a covariate. A one-way between-subjects analysis of covariance (ANCOVA) demonstrated

that schizophrenic and schizoaffective participants (M ¼ 32.39), as a group, performed significantly more poorly on

Trail Making B than normal participants (M ¼ 47.36, F(1,70) ¼ 10.20, p ¼ .002). Conclusion: This study supports pre-

vious findings that have demonstrated both intellectual and executive functioning deficits in psychotic populations.

Participants with a psychiatric diagnosis performed significantly worse on measures of intelligence. After the effects of

intelligence were controlled for, this population obtained significantly lower scores on a measure of executive functioning.

This deficit in the ability to make judgments, solve problems, and inhibit thought and behavior has vast implications for

quality-of-life and psychiatric and psychological treatment.

B-29

Cognitive Deficits in Adolescents with Major Depressive DisorderPearlson J, Scarisbrick D, Rodriguez M, Golden C

Objective: The purpose of this study was to examine if adolescents with major depressive disorder (MDD) manifest similar

cognitive deficits as do adults. Method: Scores from coding and block design from the Wechsler Intelligence Scale for

Children-Fourth Edition (WISC-IV) and Trail Making Test were examined. Vocabulary, similarities, Matrix Reasoning,

and Digit Span scores were included to rule out executive functioning, working memory, and non-verbal skills as confounds.

The sample consisted of 58 adolescents aged (M ¼ 10.4 years, SD ¼ 2.8). Thirty-two patients were diagnosed with MDD (M ¼

10.8 years, SD ¼ 2.8) and 26 adolescents with no psychological diagnoses (M ¼ 9.9 years, SD ¼ 2.8). The majority of the

sample was Caucasian (54%), followed by Hispanic (24%), Other (14%), and Black (8.0%); the sample was also predomi-

nantly males (58.6%) and right-handed (91.7%). Results: A one-way analysis of covariance (ANCOVA) was conducted con-

trolling for age. Significant differences were found at the .05 level for coding (F(1, 54) ¼ 14.43, p , .001), Trails A (F(1,

49) ¼ 11.36, p ¼ .001), and Trails B (F(1, 49) ¼ 14.59 p , .001). Participants with MDD performed significantly lower

than participants with no psychological diagnoses. Significant differences were also found in Digit Span (F(1, 54) ¼ 9.690,

p ¼ .003) and vocabulary (F(1, 54) ¼ 9.01, p ¼ .004). No significance was found for matrix reasoning or similarities.

Conclusions: This research indicates that adolescents with MDD suffer from similar cognitive deficits as their adult counter-

parts. This is consistent with existing evidence regarding cognitive deficits associated with MDD and indicates that these def-

icits already emerge during adolescence. More research is required to determine the relationship between MDD, working

memory, and executive functioning among adolescent populations to determine if these affect or are effects of this deficit.

B-30

Visual Perception Deficits in Psychotic Disorders

Restrepo L, Morrow J, Golden C

Objective: Previous research has focused on overall deficits in psychotic disorders as reflected on Full Scale IQ, attention, and

problem-solving. The purpose of this study was to measure visual perception deficits in individuals with psychotic disorders.

Method: Participants consisted of schizophrenics and schizoaffectives (N ¼ 38) and normals. There were 57.3% females; 89%

were right-handed and 75.0% Caucasian, with mean age 64. Measures included participants’ PIQ scaled score as well as Block

Design, Picture Completion, and Matrix Reasoning scaled scores. Results: Data on visual perception were analyzed using a

one-way between-subjects analysis of variance (ANOVA). There was a significant difference at the .05 level (p , .001)

between schizophrenics/schizoaffectives (M ¼ 79.368) on visual perceptual tasks in PIQ and normals (M ¼ 100.912, F(1,

70) ¼ 32.012, p , .001). There were also significant differences in each of the subtests as measured by a series of one-way

between-subjects ANOVAs; Block Design schizophrenics/schizoaffectives (M ¼ 6.526), normals (M ¼ 9.618, F(1, 70) ¼

23.841, p , .001); Picture Completion schizophrenics/schizoaffectives (M ¼ 6.538), normals (M ¼ 10.500, F(1, 70) ¼

25.168, p , .001). Matrix Reasoning schizophrenics/schizoaffectives (M ¼ 7.552), normals (M ¼ 11.088, F(1, 70) ¼

21.804, p , .001). Conclusion: Participants with psychotic disorders performed significantly more poorly across perceptual

measures than those without psychiatric diagnoses. This study supports previous findings that have demonstrated visual percep-

tion deficits in psychotic populations. These results should be applied to the development of adequate perceptual assessments

for future clinical trials.


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B-31

Neuropsychological Functioning Across Different States of Bipolar Disorder: Mania or Hypomania and Depression

Switalska J

Objective: The aim of the study was to compare neuropsychological functioning across different states of bipolar disorder:

mania/hypomania and depression. Method: Cognitive functions were examined in 30 depressed bipolar patients aged 18–

68 (M ¼ 45.6, SD ¼ 12.6; 18 women and 12 men) who fulfilled DSM-IV criteria for depressive episode (Hamilton

Depression Rating Scale score ≥ 11) and 30 manic or hypomanic bipolar patients aged 23–68 (M ¼ 48.1, SD ¼ 11.5; 18

women and 12 men) who fulfilled DSM-IV criteria for manic or hypomanic episode (Young Mania Rating Scale ≥ 11).

The comparison group consisted of 30 healthy participants aged 23–71 (M ¼ 46.2, SD ¼ 12.2; 20 women and 10 men)

without history of psychiatric or neurological disorders. The study was performed at Central Clinical Hospital in Lodz,

Poland. A neuropsychological battery assessed executive functions and fluency (Wisconsin Card Sorting Test [WCST],

Controlled Oral Word Association Test FAS, Stroop Color-Word Interference Test), working memory and attention (Trail

Making Test Part B-TMT, N-back Test), psychomotor speed (TMT A), and reaction time (N-back Test). Results: The

bipolar groups showed cognitive dysfunctions in working memory, fluency, attention, psychomotor speed, and reaction

time in relation to comparison group. Manic/hypomanic group was also impaired on WCST, a measure of executive functions,

which was not observed in depressive patients. Manic/hypomanic patients were significantly more impaired on executive func-

tions than depressed group. Conclusion: A poorer neuropsychological performance was observed in different states of bipolar

disorder but during manic/hypomanic state, cognitive deficits were more serious regarding executive functions.

B-32

Cognitive Functioning and Longitudinal Functional Outcomes in Patients with First Episode Bipolar I DisorderTorres I, DeFreitas C, DeFreitas V, Bond D, Yatham L

Objective: Cognitive deficits are present early in the course of bipolar disorder, but it is unknown whether such deficits predict

longitudinal functional outcomes. The goal of this study was to evaluate whether cognitive functioning early in the course of

bipolar illness predicts functional outcomes 6 months after cognitive assessment. Method: Fifty-three clinically stable patients

with a DSM-IV Bipolar I diagnosis were recruited from a large Medical School Mood Disorders clinic within 3 months of their

first manic episode. Participants were administered a neuropsychological battery yielding cognitive scores in verbal/premorbid

IQ, spatial reasoning, attention/processing speed, learning/memory, and executive functioning. Six months later, 45 patients

were administered the Multidimensional Scale of Independent Functioning (MSIF), a structured interview rating scale asses-

sing functioning across work, educational, and residential environments. Mood ratings were also obtained at baseline and 6

months. Results: Using sequential multiple regression, mood ratings were entered simultaneously and found to marginally

predict 6-month MSIF scores (R2 ¼ .15, F(3, 41) ¼ 2.42, p ¼ .08). Only 6-month depression ratings predicted MSIF scores

(t ¼ 2.4, p ¼ .02). In the second step of the regression, the five cognitive scores were entered simultaneously, yielding a sig-

nificant increase in R2 (R2 change ¼ .29, F change(5, 36) ¼ 3.7, p ¼ .008). Learning/memory was the only cognitive domain

adding unique variance in the full model (t ¼ 23.3, p ¼ .002). Conclusions: Learning/memory functioning predicted 6-month

functional outcomes in recently diagnosed patients with bipolar disorder. Findings provide support for the utility of neurop-

sychological assessment early in the course of bipolar illness and suggest that cognitive difficulties in recently diagnosed

patients may represent clinical targets for treatment and intervention.

B-33

On the Moderating Role of Mood Disorder in Patients with Pain Disorder and Its Impact on NeuropsychologicalFunction

Zakzanis K, Gammada E, Jeffay E, Yeung E, Amirathavasagam S, McDonald K

Objective: The present study examined the moderating role of psychological impairment in patients with pain disorder and its

impact on neuropsychological function. More specifically, we set out to determine whether reliable differences exist in terms of

neuropsychological functioning between patients with pain disorder reporting psychological impairment and patients with pain

disorder without any psychological concerns. Method: Archival data were obtained from a random sample of litigating, but

non-feigning patients who sustained a traumatic injury (e.g., soft tissue, fracture, whiplash, but no traumatic brain injury)

as a result of a motor vehicle accident. A total of 63 patients who had undergone a comprehensive neuropsychological exam-

ination were included in this study. Participants in this study were given a host of omnibus measures related to neuropsycho-

logical and psychological functioning, in hand with symptom validity measures. Based on their test findings and subjective

report within the context of a clinical interview, these patients were grouped into two groups: (a) patients suffering from

pain with no psychological complaints (n ¼ 21) and (b) patients suffering from pain who also endorsed psychological


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impairments (n ¼ 42). Results: We found significant differences between the two groups on measures of neuropsychological

functioning, reported pain severity, and in terms of various aspects of personality. Conclusion: Understanding the moderating

role of mood disorder in patients with pain disorder and its impact on neuropsychological function can help the practicing neu-

ropsychologist in terms of a differential diagnosis and in terms of directing treatment.

B-34

Pseudo-Dementia Secondary to Generalized Anxiety Disorder

Hertza J, Bell C, Estes B, Schiff W

Objective: The objective of this study was to explore the utility of neuropsychological assessment in determining dementia

versus pseudo-dementia. Pseudo-dementia refers to reported symptoms of memory loss caused by psychiatric disturbance

rather than a neurodegenerative disorder. Pseudo-dementia is often characterized by vague memory complaints, bradyphrenia,

and bradykinesia of a less insidious onset than is often seen in true dementias. Treatment typically involves psychotherapy,

medication, or a combination. Method: A 58-year-old, right-handed, Caucasian female was assessed in a hospital setting fol-

lowing neurologist diagnosis of a dementia. Patient reported changes in cognitive abilities 1–2 years ago with difficulty sus-

taining attentional focus, completing simple mathematics, switching topic, staying mentally organized, recalling where she

placed personal objects, and recalling new information. Frank repeating was reported by family members as were word-finding

difficulties. Personality changes were noted, with social withdrawal, new onset of ruminative thoughts, and high levels of

anxiety. Archival neuropsychological data, de-identified history, and neurologist report conducted pre- and post-treatment

for anxiety will be organized and presented in a single study case summary. Evaluation procedures included administration,

scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Pre-treatment assessment revealed

several areas of mild relative impairment in executive functioning (complex attention, processing speed, and verbal fluency)

and variable verbal memory with significant depression and anxiety. Post-treatment assessment revealed generally intact cog-

nitive abilities. Conclusion: Neuropsychological assessment is an extremely effective tool in differentiating between a true neu-

rodegenerative condition and a pseudo-dementia.

B-35Case Studies: Pre- to Post-Neuropsychological Assessment in Patients Reporting Catastrophic Post-ECT Memory Loss

Bayless J, McCormick L, Long J, Brumm M, Lewis J

Objective: It has been reported that given advances in safety and efficacy of electroconvulsive therapy (ECT), cognitive issues

have emerged as the main clinical concern. We have implemented a brief (,45 min) battery to evaluate neurocognitive func-

tions in patients prior to undergoing ECT based on the Repeatable Battery for the Assessment of Neuropsychological Status

and other selected measures of working memory, initiation, and mental flexibility. A previous group study indicated that ECT

resulted in significant improvement in depressive symptoms, with most measures of cognitive functioning showing net gains

following ECT. It is particularly important to investigate specifically the individual cases of patients complaining of cata-

strophic post-ECT memory deficits. Method: We present two such clinical cases of patients who were assessed prior to the

initiation of ECT and again 3.5 and 5 months later, respectively (later assessments were conducted as well). Following

ECT, both participants complained of generalized cognitive decline, with one participant reporting complete amnesia for a

very significant event (autobiographical memory deficit). Results: In both cases, comparison of pre- and post-ECT results pro-

vided no evidence for systematic deterioration of mental status, with improvements in most cognitive measures. Conclusions:

Findings were discussed in terms of feasibility/patient tolerance as well as clinical utility.

NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: TREATMENT AND REHABILITATION

B-36Sensory Modulation, A Neuropsychologically-based Intervention

Benigno A, Leigh K, Drexler M, Weiss E

Objective: To review the neuropsychological mechanisms and evidence for efficacy of sensory–motor groups as an intervention

for patients with SMI experiencing sensory dysregulation. Exploration of this topic is timely in that sensory processing disorders

are likely to be included as a new diagnostic category in DSM-V. Data selection: A review of the occupational therapy and neu-

ropsychological literature focusing on sensory integration with results as measured by fMRI, EEG, and the Adult/Adolescent

Sensory Profile (A/ASP), as well as review of the relevant neuropsychological and neurological mechanisms of sensory inte-

gration. Data synthesis: Sensory–motor groups, based on A. Jane Ayres’s theory of Sensory Integration (Ayres, 1972), increase

the likeliness of recovery by effectively addressing dysregulation (i.e., decreased attention, aggression, impulsiveness, etc.) often


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found in the SMI population (Ogden, Pain, & Fisher, 2006). Consistent with Ayres’s theory, multiple sources attribute dysregula-

tion to CNS and PNS inefficiency; this inefficiency includes the presence of underreactive or overreactive responses to sensory

information (Blakeney, Strickland, & Wilkinson, 1983; Brown, Tollefson, Dunn, Cromwell, & Filion, 2001; MacRae, 2005)

which may result in the misinterpretation of sensory information, disorientation, decreased visuo-spatial skills, poor visual percep-

tion, altered body scheme, and astereognosis. Sources are mixed but suggest neurological changes as shown on fMRI and EEG

following interventions, and anecdotal information from our group shows notable changes in mood, outlook, and ability to

attend to stimulation appropriately. Conclusions: Evidence suggests that sensory–motor groups are effective for this population.

This corroborates the results observed in an inpatient unit. Recommendations for further research are included.

B-37

Cognitive Change Following Bone Marrow Transplant for Multiple SclerosisBharadia V, Walker L, Freedman M, Atkins H

Multiple sclerosis (MS) is an autoimmune disease routinely treated with immunomodulators. A sub-population of patients,

however, demonstrate mounting disability despite pharmacotherapy. Bone marrow transplantation (BMT) is an immunoabla-

tive technique that reconstitutes the immune system to slow, halt, or reverse MS pathology at a cellular level.

Neuropsychological testing was added to the protocol to evaluate the impact of BMT on cognition. Objective: To determine

the extent and severity of cognitive dysfunction and to determine if BMT impacts cognition. Method: Seven participants were

assessed before and after 2 months BMT with neuropsychological measures from various cognitive domains. Results:

Seventy-one percent show impairment on one or more cognitive measures at both time points. Forty-three percent and 57%

show impairment on five or more measures at baseline and follow-up, respectively. Cognitive domains prone to impairment

include processing speed, immediate visual memory, expression of conceptual reasoning, and semantic fluency. Decline

was evident in all participants on at least one cognitive measure at follow-up, with 86% demonstrating decline on at least

three measures. Immediate visual recall, attainment and expression of conceptual reasoning, and phonemic and semantic

verbal fluency declined as measured by practice-adjusted reliable change indices. Conclusions: Findings are consistent with

literature documenting cognitive impairment in a large proportion of individuals with MS. The deterioration of cognition

over time was representative of the early recovery phase following BMT. Follow-up of patients by our group shows stable

or improved neurological function over time. Further longitudinal follow-up of cognition will evaluate whether eventual neu-

ropsychological change proceeds in parallel with this neurological outcome.

B-38

Pediatric Outcomes in Neurorehabilitation

Jackson A, Perna R, Cooper D

Children often have a better prognosis from mild brain injury, but there is limited research on child outcomes following severe

brain injury and there are often a diverse array of cognitive and behavioral symptoms in children. The research hypothesis in

this study is that children will have significant neurorehabilitative gains across multiple domains of functioning as measured by

the Mayo Portland Adaptability Inventory-4 (MPAI-4). Children (N ¼ 49, 26 boys and 23 girls) involved in neurorehabilitation

and completed the MPAI-4 at admission and discharge. Mean age is 14.8 years and mean grade level is 9. Most participants had

TBIs (68%) which were severe (63%) and 32% of participants had one of three other CNS disorders (epilepsy, infection, post-

tumor resection). The average length of stay was 252 days. After discharge, there was a 90-day follow-up call to parents regard-

ing if their child was improving, stable, or worse since discharge. Children’s discharge scores were statistically significantly

lower on all MPAI subscales suggesting improved functioning (physical/cognitive ability 49.6–46.8, community participation

48.4–46.5, psychosocial adjustment 49.3–46.1), however the magnitude of difference is smaller than the adult treatment

effects and may not represent clinically significant gains. Total MPAI-4 scores were significantly lower for 44 of 49 children

at discharge. Children’s MPAI-4 score change (treatment effect size) was compared with the adult score change and was sig-

nificantly smaller (2.9 versus 5.0 Total MPAI score points), despite similar length of stay and time since injury. Data suggest

that pediatric ABI outcomes are complex and likely require multiple instruments to adequately measure.

B-39

A Test of the Health Belief Model: The Ability of Barriers, Benefits, Susceptibility, and Severity Perceptions to Predict

Parental Adherence to Pediatric Assessment RecommendationsLau D, Lyons H, Culotta V, Griffith K, Coiro M, Papadakis A, Weden S

Objective: This study explored the utility of the Health Belief Model (HBM) as a predictor of parents’ adherence to recommen-

dations made by mental health professionals after a pediatric neuropsychological evaluation. Method: The sample was made up


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of 40 parents seeking a neuropsychological evaluation for their school-aged children aged 5–18 at a private practice or com-

munity setting in Baltimore, MD. There were no additional exclusion criteria for the purpose of this study. Well-established

measuring instruments, with confirmed reliability and validity, were used to assess each component of the four constructs of the

HBM (i.e., perceived severity, perceived susceptibility, perceived benefits, and perceived barriers) and adherence to neurop-

sychological assessment recommendations. Results: The major findings were that (a) perceived behavior severity, perceived

susceptibility to future problems, perceived benefits of following recommendations, and perceived barriers were not signifi-

cantly associated with adherence to neuropsychological evaluation recommendations. (b) Adherence rates were not signifi-

cantly different between home-based recommendations and service-related recommendations. Conclusions: Although the

study had a number of limitations, the results suggest that although the constructs of HBM often predict adherence to

medical regimens, the HBM does not appear to predict adherence to recommendations made by mental health professionals

after a neuropsychological evaluation. Studies examining adherence to recommendations after psychological assessment is

scant. Thus, future studies may want to look at additional predictors of adherence to recommendations in the hopes of improv-

ing adherence rates.

B-40

The Effect of a Goal-Focused Intervention for Everyday Action in Schizophrenia

Sestito N, Brennan L, Benjamin T, Ciaudelli B, Fanning M, Giovannetti T, Chute D

Objective: Executive functioning is a strong predictor of everyday action abilities in schizophrenia. Previous research has

shown that patients with schizophrenia show a unique performance on the Naturalistic Action Test (NAT), a measure of

everyday action, which consisted of a high number of off-task errors consistent with executive dysfunction. This study

examined that whether or not an intervention aimed at remediating executive deficits would positively impact everyday

action performance in individuals with schizophrenia. Method: The sample consisted of 23 participants with a diagnosis

of schizophrenia or schizoaffective disorder who were recruited from inpatient psychiatric units. Participants were ran-

domly assigned to two groups, and they performed the NAT at a baseline session and again after either the intervention

or a placebo-controlled session. Each participant also received a short battery of neuropsychological tests. Results:

Group-by-time analysis of variance (ANOVA)s showed that patients who received the intervention did not show greater

overall performance on the NAT (p ¼ .79), did not commit fewer errors (p ¼ .91), and did not accomplish more of the

steps (p ¼ .81) than patients who received a placebo-controlled intervention. Effect sizes were also small. Conclusion:

The hypothesis that this intervention would help improve patients’ performance on the NAT was not supported.

Because this intervention worked previously in a brain-injured population with executive dysfunction, these results may

indicate that patients with schizophrenia differ fundamentally from other patient populations in their underlying pathology.

Because of the severe functional impairments present in schizophrenia, future research should continue to investigate

different cognitive intervention strategies and their effectiveness.

B-41Neuropsychological Profiles as Predictors of Treatment Response in Chronic Depression

Vathhauer K, Steh B, Osuji J, Steh B, Katz D

Mood disorders are associated with cognitive deficits, and reports indicate that repeated (chronic depression) depressive

episodes might actually have the most deleterious impact on cognition. Neuropsychological instruments successfully

characterize cognitive functions, whereas cognitive therapy and its many variants, including cognitive-behavioral

therapy (CBT), have demonstrated effectiveness and efficacy in treating depressive disorder. In a proof-of-concept inves-

tigation, 25 participants with recurrent/chronic major depressive disorder were recruited to receive manualized CBT (Mind

Over Mood). Baseline evaluations included the NEO PI-R, a test of normal personality traits, and a selected battery of

neuropsychological measures designed to be brief, but comprehensive of the cognitive domains (attention/concentration,

processing speed, and learning/memory) reportedly affected by depression. A prerequisite for enrollment in the study

was current, unsuccessful treatment with an antidepressant, which was defined by an entry score of 17 or higher on the

Hamilton Rating Scale for Depression (HRSD). California Verbal Learning Test-II (CVLT-II), Trail Making Test

(TMT-B), Stroop Color & Word Test, and the Brief Visuospatial Memory Test-Revised (BVMT-R) were among the neu-

ropsychological tasks administered at baseline and at the conclusion of the 12-week intervention. The neurocognitive and

NEO PI-R variables were compared using an area under the curve and random regression analysis that used all of the

available data. Neuropsychological measures of fluency and impulse control appeared to predict treatment response, as

did a few factors from the NEO PI-R. Our findings suggest that neuropsychological instruments could have a role in

the diagnosis and appropriate treatment of chronic depression.


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B-42

The Effect of a Speed of Processing Intervention on Adults with HIV

Ackerman M, Vance D, Fazeli P, Ross L

Objective: Those aging with HIV are more vulnerable to cognitive and functional deficits. In this study, 52 middle-aged

and older adults (Mage ¼ 51.5 years; range 40.7–70.6 years) with HIV were randomly assigned to a visual speed of pro-

cessing training condition or a no-contact control condition to determine the effectiveness of this intervention. Method: In

the visual speed of processing training condition, participants received 10 hr of computerized visuo-cognitive exercises. At

baseline and post-test, the following measures were administered: Useful Field of View (UFOVw) Test, Wisconsin Card

Sorting Test, Finger Tapping Test, and the Timed Instrumental Activities of Daily Living (TIADL) Test. Results:

Controlling for baseline performance, analysis of covariance (ANCOVA)s were used to examine treatment effects on

these measures between the two groups at post-test. Treatment effects were detected on UFOVw (F(2, 40) ¼ 5.61, p ¼

.022); the visual speed of processing training group improved on their UFOVw performance. Furthermore, transfer of train-

ing was observed on the TIADL Test (F(2, 37) ¼ 4.104, p ¼ .05); the visual speed of processing group improved their

speed and accuracy in performing these laboratory instrumental activities of daily living. Next, we examined the relation-

ship between the cognitive measures and performance on the TIADL Test; only baseline (r ¼ .52, p ¼ .001) and post-test

(r ¼ .48, p ¼ .001) UFOVw scores were significantly related to baseline and post-test TIADL performance, respectively.

Conclusions: This study emphasizes that computerized cognitive remediation therapy may benefit cognitive and everyday

functioning in this growing population.

B-43Development of a NeuroCognitive Enrichment Program as an Adjunct to Traditional Behavioral Health

Therapies

Strang J, Strauss A, Bienia K, Hollingsworth D, Ensley M

To meet the growing demand for behavioral health services for service members returning from the wars in Iraq and

Afghanistan, we developed a NeuroCognitive Enrichment Program as an adjunct to traditional behavioral health treatment

modalities. In this poster presentation, we will discuss advances in the treatment of traumatic brain injury (TBI) and post-

traumatic stress disorder (PTSD), with an emphasis on cognitive retraining and neurofeedback methods. In addition, we

will discuss the development of our neurocognitive program and present pre- and post-treatment data on a subset of participants

diagnosed with PTSD and/or TBI. In particular, we are interested in the effects of the therapies on participants’ self-report of

quality of life, perceived control, and psychological well-being.

B-44Long-term Neuropsychological Sequelae Following Electrical Injury: Preliminary Results of the Initial Phase of a

Longitudinal Research Study

Atkins J, Grigorovich A, Bell C, Fish J, Hertza J, Leach L, Schiff W, Gomez M, Estes B, Dennison A

The purpose of this study was to determine the nature and prevalence of neuropsychological and psychiatric sequelae fol-

lowing electrical injury. Electrically injured patients were recruited from the outpatient clinic of a rehabilitation hospital

between January 2008 and March 2010. Patients completed psychological questionnaires measuring depression, anxiety

and post-traumatic stress disorder (PTSD), and a series of standardized psychometric measures of neuropsychological func-

tioning. Student’s t-tests and regression analyses were conducted to examine the effects of injury factors and psychiatric

symptoms on neuropsychological functioning. Twenty-four patients (23 males and 1 female) were studied, with a mean

(+SD) age of 44.2 + 10.4 years and mean education of 11.9 + 2.5 years. They were evaluated on average 38.0 +47.9 months post-injury, and high-voltage electrical injury was the most frequent etiology (62.5%). Psychiatric symptoms

were found in 18 (73.9%) patients, of which depression and PTSD were the most frequent (73.9%), followed by anxiety

(65.1%). The majority (65.2%) of patients experienced a combination of depression, anxiety, and/or PTSD. Younger (24–

44 years) patients had significantly more anxiety and PTSD symptoms than older (45–64 years) patients (p , .05).

Patients tested more than 1 year post-injury had significantly poorer performance in processing speed and semantic

fluency (p , .01). Those with psychiatric symptoms had significantly worse scores in language, attention, processing

speed, visual spatial ability, and memory (p , .05), than those without psychiatric symptoms. These findings support

the conclusion that psychiatric symptoms and neuropsychological deficits in language, visual spatial ability, visual

memory, and processing speed are common following electrical injury. A larger, multi-center, longitudinal study is war-

ranted to further explore these findings.


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NEUROPSYCHOLOGICAL DOMAINS: OTHER

B-45What Does Naming Pictures of Objects Measure for Preschool Children?

Davis A, Roberds E, Lutz J, Byerley A, Mazur-Mosiewicz A

Objective: The Naming Pictures of Objects subtest on the Dean–Woodcock Sensory Motor Battery (DWSMB) is listed with

the sensory tests and can be useful in assessing sensory–motor dysfunction such as visual agnosia, oral-motor dyspraxia, or

dysarthria. The simplicity of the stimuli pictures should theoretically increase the dependency of sensory–motor functioning

and minimize the impact of language skills. The purpose of this study was to test this hypothesis for preschool children.

Method: Participants were 31 preschool children (mean age 4.53 years, SD ¼ .31 years). All participants completed the

Phonological Processing and Speeded Naming subtests from the NEPSY and the DWSMB as part of a reading study.

Results: There were five significant correlations between the Naming Pictures of Objects subtest and 16 sensory subtests

from the DWSMB. The mean of these correlations was .280. There were two positive correlations between the Naming

Pictures of Objects subtest and 12 motor subtests from the DWMSB. The mean of these correlations was .246. The correlation

between the Naming Pictures of Objects and Speeded Naming and Phonological Processing was 2.232 and .461, respectively.

Linear regression showed that Speeded Naming predicted a significant proportion of the variance in the Naming Pictures of

Objects subtest (R2 ¼ .188, p ¼ .015). Conclusions: The results suggest that although Naming Pictures of Objects seems

related to sensory and motor skills, there is a large rapid automized naming component. This was expected given that preschool

children will not find the stimuli as linguistically simple as older children and adults. The implications will be discussed for

practitioners and researchers.

B-46

Semantic Learning Strategy on the California Verbal Learning Test (CVLT)

Davis M, Sutton S, Moses J

In the present study, we were looking for the relationship of semantic clustering to a variety of CVLT recall variables, rate of

learning, education level, and the attention and verbal ability measures of the Wechsler Adult Intelligence Scale-Revised

(WAIS-R). Verbal intelligence and education level were expected to be primarily associated with semantic strategy, and a rela-

tively lesser use of semantic strategy would be individual of attention and concentration ability. We found strong systematic

and specific factorial relationships among the CVLT short-term free and cued recall variables, long-term free and cued recall

variables, CVLT Slope, CVLT semantic clustering, and the WAIS-R FFD factor scale. All of the variables were dimensionally

individual of the WAIS-R verbal comprehension factor score and education level. It was concluded that short-term and long-

term recall rate of learning and use of a logical semantic learning strategy were primarily associated with attention and con-

centration ability rather than verbal comprehension and education level in our diagnostically and demographically diverse, neu-

ropsychiatric sample.

B-47

An Investigation of Head Accelerometry, Cognitive Function, and Brain Blood Flow during Intercollegiate Boxing and

Its Impact Regarding Head Injury Assessment in CombatDoan B, Hanna M, Adam G, Wile A, Butler M, Self B, Heaton K, Brininger T

Objective: The goal of this study was to investigate head impacts, neuropsychological performance, and cerebral blood flow in

intercollegiate boxers to increase understanding about consequences of head impacts in this population. If significant corre-

lations were found between measures, recommendations for increasing efficiency of head impact assessment in combat

environments might be made. Method: Participants were 31 intercollegiate male boxers with a mean age of 20.74 years,

height 70.14 in., weight 164.32 lbs., and experience 1.5 years. Assessments occurred before and after two full-effort 2-min

sparring rounds. The Impact Headgear system tracked location/number of head impacts, translational acceleration, and

rotational forces. The ImPACT test and Automated Neuropsychological Assessment Metrics (ANAM) measured neuropsycho-

logical performance and the Brain Acoustic Monitor (BAM) measured cerebral blood flow. Sparring bouts were videotaped to

validate head impacts. Results: Impact Headgear recorded an average of 26.81 impacts per boxer, most of which were below

the 25% probability for brain injury. The ImPACT test showed a decrease in verbal memory (p , .05), delayed memory (p ,

.01), and improved reaction time (p , .01). The ANAM showed a decrease in delayed memory (p , .01) and improved reac-

tion time (p , .01). BAM detected no significant changes, and no significant correlations were found between the BAM and

the neuropsychological measures. Conclusion: In the current sample, head impacts were below threshold to cause brain dis-

turbance detectable through BAM; however, consistent with research in amateur boxing, mild decline in memory function


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was detected. Research with a larger sample across greater impacts is recommended to further investigate the efficacy of the

BAM.

B-48

The Influence of Thyroid on Cognition in a Sample of Hispanic and Non-Hispanic Rural Dwelling WomenEdwards M, Johnson K, O’Bryan S, Williams J, Joes K

Objective: The aim of this study was to examine the relation of thyroid markers (TSH and FT4) and cognition in a sample of

Hispanic and non-Hispanic rural dwelling women. Methods: Project FRONTIER is a community-based participatory research

project studying rural health. Data were analyzed from 198 enrolled women (Hispanic: n ¼ 75; non-Hispanic: n ¼ 121).

Thyroid function was assessed using TSH and FT4 markers. Cognition was assessed using the Repeatable Battery for the

Assessment of Neuropsychological Status (RBANS). Data were analyzed using linear regression. Age was entered into the

model as a covariate. Results: TSH was related to neuropsychological functioning in Hispanic women, but not in

non-Hispanic women. In Hispanic women, TSH levels were negatively related to the RBANS Attention Index and

Language Index, indicating that elevated TSH levels were related to poorer Attention and Language scores. The reFT4

levels were not significantly related to neuropsycholgical functioning. In non-Hispanic women, neither TSH nor FT4 levels

were related to RBANS scores. Age did not significantly influence the results of this study. Conclusions: The current study

demonstrated a significant association between TSH and neuropsychological functioning for Hispanic women only. As few

studies have examined the relationship between thyroid functioning and cognition in an ethnically diverse sample, this

study provides new insights regarding the relation of thyroid functioning on cognition in rural Hispanic women.

B-49

A Factor Analytic Investigation of a Four-Factor Component Model of Right–Left Orientation and Judgment of Line

OrientationFrazier D, Moses J

The study employed a confirmatory approach to investigate correlations between performances on two measures thought to be

associated with spatial orientation. A factor analysis was conducted for A.L. Benton’s right–left orientation (RLO) and judgment

of line orientation (JLO) among a demographically mixed, heterogeneous neuropsychiatric sample. Items obtained from RLO were

utilized to construct four component variables: (1) identifying single left parts of the confronting examiner, (2) identifying single

right parts of the confronting examiner, (3) executing double uncrossed commands, and (4) executing double crossed commands.

These variables were factor analyzed with total performance on JLO. Factor analysis indicated JLO performance to be vastly inde-

pendent of the four component variables of RLO, with 94% of the variance explained. Contrary to the supposition of a shared inter-

dependence between visuospatial and proprioceptive skill, findings suggest that these abilities are highly independent of each other,

indicating that both RLO and JLO uniquely contribute information with regard to neuropsychological status.

B-50Cognition in Polysubstance Users with Hippocampal-Associated Anomalies: An Urban Case Series

Giesbrecht C, Nielson H, Barone C, Thornton A, Vila-Rodriguez F, Paquet F, Barr A, Vertinsky T, Lang D, Honer W

Objective: This case series examines marginalized chronic polysubstance users with multiple physical and mental illnesses.

Neuropsychological and neuroimaging findings are used to document the cases. We describe polyetiologic factors that may

contribute to the observed impairments. Method: Three cases were selected from a larger study (n ≈ 200) examining residents

living in single-room occupancy hotels in a Canadian urban setting. Using MRI scans, individuals were selected for hippocam-

pal anomalies, based on size and location of fluid-filled spaces which are not typically seen in normal hippocampi.

Abnormalities outside the hippocampus included white matter hyperintensities, prominent Virchow-Robin spaces, and cortical

atrophy. All three cases tested positive for hepatitis C and negative for HIV. Psychiatric diagnoses included cocaine depen-

dence and substance-induced psychosis. Neurocognitive measures evaluated information processing, sustained attention,

motor functioning, executive functioning, and memory. Results: Cognitive deficits (including severe memory impairments)

were evident in the context of premorbid ability estimates that fell within normal limits, with predicted FSIQ ranging from

90 to 110. Interestingly, impairment profiles differed across the three cases. Despite chronic heavy substance use and identifi-

able hippocampal anomalies, memory was not universally impaired in this series. Indeed, performance on a memory measure

(Hopkins Verbal Learning Test [HVLT]) ranged from normal to 3 SD below the standard mean. Conclusions: This case series

illustrates a range of neurocognitive impairments and neuroanatomical aberrations in marginalized urban dwellers engaged in

chronic polysubstance use. Our observations reveal the complexity and challenges inherent in the evaluation of this cohort,

particularly with reference to the potential etiological factors contributing to variation in the cognitive profiles.


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B-51

Employment-Focused Neuropsychological Assessment: Implications for Autism Spectrum Disorder (ASD), Job

Coaches, and EmployersHart J, Lavach J

Objective: Social, communication, motor, and cognitive deficits of autism, a complex neurodevelopmental disability, are typi-

cally identified by age 3. In 1980, the American Psychiatric Association added autism to known mental disorders, and federal

law mandated programs for school-age children. However, there are limited federal initiatives to support the new face of

autism—the young adult. Seventy-six percent of teenagers with Autism Spectrum Disorder (ASD) over 16 have never

applied for a job and 79% of adults with ASD live at home. Wages for disabled workers are linked to productivity—not

hours worked—and 90% live in poverty. A transition program for school-age students of 14 and older offers an entry into

the work world while receiving services through their schools. Method: Participants included six public school ASD students,

aged 14–16. Each received a neuropsychological evaluation including the NEPSY-II, Wechsler Intelligence Scale for

Children-Fourth Edition (WISC-IV)-Integrated, and personality assessment. Neuropsychological profiles identified cognitive,

psychomotor, and affective characteristics. Six employment sites were identified for part-time placement, 2 days per week, for

the scholastic year. Sites included a golf course, theatre, grocery store, library, and town hall. A counselor was assigned as job

coach/social facilitator/translator among the employer, co-workers, and participants. Analysis of the neuropsychological

strengths and occupational preferences was matched with position demands, employer support, possible environmental modi-

fications, task analysis, and training procedures. Results: Five of the six participants received favorable evaluations and con-

tinued on through the summer. Conclusion: Awareness of individual neuropsychological strengths, co-morbidity, and

idiosyncratic behavior resulted in decreased miscommunication and a successful experience with the world of work.

B-52

Are There Adverse Effects of Multiple Chronic Medical Conditions on Cognition?

Hietpas-Wilson T, Pella R, McCoy K, VanBuren K, Hilsabeck R

Objective: An emerging literature suggests that there may be an additive negative effect of chronic medical conditions (CMCs)

on cognitive functioning. The purpose of this study was to extend this literature, which suggests that multiple CMCs have a

negative impact on attention, by using a more comprehensive battery to examine processing speed, attention, and executive

functioning. Method: A mixed clinical sample of 111 veterans with valid performances on the Test of Memory

Malingering (TOMM) but no conditions with known neuropathology was seen for neuropsychological evaluation.

Participants were placed into three groups of approximately equal size based on number of CMCs: ≤2 (n ¼ 31), 3–4 (n ¼

38), and ≥5 (n ¼ 42). Composite domain T-scores for processing speed, attention, executive functioning, language, visuoper-

ception, and memory were calculated and analyzed using analysis of variance (ANOVA). Results: There were no significant

group differences in gender, education, or ethnicity, but the 3–4 CMC group was significantly younger than the other two

groups (M ¼ 48.76 vs. M ¼ 55.35 for the ≤2 group and M ¼ 59.93 for the ≥5 group). Using age as a covariate, there were

no significant group differences on any of the domain T-scores. Conclusion: Contrary to the current literature, the results of

this study did not replicate previous findings of an additive negative effect of CMCs on cognitive functioning. Differing

results may be due to sample composition and the definition of what constitutes a chronic medical condition.

B-53

A Neuropsychological Perspective on the Comorbidity of Anxiety and Behavior Disorders

James S, Robillard R, Holder C

Objective: The U.S. Department of Education estimates that nearly 439,000 students in the United States are served in special

education under the category of emotional disturbance. Within this classification, however, there is rarely a documented dis-

tinction between internalizing and externalizing disorders, likely because internalizing disorders only affect the individual and

are therefore not addressed in the school system. As a result, when children and adolescents are experiencing both externalizing

(disruptive behaviors) and internalizing (anxiety) symptoms, the system fails to recognize and treat the internalizing symptoms.

This poster will explore the relationship between disruptive behaviors (i.e., oppositional defiance and conduct problems) and

anxiety in children and adolescents, and will propose a case for comorbidity that is useful in treatment for disruptive behavior

disorders. Data selection: Reviews of literature and empirical studies were synthesized as data sources if they specifically

addressed neurological, environmental, or developmental differences in the development of anxiety and disruptive behaviors

in child or adolescent samples. Empirical studies were constrained to the last decade in order to make use of the most advanced

findings. Data synthesis: This review identified shared neurological underpinnings of anxiety and disruptive behaviors, as well

as empirically supported interventions that have been successfully applied to both disorders. Conclusions: A strong case for the


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comorbidity of anxiety disorders and disruptive behavior is presented in this review, and makes the argument for empirical

research to support the conclusions.

B-54

Analyses of Verbal Intellectual Ability within the Wechsler Adult Intelligence Scale-Revised, Boston Naming Test, andthe California Verbal Learning Test (CVLT) among United States Veterans

Long M, Sandhu K, Padua M, Moses J

Objective: Verbal intellectual ability, as well as years of formal education, has been empirically predictive of how well an

individual utilizes either a serial or semantic learning strategy. The dimensional relationships between demographic variables

(age and years of education), factors of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) (VCI and FFD), Boston

Naming Test total score, and utilizing serial or semantic clustering on the California Verbal Learning Test (CVLT) were exam-

ined. Method: An unselected serial sample of 347 U.S. veterans were clinically referred for neuropsychological assessment

within the Palo Alto VA Healthcare System. No exclusion criteria were used. These veteran patients exhibited mixed

medical and neuropsychiatric diagnoses and were administered the WAIS-R, Boston Naming Test, and the CVLT. Factor

scales were derived from the test variables. First, VCI (as a measure of verbal intellectual ability) was grouped with years

of education and FFD (as a measure of attention span) was grouped with age; Boston Naming Test total score, CVLT

serial clustering, and semantic clustering were then each individually factored in. Robust factorial relationships were found

between Boston Naming Test and the VCI/education factor, and between the FFD/age factor with CVLT clustering (serial

or semantic). Results: Analyses resulted in the finding that the ability to use either semantic or serial clustering, on the

CVLT, is independent of verbal intellectual ability and education. Dimensionally, verbal intellectual ability is better predicted

by attention span (FFD) within this sample (r2 ¼ 63.43). Conclusion: These results suggest implications for interpretation of

the CVLT learning strategies in combination with intellectual and demographic variables.

B-55

Does Neuropsychological Impairment Overrule Sex Differences in Processing Speed Within a Pediatric Sample?

Lutz J, Mazur-Mosiewicz A, Dean R

Objective: Recent research involving the Woodcock–Johnson Test of Cognitive Abilities has suggested that significant proces-

sing speed differences exist between sexes in a normal sample (Camarata & Woodcock, 2006). The present study explores the

differences in processing speed between sexes in a sample of neuropsychologically impaired children and adolescents. Method:

Independent sample t-tests were utilized to compare processing speed differences between sexes in children with neuropsycho-

logical disorders. Group 1 (n ¼ 79) included children ages 5:0 to 6:11, group 2 (n ¼ 489) included children ages 7:0 to 9:11,

and group 3 (n ¼ 535) included children ages 10:0 to 13:11. All children were administered the Dean–Woodcock Sensory

Motor Battery and the Woodcock–Johnson Test of Cognitive Abilities-Third Edition. Results: There were no significant differ-

ences in processing speed between sexes in either group 1 (t(77) ¼ .203, p ¼ .84) or group 2 (t(487) ¼ .409, p ¼ .68).

However, there was a significant difference in processing speed scores between sexes for group 3 (t(533) ¼ 22.02, p ¼

.44). Within this group, girls (M ¼ 502.51, SE ¼ 1.69) demonstrated better processing speed than boys (M ¼ 497.84, SE ¼

1.58). However, the effect size for this difference was small (r ¼ .09). Conclusions: According to our findings, children

with neuropsychological disorders may not demonstrate the same processing speed differences observed between boys and

girls without such impairment. Although processing speed differences were found in the 10–13 age group, the small effect

size suggests that there is likely little clinical utility to the finding.

B-56

Neuropsychological Profile Comparisons of Anosognosic and Alexithymic Individuals

Olivier T, Nemeth D, Whittington L, May N, Hamilton J, Steger A

Objective: Anosognosia is currently defined as a “commonly occurring unawareness of cognitive, linguistic, sensory, and

motor deficits after focal injuries (e.g., Wernicke’s aphasia) or conditions affecting the CNS more diffusely (e.g., traumatic

brain injury and dementia)” (Loring, 1999, p. 14). Conversely, alexithymia, a condition characterized by “difficulty in recog-

nizing and describing one’s emotions” (Loring, 1999, p. 10), causes “disruption of both affective and cognitive processes.”

Individuals diagnosed with alexithymia are often “incapable of expressing emotions in the sense that, while the emotion

may be experienced . . . it cannot be associated with a mental representation and so formally expressed” (Beaumont,

Kenealy, & Rogers, 1999, p. 43). This poster highlights the neuropsychological profiles of two clinical cases. Method: Two

neuropsychological evaluations were conducted. The first is a 68-year-old Caucasian female, who suffered a mild

Traumatic Brain Injury (mTBI) following a motor vehicle accident (MVA). This woman believed that she was “just fine”


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and that “nothing was wrong.” The second is a 55-year-old male, diagnosed with alexithymia, had no history of neuropsycho-

logical involvement, but did exhibit suicidal ideation and action (i.e., he bought a gun) and was psychiatrically hospitalized for

6 weeks. Results: Normal and impaired neuropsychological data for each case example will be presented. Conclusion: The first

individual’s anosognosia compromised effectiveness of outpatient rehabilitation (e.g., missing appointments, refusing to take

medicine). The second individual’s alexithymia compromised the effectiveness of inpatient treatment (e.g., inability to cope

with others’ intense emotions, lack of affective awareness that interfered with integrated problem solving).

B-57Self-Reported Information Processing Speed Deficits in Multiple Sclerosis: Association with Neuropsychological

Functioning, Emotional Status, and Personality

Roberg B, Hancock L, Jacobson J, Tyrer J, Lynch S, Bruce J

Objective: Information processing speed (IPS) deficits are common in multiple sclerosis (MS). However, no studies have inves-

tigated whether MS patients accurately perceive these deficits. This study investigated the associations between a Processing

Speed Questionnaire (PSQ) and measures of neuropsychological functioning in a sample of MS patients. Method: Patients

were recruited through a large specialty clinic of a university medical center. Controls were recruited from the community by

word-of-mouth, flyers, and email list servers. The PSQ was administered as part of a comprehensive neuropsychological

battery assessing cognition, emotional functioning, and personality. Results: MS patients (N ¼ 83) reported significantly more

IPS deficits than controls (N ¼ 22, t(21.68) ¼ 6.340, p , .001). Among MS patients, self-reports of slowed IPS were significantly

associated with increased age (r ¼ .28, p ¼ .010). When controlling for age, slowed IPS was significantly associated with low

conscientiousness (r ¼ 2.33, p ¼ .003), and low extroversion (r ¼ 2.50, p , .001), but increased depression (r ¼ .34, p ¼

.002), neuroticism (r ¼ .35, p ¼ .001), and anxiety (r ¼ .43, p , .001). In contrast, PSQ scores were not significantly correlated

with objective tests of IPS. Conclusions: Consistent with our previous research in self-reported memory, self-reported IPS deficits

were not significantly associated with performance on objective tests. However, patients’ PSQ scores did correlate with anxiety,

depression, and various personality traits. Further knowledge of these associations may help clinicians better understand patient

reports of slowed IPS and may contribute to improved assessment and feedback practices in clinical neuropsychology.

B-58

Processing Speed in Collegiate Athletes as Measured by the Wechsler Adult Intelligence Scale-Fourth Edition

Sordahl J, Hertza J, Bell C, Estes B, Schiff W

Objective: The purpose of this research was to examine whether the Processing Speed Index (PSI) subtests of the Wechsler

Adult Intelligence Scale-Fourth Edition (WAIS-IV) would detect differences in collegiate athletes and non-athletes.

Further, the study explored whether there was a relationship between PSI and coaches’ ratings of “decision-making speed”

among their athletes. Methods: Participants included fifty-five 18–24-year-old college students from a private university. A

collegiate athlete subgroup included 20 players from the men’s baseball team and 17 from the men’s soccer team. A contrast

group included 18 students from a humanities course. The WAIS-IV PSI subtests were administered to all participants. Coaches

were asked to complete two Likert scale ratings of their athletes’ speed of problem-solving while engaged in their sports

activity. Results: One-way analysis of variance (ANOVA) indicated no significant differences between the collegiate athletes

and non-athletes using Coding and Symbol Search scaled scores. A bivariate correlation between the coaches’ ratings of ath-

letes’ perceived abilities also showed no relationship with performance on PSI subtests. Discussion: PSI is a construct recently

introduced on Wechsler intelligence scales. Little is said in the test’s manual about what achieving high or low scores mean in

everyday life. Despite intuitive expectations, this investigation showed that PSI is not related to speed in making decisions

while engaged in collegiate sports. This finding raises questions about just what PSI measures. Additional research is underway

to examine the relationship PSI has with other paced, everyday decision-making tasks.

B-59

Neural Correlates of Divergent Thinking

Sousa J, Jerram M, Wiebe-Moore D, Susmaras T, Gansler D

Objective: The objective of this study was to examine the neural correlates of creativity through the Torrance Test of Creative

Thinking (TTCT). It was hypothesized that TCTT would negatively correlate with the corpus callosum and positively correlate

with specific gray matter regions, including parietal lobe, anterior cingulate gyrus, and the inferior frontal gyrus. Methods:

Eighteen male healthy control participants (age range: 25–52, mean age ¼ 40.78, SD ¼ 7.74; 15 right-handers;

college-educated) were sampled from the community via advertisement. High-resolution MRI scans were acquired on a

1.5 T MRI scanner. Participants completed the non-verbal portion of the TTCT as part of a larger cognitive battery.


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Voxel-based morphology was used to analyze regional volumes. Regression analyses of TTCT to volume were restrained

within the anatomic regions identified. Results: Regression identified one significant focus of association with TTCT. This

was located within the right parietal lobe (MNI coordinates: 44, 224, 63; 276 voxels). The relationship indicated that increased

volume was associated with increased scores on the TCTT. No other significant foci were found. Conclusion: This report adds

to the growing body of literature indicating associations of creative or divergent thinking with specific brain regions. Here, a

region of the parietal lobe was found to be positively correlated with a measure of divergent or creative thinking. Based on

theories of parietal lobe function and the requirements of the TCTT, the area observed may be related to the translation of

an internal verbal description to external graphic spatial representation.

B-60

Criterion Validity of the Test of Memory and Learning (TOMAL) in Pediatric TBIVertinski M, Smith L, Thaler N, Mayfield J, Allen D

Objective: Children with traumatic brain injury (TBI) often undergo neuropsychological evaluation to identify neurocognitive

deficits and sparing, as well as to assist in rehabilitation and educational planning. However, for many commonly available

tests, only limited information is available regarding sensitivity to TBI. To address this issue, the current study examined

the criterion validity of the Test of Memory and Learning (TOMAL) in youth that sustained TBI. Method: Participants included

300 children; 150 had sustained moderate-to-severe TBI. They were 11.7 years of age (SD ¼ 3.7) and 57.3% were males. The

remaining 150 were gender- and age-matched controls who were 11.5 years of age (SD ¼ 3.1) and 52.7% were males.

Multivariate analysis of variance (MANOVA) was used to examine the differences between the groups in the TOMAL subtests

and index scores. ROC analysis was used to examine sensitivity and specificity of classification of TBI and control participants

based on TOMAL subtests and indexes. Results: The TBI group scored approximately 1.3 SDs below the control group on most

TOMAL scores. The ROC analysis indicated that Object Recall (OR) had the highest area under the ROC curve at .82, followed

by Memory for Stories Delayed, Visual Selective Reminding, Letters Forward, Digits Forward, and Facial Memory subtests.

Of the indexes, the Composite Memory Index (CMI) proved to be most sensitive, yielding an optimal cutoff score of 83.

Discussion: Findings suggest that TOMAL subtest and index scores show differing levels of sensitivity and specificity to

TBI. Furthermore, the OR subtest and CMI are the most sensitive to deficits following TBI.

B-61

The Relationship Between Self-Reported Cognitive Difficulties and Medication Adherence in Multiple SclerosisBuscher L, Jared B, Hancock L, Roberg B, Tyrer J, Lynch S

Objective: Patients who report missing medications frequently identify problems with memory as a primary cause. To date, no

study has specifically examined the relationship between self-reported cognitive difficulties and adherence to medication regi-

mens in multiple sclerosis (MS). The purpose of this study was to examine the association between self-reported cognitive

difficulties and adherence to medications in MS. Methods: Seventy-two patients with MS were recruited from a local MS speci-

alty clinic and given a complete psychodiagnostic interview. The interview included self-report questionnaires about perceived

cognitive difficulties and auxiliary medication adherence (e.g., psychotropics and spasticity medications). Adherence to

disease-modifying therapies (DMT) was also monitored prospectively for 2 months using Medication Event Monitoring

System (MEMS) caps. Results: Patients who retrospectively reported missing auxiliary medications at the outset of the

study missed significantly more DMT prospectively (Z ¼ 23.98, p , .001). In addition, patients who missed auxiliary medi-

cations reported significantly more processing speed (t(71) ¼ 22.18, p ¼ .035) and memory difficulties (t(71) ¼ 22.97, p ¼

.004) than patients who demonstrated good auxiliary medication adherence. Difficulties with memory and processing speed

were also associated with poorer prospective adherence to DMT (r ¼ .31, p ¼ .007 and r ¼ .26, p ¼ .029, respectively).

Conclusion: Self-reported memory and processing speed difficulties are related to poor auxiliary medication adherence.

Poor adherence to auxiliary medications is also related to worse prospective DMT adherence. Clinicians should note that adher-

ence should be carefully monitored among patients who report cognitive difficulties.

B-62Working Memory and Academic Achievement in Chinese Children with Obstructive Sleep Apnea

Choi W, Lai S, Lau E, Li A

Objective: This study hypothesizes children with obstructive sleep apnea (OSA) would have neuropsychological deficits in

working memory (WM) and lower levels of academic achievement, compared with healthy controls. It is hypothesized

that academic achievement would correlate with working memory performance in OSA children. Method: This is a prospective

study for baseline assessment of WM functions and academic achievement in children. Chinese children with OSA (n ¼ 12),


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and healthy gender- and age-matched controls (n ¼ 12) were recruited from the Sleep Disorders Clinic, Prince of Wales

Hospital, Hong Kong. All children were assessed with verbal/spatial N-back tasks, digit- and spatial-span tasks tapping on

Baddeley’s WM model components, and standardized academic assessment tools on Chinese reading-comprehension and

arithmetic skills. All underwent overnight polysomnographic sleep study (PSG). Between-group comparisons were used to

reveal deficits in WM and academic attainment in the OSA group and relationships between WM and academic attainment

in the OSA group were explored with correlational analyses. Results: Children with OSA had significantly more problems

than healthy controls on verbal 0-back task (t(22) ¼ 2.656, p ¼ .017, d ¼ 1.084). They scored significantly lower on academic

achievement test that measures arithmetic skills (t(22) ¼ 2.150, p ¼ .043, d ¼ .876). Strong correlation was found between

verbal working memory functions and arithmetic test performance among OSA children (r ¼ .704, p ¼ .011).

Conclusion(s): Impairments in verbal working memory and arithmetic skills were found in children with OSA and the two

were highly correlated. Further investigations into specific predictors of working memory and its related deficits and potential

intervention strategies are crucial to reduce long-term adverse effects of OSA in children’s cognitive development and

learning.

B-63

Examining Sex Differences on Concussion Outcomes in High-School and Collegiate Athletes

Covassin T, Elbin R, Kontos A, Larson E

Objective: To investigate sex differences in neurocognitive function and post-concussion symptom scores among con-

cussed high-school and collegiate athletes. Method: A prospective repeated-measures design was used to compare baseline

and post-concussion neurocognitive performance and concussion symptoms. Independent variables were sex (male,

female) and time (baseline and 2 days, 7 days, 14 days post-injury). The dependent variables were the Immediate

Post-concussion Assessment and Cognitive Test (ImPACT) cognitive composite scores (i.e., verbal memory, visual

memory, motor processing speed, reaction time) and total concussion symptoms. Ninety-four concussed athletes with a

baseline ImPACT test completed a follow-up ImPACT test at 2-, 7- and 14-day post-concussion. Repeated-measures

analysis of variance (ANOVA)s were conducted on each cognitive composite score. Results: Results revealed a significant

sex difference in visual memory composite scores (F(3, 32) ¼ 3.53, p ¼ .03). Female athletes demonstrated cognitive

impairments 14 days post-concussion compared with male athletes who demonstrated a return to baseline at 14 days post-

injury. The results also indicated significant sex differences on total concussion symptoms at 7 days post-concussion (F(3,

32) ¼ 5.75, p ¼ .003), as female athletes reported a higher total number of concussion symptoms than males. There were

no other significant sex differences on the other neurocognitive composite scores. Conclusion: Female athletes at both

high-school and collegiate levels may exhibit a more prolonged cognitive recovery and appear to exhibit longlasting con-

cussion symptoms than males.

PROFESSIONAL ISSUES: TEST DEVELOPMENT AND METHODS

B-64

Do the Rey-Osterrieth and Modified Taylor Complex Figures Show Similar Levels of Perceptual Clustering and

Fragmentation?Hubley A

Objective: The Rey-Osterrieth (ROCF) and modified Taylor (MTCF) complex figures generally produce comparable accuracy

scores on learning, memory, and construction but no studies appear to have compared these figures using process scores. The

purpose of this study was to examine whether the figures show similar levels of perceptual clustering and fragmentation.

Method: The sample consisted of 74 adults (30 men, 44 women), aged 21–88 with 10–21 years of education, recruited

from the general community. A repeated-measures design was used wherein all participants received both figures 1 week

apart in counterbalanced order. An incidental memory procedure (copy, immediate recall [IR], delayed recall [DR]) was

employed. Figures were scored for accuracy (see Lezak et al., 2004) and process (Binder & Wonser, 1989). Results: Using

paired sample t-tests, there were no significant differences between the figures on perceptual clustering or fragmentation at

copy, or fragmentation at IR or DR. The MTCF produced moderately higher scores than the ROCF on some, but not all, per-

ceptual clustering scores at IR and DR. Correlations between accuracy and process scores (perceptual clustering: r ¼ .11 to .60;

fragmentation: r ¼ 2.06 to 2.37) were similar for both figures. Conclusions: The ROCF and MTCF showed similar levels of

fragmentation on all trials, but there were differences in some perceptual clustering scores at memory that favoured the MTCF.

Given that the two figures share the same basic features (rectangle/square, horizontal and vertical midlines, two diagonal lines)

that form the basis of this process scoring system, this is a curious finding that will be explored further.


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B-65

Neuropsychological Test Usage in the United States

Lazarus G, Puente A, Ojeda C

Objective: To investigate and update existing literature on neuropsychological test usage in the United States. To compare this

information to previously presented (pilot study presented at National Academy of Neuropsychology (NAN) Annual Meeting

2009) and published (Camara, Nathan, & Puente, 2000) on neuropsychological test usage. Method: A comprehensive list of

neuropsychological tests was compiled using information from test publishers, published literature, and a previous study ana-

lyzing neuropsychological test usage from the Pacific Northwest Neuropsychological Society and North Carolina

Neuropsychological Society. Survey monkey was used to send this list of neuropsychological tests, as well as demographic

questions, to members of the NAN. Three reminders resulted in 545 responses. Results: The findings indicate that many of

the same tests were endorsed by both the regional groups as well as those a decade ago. However, the order of prevalence

of usage did change relative to 10 years ago. Tests involving intellectual and executive functions were more common in

the current list. The top 10 tests were as follows: Trail Making Test, Boston Naming Test, Rey Complex Figure Test,

Wisconsin Card Sorting Test, Minnesota Multiphasic Personality Inventory, California Verbal Learning Test, Controlled

Oral Word Association Test (FAS), Word Fluency, Wechsler Adult Intelligence Scale, Beck Depression Inventory, and

Grooved Pegboard Test. No patterns were evident with regard to relationship of test usage to demographics. Conclusion:

Findings suggest that no great change has occurred over the last decade with regard to neuropsychological test usage although

a greater emphasis appears to be placed on tests of executive, memory, and intellectual functions. Batteries were not very

prevalent in the current survey. Although no clear demographic differences emerge, additional work needs to be pursued rela-

tive to related issues, including time to administer, score, and interpret such tests.

B-66

Exploratory Factor Analysis of the Cattell-Horn-Carroll and Tactile-Kinesthetic Factors

Mazur-Mosiewicz A, Trammell B, Dean R

Objective: The study analyzed the factorial structure of sensory–motor and cognitive abilities using exploratory factor analysis with

promax rotation. The goal was to verify whether sensory–motor abilities contribute to the existing factor solution of the

Cattell-Horn-Carrell (CHC) approach. Method: Participant sample (n ¼ 4,952) consisted of 4,457 neurologically impaired individ-

uals and 495 normals. Diagnoses were made by a licensed neuropsychologist after a review of results from medical examinations and

neuropsychological assessment conducted prior to the study. The Dean–Woodcock Neuropsychological Battery (DWNB) offers

tactile and kinesthetic tests adopted from well-known neurological examination tasks. Cognitive functions were tested using

Woodcock–Johnson III Test of Cognitive Abilities (WJ-III-COG). Each participant was administered the DWNB and

WJ-III-COG according to the procedures described in the manuals. An exploratory factor analysis (EFA) was conducted using prin-

cipal axis factoring in SPSS and used multiple extraction methods. Results: The results suggested a four-factor solution, with the CHC

factors loading on a separate factor than tactile-kinesthetic abilities. Conclusions: The first factor was related to variables that included

simple sensoryand simple motor tasks. The second factor was related to cognitive abilities. The third factor mostly contained complex

motor, and the fourth factor was a mixture of simple sensory and construction tasks. Although factors were correlated, the current

factor solution indicated that tactile-kinesthetic factors may exist separately from cognitive factors in the existing CHC model.

B-67

Comparison of Trail Making Test A and B Standard Scores based on Heaton and Tombaugh Systems

Patwardhan S, Fitzgerald K, Meyers C, Wefel J

Objective: For the widely used neuropsychological measures Trail Making Test A (TMTA) and B (TMTB), Heaton et al.

(1991) created robust norms correcting for age, gender, ethnicity, and education, whereas Tombaugh (2004) norms correct

for age and education (starting age 55+ years). Clinically often-observed discrepancy between standard scores based on

Heaton and Tombaugh systems may affect uniformity of test score interpretation and also call for improved psychometric

sophistication of norms for certain demographic groups. This study investigated frequency of discrepancy between Heaton

and Tombaugh standard scores and evaluated group effects on the discrepancy based on demographic factors. Methods:

TMTA and TMTB scores of 271 primary brain tumor patients (mean age ¼ 46.06 + 15.27, education ¼ 15.00 + 2.74,

female ¼ 45%, GBM ¼ 36.9%, left hemisphere tumor location ¼ 66%) were obtained from baseline evaluation. Raw

scores were converted to Heaton and Tombaugh norms. Correlations, chi-square analyses, and one-way analysis of variance

(ANOVA)s were performed. Results: As expected, standard scores with Heaton and Tombaugh norms correlated significantly

(rTMTA ¼ .62, p , .01, rTMTB ¼ .79, p , .01), but exhibited statistically significant within-group differences (x2TMTA ¼

202.65, p , .01, x2TMTB ¼ 267.49, p , .01). Compared with Heaton system, patients who obtained lower standard scores


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on Tombaugh system had received less education (mean years ¼ 13.65 + 2.35) than those obtaining equivalent (mean years ¼

15.23 + 2.68) and higher (mean years ¼ 17.00 + 1.00) standard scores on Tombaugh system (FEducation ¼ 7.61, p , .01).

Other demographic characteristics of age, gender, ethnicity, handedness, tumor location, and laterality did not differentiate

the patients showing discrepancy on two systems. Conclusion: Interesting differences emerged between TMTA and TMTB

standard scores based on Heaton and Tombaugh systems. Future studies are indicated to assess these discrepancies.

B-68

Driving Simulator Assessment: Reliability, Factor Structure, and Validity in Veterans with Traumatic Brain Injury andHealthy Controls

Poole J, Gray M, Utley J, Lew H

Objective: Simulators are widely used, but recognized standards of assessment are needed. We analyzed the psychometric prop-

erties of multiple driving simulator measures. Method: Twenty-one veterans with moderate-to-severe traumatic brain injury

(TBI) and 20 healthy controls drove four standard simulator scenarios of increasing complexity, while automated measures

and observer ratings were made. History of car accidents in the past 5 years was obtained by structured interview. Analyses:

internal-consistency reliability, factor analysis, correlation. Results: Moderate-to-high reliability (.7 to .9) was found for auto-

mated measures of steering accuracy, steering variability, speed compliance, speed variability, reaction time, divided attention,

and driving legality. Two factors accounted for over 70% of the variability: basic vehicle control (steering, speed) and cognitive

skills (attention, reaction time, legality). TBI was associated with significantly lower scores on the cognitive skills factor, but not

with basic vehicle control. History of car accidents correlated significantly with poorer performance on automated measures of

steering accuracy and driving legality. Accident history had weaker correlations with observer-rated performance. Conclusion:

This study describes seven reliable simulator indices, with initial indications of ecological validity. These measures added sig-

nificantly to observational driver ratings. We found that TBI may have greater impact on patients’ higher-order cognitive driving

skills, such as processing speed, divided attention, and ability to follow rules, than on their basic ability to control a vehicle’s

speed and direction. Future studies should provide norms for these simulator indices, analyze their ability to predict driving

skills in the community, and evaluate the efficacy of simulator training for neuropsychological rehabilitation.

B-69

Evaluation of a Computer Graphics Tablet-based Administration of the Rey-Osterrieth Complex Figure Test

Riordan P, Sawyer J, Buscemi J, Lombardo T

Objective: Computer-based administration of visual design copy measures with a computer graphics tablet presents significant

data collection advantages in both clinical and research settings. We measured time-to-completion and participant reactions to

using a tablet-based data entry method when completing a widely used design copy measure, the Rey-Osterrieth Complex

Figure Test (ROCFT). Method: The ROCFT was administered to a convenience sample of 62 university students using a com-

puter graphics tablet input method. In addition to completing the ROCFT, participants completed an alternate form of the test

using pencil and paper, as well as an ad hoc measure of participant attitudes regarding the computer entry method and hard-

ware. Time-to-completion data and qualitative participant reactions were also collected. Statistical analyses included compari-

son of time-to-completion across computer-based and paper-and-pencil administration methods and descriptive statistics for

quantitative participant ratings of the computer-based administration method. Results: Time-to-completion was greater for

tablet computer-based administration at a statistically significant level (p , .0001). Mean participant ratings on a 5-point

Likert-type scale (1 ¼ disagree; 5 ¼ agree) were as follows for tablet computer-based administration variables: uncomfortable

w/equipment ¼ 3.39; would perform better w/paper-and-pencil ¼ 4.63; computer method more interesting ¼ 4.03; distracted

by equipment ¼ 2.43; would be uncomfortable using computer method in high stakes situations ¼ 4.03; preferred computer

method to pencil-and-paper ¼ 2.43; and previous experience with similar computer equipment ¼ 1.26. Conclusion(s):

Results of the study strongly suggest that computer graphics tablet-based administration increases time-to-completion

versus traditional pencil-and-paper administration methods. Additionally, participant ratings regarding use of the computer-

based administration method indicate that participants experience significant misgivings about using this administration

method, particularly in real-world situations.

B-70

Construct Validity of Reynolds Intellectual Assessment Scales (RIAS) in Brain-Injured ChildrenBarney S, Allen D, Stolberg P, Mayfield J

Objective: The Reynolds Intellectual Assessment Scales (RIAS) is a new measure of intelligence whose psychometric

properties in clinical populations have not been extensively studied. The current study examines the construct validity


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of the RIAS in children and adolescents with various forms of brain injury. Methods: Participants included 100 children

and adolescents with various forms of brain damage, primarily traumatic brain injury. The sample was on average 13.5

years old (SD ¼ 3.6), and 57% were males. Participants were administered the RIAS as part of a comprehensive neu-

ropsychological evaluation, as well as the Continuous Performance Test (CPT), Processing Speed Index (PSI) subtests

of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Oral and Written Language Scales

(OWLS), Beery-Buktenica Developmental Test of Visual-Motor Integration, 5th ed. (VMI), and Purdue Pegboard

(PP). Correlations between the RIAS and the other measures were used to examine the construct validity of the

RIAS. Results: As anticipated, compared with the RIAS Verbal Index (VIX), the Nonverbal Index (NIX) exhibited stron-

ger correlations with the VMI (r ¼ .39 vs. .60), PSI (r ¼ .32 vs. .58), and PP (r ¼ .18 vs. .30). Variable correlations were

present across the CPT scores. Contrary to expectations, the VIX and NIX exhibited comparable correlations with the

OWLS (r ¼ .76 vs. .72). Conclusions: These results provide preliminary evidence supporting the RIAS construct validity

in children and adolescents with various forms of brain dysfunction, although high correlations between the NIX and

OWLS deserve further investigation. Additional research is necessary to confirm these findings, including examination

in more homogeneous samples to determine whether the relationships identified here generalize to other clinical

populations.

B-71Saliency and Carry-Over Effects of the Items of the Test of Memory and Malingering

Brown S, Tussey C, Barrow M, Marcopulos B, Kingma J, Heinly M

Objective: To investigate whether the target items in the recognition phase of the Test of Memory and Malingering (TOMM)

booklets would be more or less salient than the distracter items. The secondary purpose was to determine if participants would

be subject to carry-over effects on subsequent booklets through mere exposure to the targets from the initial presentation where

saliency was tested. Method: Thirty-eight undergraduate students from a small U.S. state university were presented only the

recognition phase from the three booklets of the TOMM. The participants were asked which image did they prefer for each

recognition trial. Each of the TOMM booklets was presented in each of the serial positions to test saliency in the first serial

position and carry-over effects in the subsequent serial positions. Results: An exact binomial sign test indicated that 17 of

the target items of the TOMM were either selected for or against at a level significantly greater than would be expected by

chance. A one-way repeated-measures analysis of variance (ANOVA) was run to determine if there were differences

between the number of target hits for any book in each serial position. A significant carry-over effect was not found,

Wilks’ Lambda ¼ .800, F(4, 66) ¼ 1.952, p ¼ .112. Conclusions: Despite the fact that some of the target or distracter items

may have been more salient, all of the trial booklets in all serial positions were at a chance level and they did not differ sig-

nificantly, which suggests that any normally administered TOMM or other symptom validity test should approximate chance

performance.

B-72Initial Psychometric Properties of the Fazio Laterality Inventory

Fazio R, Griswold S, Denney R

Objective: To provide a modernized handedness measure with clear instructions to produce an accurate measure of

lateral preference. Methods: Participants: Participants were 280 people with an average age of 34.6 years (SD ¼

13.9). The participants predominantly considered themselves right-handed (86%), were Caucasian (87.6%), and

female (73.1%). Participants were a convenience sample from a graduate institution; they were also asked to invite

others to participate. Only participants who indicated not having a condition affecting their hand use were included

in statistical analyses (n ¼ 275). Measures: Participants were administered the handedness instrument under investi-

gation, the Fazio Laterality Inventory (FLI). The FLI was available online and in a paper version. The FLI is based

on earlier handedness research. Participants rated the use of their right hand as a percentage on 12 everyday tasks.

Psychometric properties were examined using SPSS. Results: The FLI showed a high level of internal reliability

(Cronbach’s alpha ¼ .921). Sample size proved adequate to run a PCA (KMO ¼ .905). Two components were extracted

(initial eigenvalues were 6.67 and 1.19) with a correlation of .533, so a direct oblimin rotation was used. The com-

ponents are believed to represent handedness and uncertainty regarding hand usage. Conclusion: The FLI uses

modern everyday tasks to assess laterality. The instructions seemed to be well understood by all participants. It

shows promising initial psychometric properties which will likely be improved with item revision to remove those

which load predominantly on uncertainty. Future studies will validate the initial component loadings as well as estab-

lish criterion and discriminant validity.


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Poster Session C

AGING AND DEMENTIA: ALZHEIMERS DISEASE

C-1

Accuracy of Attentional Measures in Discriminating Alzheimer’s Disease from Normal AgingCorney P, Crossley M

Although Alzheimer’s disease (AD) has been traditionally characterized as a memory disorder, an increasing body of research

has demonstrated that attention is also impaired in early-stage AD. Given recent suggestions that the benefits of pharmacologi-

cal interventions for AD are maximized if treatment is initiated in the beginning stage of the disease, early diagnosis is essen-

tial. The present study investigated the clinical utility of four experimental attention tasks in discriminating early-stage AD

patients from healthy older adults. Participants were 19 individuals diagnosed with early-stage AD and a comparison group

of 30 healthy older adults. All participants completed the four experimental tasks, which were designed to assess various sub-

types of attention (selective attention, focused attention, and two tasks of divided attention). Receiver operating characteristic

(ROC) plots were constructed and examined to determine the sensitivity and specificity of each task at a range of cutoff points.

There was variability in the discriminative ability of the four tasks, with areas under the curves ranging from a low of .696 for

the selective attention task to a high of .933 for one of the divided attention tasks. When the four tasks were considered in

combination via discriminant function analysis, one discriminant function was calculated and was significantly associated

with group membership (x2(4) ¼ 45.58, p , .001). The combination of the four tasks correctly classified 89.9% of partici-

pants. These findings suggest that the use of attentional measures can contribute to the early detection and accurate diagnosis

of Alzheimer’s disease.

C-2Serum Brain-Derived Neurotrophic Factor (BDNF) Levels are Associated with Memory Performance in Alzheimer’s

Disease: An Investigation by the Texas Alzheimer’s Research Consortium (TARC)

Edwards M, O’Bryant S, Hobson V, Hall J, Barber R, Zhang S, Johnson L, Diaz-Arrastia R

Objective: The exploration for biomarkers that have diagnostic, predictive, and/or therapeutic utility for Alzheimer’s disease

(AD) is of vital importance given the rapidly aging population. Several recent studies have documented altered levels of brain-

derived neurotrophic factor (BDNF) in mild cognitive impairment (MCI) and AD. However, few human studies have examined

the link between peripheral BDNF levels and detailed neuropsychological functioning among normal elders or patients diag-

nosed with AD. The current study sought to examine the link between serum BDNF levels and neuropsychological functioning

in a sample of controls and patients with AD from the Texas Alzheimer’s Research Consortium (TARC). Method: There were

399 participants (probable AD: n ¼ 198; controls: n ¼ 201) in the TARC Longitudinal Research Cohort available for analysis.

BDNF levels were assayed via multiplex immunoassay. Regression analyses were utilized to examine the relationship between

BDNF levels and neuropsychological functioning. Results: BDNF levels did not significantly predict any neuropsychological

scores among the control group. In the AD group, BDNF levels were significantly negatively associated with scores on immedi-

ate (b ¼ 2.07 (.02), t ¼ 23.55, p ¼ .001) and delayed (b ¼ 2.05 (.02), t ¼ 22.79, p ¼ .01) verbal memory (Wechsler

Logical Memory immediate and delayed indices) and immediate (b ¼ 2.12 (.05), t ¼ 22.70, p ¼ .01) visual reproduction

(Wechsler Visual Reproduction immediate index). No other neuropsychological variables were significantly related with

BDNF levels. Conclusions: BDNF was associated with poorer attention and visual learning in AD patients.

C-3

Depression Symptoms and Neuropsychological Performance in a Sample of Alzheimer’s and Normal Elderly

Hall J, Johnson L, Barber R, Cullum M, Lacritz L, O’Bryant S

Objective: There is little information on how specific depression symptoms may differentially impact neuropsychological func-

tioning in cognitively intact elders and elders with Alzheimer’s Disease (AD). The current study investigated the relation of

depressive symptom clusters to performance on neurocognitive testing. Method: Three hundred and thirty-one normal controls

(NC) and 284 AD were administered the Geriatric Depression Scale (GDS) and a standardized neuropsychological battery as

part of a large cohort study. Total score and depression subscale scores of dysphoria, meaninglessness, apathy, and cognitive

impairment were calculated. Data were analyzed for AD and normal controls by gender using linear regression with neurop-

sychological test scores as outcome variables and subscale scores as predictor variables. Results: Total GDS and subscale


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scores were differentially related to neuropsychological test scores by gender and diagnosis. None of the subscales were related

to test scores for NC males. NC females’ performance was negatively related to cognitive impairment subscale for Trails B,

Logical Memory I & II (LMI & LMII), and Visual Reproductions II: apathy to Trails B and meaninglessness to Controlled Oral

Word Association Test (COWAT). For AD performance was negatively related to dysphoria for females on BNT, Trails B, LMI

& LMII and for males to Digit Span. Apathy was positively related to LMII for both genders. For male AD, meaninglessness

was negatively related to LMII. Conclusion: The impact of depression and symptoms of depression varies for both gender and

cognitive impairment. These results suggest the importance of taking depression and depression symptoms along with gender

into consideration when evaluating specific cognitive functions in both AD and cognitively intact elders.

C-4

Processing and Motor Speed in Alzheimer’s Disease and Vascular DementiaLena P, Robbins J, Martin P, Stewart J, Golden C

Objective: A recent study found that motor speed and processing may be a better marker of Alzheimer’s disease (AD) than of

vascular dementia (VaD). The current study aimed to investigate possible differences in processing and motor speed in indi-

viduals with AD and VaD. Method: There were 64 participants with a mean age of 78.20 (SD ¼ 8.66) and mean education of

13.81 (SD ¼ 2.93). There were 34 females and 30 males. All participants were Caucasian. Both the AD group and the VaD

group consisted of 32 individuals each. Neuropsychological examinations and CT or MRI were used to differentiate

between AD and VaD. The participants were given the Trail Making Test (Trails A + B) and the Rey-Osterreith Complex

Figure Test. Results: All analyses were conducted at the .05 level of significance. An analysis of variance (ANOVA) (F ¼

5.733, p ¼ .02, l ¼ .085) revealed that performance by individuals with AD (M ¼ 79.91, SD ¼ 12.73) was significantly

worse than individuals with VaD (M ¼ 87.91, SD ¼ 13.97) on Trails B. Conclusion: Trails B is considered the best general

indicator of cerebral dysfunction and requires more complex processing than Trails A. The findings suggest that complex pro-

cessing may be more difficult for individuals with AD than for individuals with VaD supporting the findings of the recent study,

but in contradiction to previous literature. It is important to consider that Trails B appears to be more sensitive to the progress-

ive cognitive decline of AD than the Rey-Osterreith Complex Figure Test and Trails A during assessment.

C-5

The Relationship of Education Level and Intelligence in Individuals Diagnosed with Alzheimer’s Disease or Vascular

DementiaMartin P, Prinzi L, Robbins J, Golden C

Objective: The present study examined the relationship between education and performance on the Wechsler Adult Intelligence

Scale-Revised (WAIS-R) in individuals diagnosed with dementia, hypothesizing differences in the magnitude of the relation-

ship between education and intellectual performance in VAD and AD. Method: Participants were 258 individuals with either

Alzheimer’s dementia (AD) or vascular dementia (VaD). The AD group (n ¼ 163) ranged in age from 61 to 93 (M ¼ 80.74,

SD ¼ 6.01), was 65.6% females, and had an education of 12.1 years (SD ¼ 3.12). The VaD group (n ¼ 95) ranged in age from

47 to 92 (M ¼ 77.6, SD ¼ 7.62), was 44% females, and had education of 13.21 years (SD ¼ 2.70). Pearson correlations were

utilized to determine the relationship between education and performance on six WAIS-R subtests. Results: Correlations were

significant on all six subtests (Information, Digit Span, Vocabulary, Similarities, Block Design, and Digit Symbol) for the AD

group, but only on three of the subtests (Information, Vocabulary, and Digit Symbol) for the VaD group. Correlations between

education and subtest performance were highest on Information and Vocabulary for AD (r ¼ .37 and .49, respectively) and for

VaD (r ¼ .45 and .32, respectively). Multiple regression indicated that the interaction between education and dementia type

was non-significant. Discussion: Education was correlated with performance on many of the WAIS-R subtests. Although

the magnitude of these correlations differed between AD and VaD on certain subtests, the relationship between education

and subtest performance was not shown to vary significantly as a function of dementia type.

C-6

As Easy As 1–2? Sequencing or Perseveration on Wechsler Adult Intelligence Scale-Fourth Edition Digit Span inDementia?

Ruchinskas R

Objective: To examine the rate of failure on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span

Sequencing subtest in those diagnosed with dementia or normal aging. Method: Two hundred and thirty-six individuals con-

secutively referred to a University Medical Center-based memory disorder clinic were screened with a neuropsychological

battery which included the WAIS-IV Digit Span subtest. Fifty-six individuals were diagnosed with mild or moderate


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Alzheimer’s disease, 18 with vascular dementia, 58 with mild cognitive disorder (MCI), 35 with primary depression, 36 with

mixed or other dementias, and 33 with normal aging. Failure on the first sequencing item by perseveration (continuing to

reverse the digits) and subsequent performance was recorded. Results: Fifty-three percent of individuals failed the first sequen-

cing item and 42% of those continued to perseverate until quickly meeting discontinue criteria. Failure was highly correlated

with other measures of frontal functioning such as the Stroop Color-Word score and Trails B, along with other measures of

information processing. Failure rates on the first sequencing item were higher for those diagnosed with any form of dementia

(60% failed) than normals (18% failed). Ninety-three percent of participants who met discontinuation criteria after the second

trial were subsequently able to perform at least a three-digit sequence if given reminders of the subtest instructions.

Conclusion(s): Failure by perseveration was noted in those with dementia and MCI on the sequencing subtest of WAIS-IV

Digit Span. Failure correlated with measures of frontal functioning. Although perseverative errors occurred in normals, the

failure rate was significantly higher in those diagnosed with a dementia or MCI.

C-7

Does Memory Predict Decline in Activities of Daily Living in Older Adults with Alzheimer’s Disease?West S, Fonseca F, Rice J, McCue R, Golden C

Objective: This study examined whether auditory and visual memory could significantly predict deficits in financial manage-

ment, medication management, driving, dressing, grooming, and feeding abilities. Methods: Participants were 54 older adults,

ranging in age between 65 and 93 (M ¼ 78, SD ¼ 5.20); all identified as Caucasian, 57% were females, and 82% were right-

handed. The auditory memory measures were the Wechsler Memory Scale-Third Edition (WMS-III)’s Auditory Memory,

Auditory Delayed Memory, Logical Memory I and II, and Word List I and II. The visual memory measures were

WMS-III’s Visual Memory, Visual Delayed Memory, Faces I and II, and Family Pictures I and II as well as the Rey

Complex Figure Test (RCFT). Results: Pearson correlations assessed the abilities of auditory and visual memory measures

to predict decline in self-care activities. Of the auditory measures, Logical Memory I significantly correlated with declines

in financial (r ¼ 2.36, p , .01) and medication (r ¼ 2.23, p , .05) management. Word List I significantly correlated

with declines in financial (r ¼ 2.43, p , .05) and medication (r ¼ 2.40, p , .05) management. Of the visual–spatial

measures, the RCFT correlated with financial management (r ¼ 2.39, p , .01), medication management (r ¼ 2.42, p ,

.01), driving (r ¼ 2.39, p , .01), and dressing (r ¼ 2.25, p , .05) abilities. Faces I correlated with medication management

(r ¼ 2.27, p , .05), and the Visual Delayed Index correlated with driving (r ¼ .33, p , .05) and dressing (r ¼ .32, p , .05)

abilities. Discussion: Auditory memory measures predicted declines in financial and medication management, whereas visual–

spatial memory measures predicted declines in financial, medication, driving, and dressing abilities. Memory measures may

help neuropsychologists make recommendations regarding daily care for individuals with Alzheimer’s.

AGING AND DEMENTIA: HEALTHY AGING AND COGNITION

C-8Neuropsychological Predictors of Self-Rated Physical and Mental Health among Community-Dwelling Older Adults

Fischer A, Yeung S, Thornton W

Objective: Self-rated health (SRH) is frequently used to index quality of life among older individuals and is an important pre-

dictor of functional outcomes. Although there is increasing appreciation of SRH as a multidimensional construct, little research

to date has examined the role of neuropsychological predictors of health perceptions. As cognitive changes are associated with

both increasing age and declining health, we addressed whether neuropsychological predictors differed between self-rated

physical (SRPH) and mental health (SRMH) in a sample of older adults. Method: Ninety-seven community-dwelling older

adults (51–91 years; M ¼ 65.9) completed a neuropsychological test battery including the California Verbal Learning

Test-Second Edition (CVLT-2), Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Coding, ETS Vocabulary, and

Delis-Kaplan Executive Function System (D-KEFS) subtests. SRMH and SRPH were measured using the SF-36v2. A compo-

site representing executive function and speed (EF/Speed) was formed from those variables displaying significant correlations

with SRH (p ≤ .05). Hierarchical regression was used to evaluate predictors of SRPH and SRMH. Results: As expected,

increasing age predicted worse ratings of SRPH (b ¼ 2.25, p , .031; R2 ¼ .05), whereas neuropsychological performance

was non-contributory. In contrast, increasing age predicted better ratings of SRMH (b ¼ .32, p , .012) as did better EF/

Speed performance (b ¼ 1.04, p , .006; overall R2 ¼ .10). Conclusions: Predictors of self-rated physical and mental

health differ with advancing age. Specifically, perceptions of physical health decline, whereas perceptions of mental health

increase, consistent with literature suggesting that emotional satisfaction may improve with age. Further, executive function

and processing speed may be important positive predictors of higher mental health ratings among older individuals.


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C-9

Cognitive Performance in Individuals with Self-Identified Cognitive Complaints

Rossetti H, Bernardo K, Weiner M, Cullum C, Lacritz L

Objective: To examine cognitive performance in individuals with and without self-reported memory and/or problem-solving dif-

ficulties in a large, diverse population-based sample. Those with self-identified cognitive complaints (CC) were predicted to have

lower cognitive functioning as measured by the Montreal Cognitive Assessment (MoCA) than those without complaints (WC).

Method: The MoCA was administered to 2,673 individuals as part of the population-based Dallas Heart Study (Mage ¼ 50.4

[11.2]; range ¼ 18–85), who answered three yes/no questions regarding cognitive complaints. The CC group endorsed ≥1 ques-

tions, and total scores of the CC (N ¼ 539) and WC (N ¼ 2,134) groups were compared, demographic variables examined, and

frequently missed MoCA items were reviewed. Results: CC participants had significantly lower MoCA scores (M ¼ 22.10 [4.5])

than WC participants (M ¼ 23.48 [3.9]; F(1) ¼ 14.6, p , .001), even when controlling for age, education, and race. In partici-

pants ≥65 years old (N ¼ 301), WC and CC MoCA performances did not significantly differ (F(1) ¼ .091, p ¼ .76) after con-

trolling for education. Participants who endorsed problem-solving difficulty had the lowest MoCA scores (M(SD) ¼ 20.32 [4.8]).

The most frequently missed MoCA items in the CC group were cube drawing, delayed recall, and sentence repetition. Less edu-

cated (p , .001) individuals were more likely to endorse cognitive problems, as were females (p , .001). Conclusion:

Participants responding to three simple cognitive complaint questions had significantly lower MoCA scores, even when control-

ling for demographic variables in the sample as a whole. Reports of cognitive complaints, particularly problem-solving difficulty,

could indicate either long-standing problems or objective cognitive dysfunction that warrants clinical follow-up in some cases.

C-10

Age Differences in Neuropsychological Predictors of Everyday Problem-SolvingYeung S, Fischer A, Thornton W

Objective: Everyday problem-solving (EPS) tasks are important markers of real-world functioning in older adults. Models

propose that EPS is comprised of fluid and crystallized components that are differentially impacted across age. To date,

little is known regarding the extent to which these neuropsychological components account for EPS. We investigated

whether fluid and crystallized abilities predicted EPS performance differently in young and older adults. Method:

Seventy-four older (M ¼ 66.24 years) and 64 young adults (M ¼ 19.5 years) were tested on a battery of traditional neuropsy-

chological and everyday cognitive measures (i.e., Californial Verbal Learning Test-Second Edition (CVLT-II), select

Delis-Kaplan Executive Function System (D-KEFS) subtests, Wechsler Adult Intelligence Scale-Third Edition (WAIS-III)

Digit Symbol-Coding, ETS Vocabulary, EPS). EPS was indexed by the number of safe/effective solutions generated for every-

day scenarios (ri ¼ .85). Separate hierarchical regression models were conducted in young and older age groups to determine

which cognitive variables accounted for EPS ability. Results: In young adults, better mental flexibility was the only significant

predictor of better EPS performance (b ¼ .434, p , .013), accounting for 9.1% of unique variance. In older adults, age, edu-

cation, female sex, and semantic knowledge accounted for 50.9% of EPS variance. Better semantic knowledge was the only

significant cognitive predictor of better EPS (b ¼ .358, p , .002), accounting for 13.8% of variance beyond demographic vari-

ables. Conclusion: Important neuropsychological predictors of EPS performance differ across age. When solving everyday pro-

blems, younger adults may rely on fluid cognitive abilities that tend to peak in early adulthood. Consistent with aging theories,

older adults rely on crystallized cognitive abilities that are more robust to the aging process.

C-11

Reliable Change Index Scores for Animal FluencyZec R, Kohlrus S, Fritz S, Robbs R, Ala T

Objective: Reliable change index (RCI) scores were determined for participants in four age groups (50–59, 60–69, 70–79,

80–89) who had follow-up testing within 9–15 months of the baseline. RCI scores indicate how much a person’s animal

fluency score must decrease to be significant at the 95% confidence level. Method: Participants were older adults without

dementia. There were 177 participants in their 50s, 408 in their 60s, 370 in their 70s, and 115 in their 80s. The mean age

for the entire sample was 68.42 years and mean education was 14.6 years. For the animal fluency task, each participant

was asked to generate as many animal names as possible in 1 min. The mean animal fluency score for the entire sample

was 18.3 and for each of the age decades (50s, 60s, 70s, 80s) was 20.49, 18.97, 17.26, and 15.87. Results: The RCI for the

total group was 7.85, indicating that an older adult’s animal fluency score must decrease by 8 or more points to be significant,

that is, to be 95% confident that the decrease was not due to chance. RCI scores for the four age groups (50s, 60s, 70s, 80s) were

9.20, 8.37, 7.15, and 5.15, respectively. A minimum 10-point decline on animal fluency is needed to reach statistical signifi-

cance for persons 50–59, 9-point decline for those 60–69, 8 for those 70–79, and 6 for those 80–89. Conclusions: An annual


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decline of at least 8 points on animal fluency is generally needed for there to be a statistically reliable decline for an individual

older adult.

AGING AND DEMENTIA: OTHER

C-12

Evaluating the Utility of the AD8: A Correlational Analysis through Cognitive and Mood Assessment Measures

Cummings T, Webbe F, Srinivasan V

The AD8 is often used in multidisciplinary settings as a brief, sensitive measure that can aid in the diagnosis of dementia. It also

aids in the detection of cognitive change through the assessment of functional activities. This study aimed to validate the AD8’s

utility as a screening assessment for patients with cognitive complaints. Patients were administered the Mini-mental State

Examination (MMSE), Montreal Cognitive Assessment (MoCA), AD8, Geriatric Depression Scale (GDS), Geriatric Anxiety

Inventory (GAI), Trails A & B, Symbol Digit Modalities Test (Oral and Written), Cognitive Screening Tool, and NEO-Five

Factor Inventory (NEO-FFI). Not all patients attended with a caregiver and thus, 371 patients were administered the AD8,

and of those, 275 caregivers also completed the measure. Pearson product moment correlations were utilized. Significant and

positive correlations were observed between patient AD8 scores and GDS (.49), GAI (.41), and Neuroticism (.37) scores. No

significant correlations were observed between these mood measures and caregiver AD8 scores. Significant inverse correlations

were observed between caregiver AD8 scores and MMSE (.33) and MoCA (.35). Inverse correlations, of lower magnitude, were

observed for caregiver AD8 scores and cognitive measures. Patient symptom complaint (cognitive or psychological) appears to

be suggestive of overall distress. This suggests the utility of the patient AD8 as a psychological marker rather than an indication of

true cognitive status. Conversely, complaints by the caregiver track cognitive status reasonably well and are not associated with

patient’s reported depression and anxiety. Depression and dementia can often present similarly in an elderly population and thus,

the caregiver AD8 may assist in teasing out actual cognitive decline in depressed patients.

C-13

Lack of Equivalence between the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) inVery Mild-to-Moderate Stage Dementia

Gavett B, Kowall N, Qiu W, Jefferson A, Green R, Stern R

Objective: Despite the ubiquity of the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) in the

assessment of older adults and the use of both tests to stage dementia severity, the score equivalence between the two tests is

unknown. We sought to create derived CDR scores based on the MMSE and to determine the accuracy of such derivations.

Methods: Data from 566 adult participants (mean age ¼ 76.6, SD ¼ 8.4) in a longitudinal research registry at an

NIH-funded Alzheimer’s Disease Center were used to create derived CDR scores based on the MMSE with and without a

measure of independent functioning, the Lawton-Brody questionnaire. Derived scores were calculated using the results of

an ordinal logistic regression model and accuracy was estimated using five-fold cross-validation. Results: A significant pro-

portion of the variance in CDR scores was explained by MMSE score (R2 ¼ .74); adding Lawton-Brody scores to the

ordinal model improved model fit (R2 ¼ .82). However, the accuracy of the derived scores was acceptable (i.e., .80%)

only at extreme CDR scores (i.e., CDR scores of 0 and 3). This accuracy was improved only marginally when

Lawton-Brody scores were added as a predictor. Conclusions: Although CDR scores can be derived from MMSE scores,

these derived scores are not accurate for true CDR scores of .5, 1, and 2. Assuming the CDR is a more reliable and valid

tool for the staging of dementia severity, the MMSE is likely misused when used to stage pre-clinical to moderate dementia.

C-14

White Matter Integrity and Working Memory in Mild Cognitive ImpairmentHill B, Su T, Correia S

Objective: To determine if performance on a verbal working memory test (n-back) is related to anterior white matter integrity

in patients with mild cognitive impairment (MCI). Method: Patients with MCI (n ¼ 18) and cognitively normal controls (n ¼

16) underwent a battery of cognitive tests including a verbal n-back task (0, 1, 2, and 3-back), and a research MRI scan includ-

ing diffusion-tensor imaging (DTI, b ¼ 0, 1000 s/mm2, 12 directions, 0.85 mm cubed voxels). Regions of interest (ROIs) were

placed in right and left anterior and posterior normal appearing white matter (NAWM) on axial slices of fractional anisotropy

(FA) and trace DTI parameter maps. ROIs were placed at the level of the trigone, the body of the lateral ventricles, and the

centrum semiovale (three consecutive slices at each level). In addition, ROIs were placed in the genu and splenium of the

corpus callosum on the trigone slices. Results: The groups were not significantly different on age, education, or sex. MCI


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patients performed significantly worse than controls on the 1-, 2-, and 3-back but not 0-back conditions of the n-back task. FA

was significantly lower in anterior NAWM compared with posterior NAWM in both groups. There was a trend (p ¼ .055)

toward higher posterior trace in the MCI group in the lateral ventricle slices only. Anterior trace in these slices was positively

correlated with 3-back performance in the MCI group. Conclusions: MCI may be associated with changes in posterior white

matter integrity. Anterior white matter integrity in MCI is associated with working memory performance.

C-15

Estimated Cumulative Residential Arsenic Groundwater Exposure and Cognitive Functioning: A Project FRONTIERStudy

O’Bryant S, Gong G, Spallholz J, Boylan M, Edwards M, Hargrave K, Johnson L

Objective: Groundwater arsenic exposure has been linked to a range of neurodevelopmental and neuropathological processes;

however, no research has been conducted looking at long-term low-level arsenic exposure and cognitive functioning. The

current study sought to examine the link between estimated cumulative residential groundwater arsenic exposure and neuropsycho-

logical functioning through an ongoing epidemiological study of rural health, Project FRONTIER. Method: Data were available on

242 participants with a mean age and education of 63.7 (SD ¼ 12.9) and 10.4 (SD ¼ 4.1), respectively. An estimated cumulative

arsenic exposure index (CAI) was generated using geospatial information systems (GIS), current residential location and time at

that location, and well-water arsenic levels from the Texas Water Development Board. Results: After accounting for appropriate

covariates in linear regression models, higher CAI was associated with significantly poorer global cognition (Mini-mental State

Examination [MMSE] scores; B ¼ 2.003, SD ¼ .002, t ¼ 22.19, p ¼ .03), executive functioning (Executive Interview

[EXIT25] scores; B ¼ .007, SD¼ .002, t ¼ 3.16; p ¼ .002), and verbal fluency (FAS scores; B ¼ 2.013, SD ¼ .006,

t ¼ 22.15, p ¼ .03). CAI was not significantly associated with scores on tests of memory (visual or verbal), visuospatial skills,

or attention. Conclusions: The Environmental Protection Agency (EPA) and National Research Council (NRC) have repeatedly

pointed toward the need for epidemiological studies examining the non-cancer health outcomes of long-term, low-level arsenic

exposure. The current results demonstrate that chronic exposure to levels of arsenic below the current U.S. standard (10 mg/L)

is associated with significantly poorer neuropsychological functioning among rural-dwelling adults and elders.

C-16

Influence of Age and Education on Tests of Executive Functioning: Comparing Older Adults

Stewart J, Golden C

Objective: The present study examined the influence of age and education on executive functioning within a sample of older

adults. Method: Participants in the present study consisted of non-patient volunteers aged 55–93 years (M ¼ 67.392, SD ¼

9.478), who participated in the Nova Southeastern University study, Normal Neuropsychological Variation in a Normal

Population. The average level of education was 13.705 with an SD of 2.857. Performance on the following tests, which are

established measures of executive functioning, was evaluated: Controlled Oral Word Association Test (COWAT), Boston

Naming Test (BNT), The Stroop Color-Word Test, Trails B, and Digit Symbol from the Wechsler Adult Intelligence

Scale-Third Edition (WAIS-III). Pearson correlations were used to determine whether age and education were related to per-

formance on tests of executive functioning. Results: Analyses were considered significant at the .05 level. A significant

relationship emerged between age and performance on the COWAT (r ¼ .155, p ¼ .028), BNT (r ¼ .223, p ¼ .002), Stroop

word trial (r ¼ 2.163, p ¼ .021), Stroop color/word trial (r ¼ 2.211, p ¼ .001), and interference (r ¼ 2.141, p ¼ .047).

Education was significantly related to performance on Digit Symbol (r ¼ .460, p , .001), Trails B (r ¼ .216, p ¼ .002),

Stroop color trial (r ¼ .204, p ¼ .004), Stroop word/color (r ¼ .159, p ¼ .024) and interference (r ¼ .226, p ¼ .001).

Discussion: Similar to findings of earlier research, the present study found that age and education profoundly influenced per-

formance on speed-dependent task of executive functioning. Measures of accuracy, such as the errors made on the Trails B test

were unaffected by age or education.

NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: CEREBROVASCULAR DISEASE

C-17

Patterns of Cognitive Performance in Stroke Patients: Use of the Cognistat in Right Versus Left Cerebrovascular

AccidentsBroennimann A, Wisniewski A, Austin B, Bens M

Objective: This study examined the effects of a right versus left hemisphere stroke (RHS vs. LHS) on patterns of cognitive

performance using the Neurobehavioral Cognitive Status Examination (Cognistat). Data selection: Archival data were utilized.


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Participants included residents with RHS (n ¼ 24; gender: males ¼ 13; females ¼ 11; age: M ¼ 60.85; education: 11.56 years)

or LHS (n ¼ 19; males ¼ 10; females ¼ 9; age: M ¼ 53.94; education: 9.56 years) from an inpatient rehabilitation setting.

Data synthesis: The Cognistat was administered as part of routine clinical care. Differences in patterns of performance

were expected between the two groups, and these differences were thought to be accounted for by the hemispheric location

of the stroke event. Parametric and non-parametric comparisons for each of the Cognistat subtests revealed few significant

differences between the groups. Specifically, those in the RHS group performed significantly better than the LHS group on

the Orientation and Calculation subtests, whereas those in the LHS group performed significantly better than the RHS

group on the Repetition subtest. Sensitivity, specificity, positive predictive power, and negative predictive power of the

screens versus metrics for each group were also calculated. Conclusions: Results demonstrated an overall sensitivity of

each of the Cognistat subtests to detect neurocognitive impairment; however, results did not confirm any predicted patterns

of performance to differentiate between the RHS and LHS groups. This study investigated the Cognistat’s utility as a brief

initial cognitive screen in stroke patients. Limitations of the study, directions for future research, and clinical implications

were addressed.

C-18

Recovery from Hypoxic Encephalopathy due to Wolff Parkinson White Syndrome

Carroll C, Knee K, Mittenberg W

Objectives: Wolff Parkinson White Syndrome (WPW) is a rare congenital disorder that causes arrhythmia and sudden cardiac

arrest (CA). This case demonstrates hypoxic encephalopathy due to CA with good subsequent cognitive recovery. The patient

was a 30-year-old woman with a Bachelor’s degree that had CA due to WPW with 6–12 min of hypoxia, tonic-clonic seizures,

and 3 days of coma. MRI was unremarkable but EEG showed diffuse slowing consistent with metabolic encephalopathy and

spiking indicative of right hemisphere seizure activity. Method: Neuropsychological examinations of intellectual, memory,

executive, language, and personality functioning were conducted at 1 month and at 8 years after CA. Results: Intelligence

(Wechsler Adult Intelligence Scale-Third Edition [WAIS-III] IQ ¼ 89, Wechsler Adult Intelligence Scale-Fourth Edition

[WAIS-IV] IQ ¼ 96) and Working Memory (99, 100) were relatively intact over time and consistent with premorbid estimates

(Wide Range Achievement Test-Third Edition [WRAT-3] Reading ¼ 105, Wide Range Achievement Test-Fourth Edition

[WRAT-4] ¼ 103, WAIS Vocabulary ¼ 9, 10). Memory (Wechsler Memory Scale-Third Edition; WMS-III General

Memory ¼ 69, Immediate ¼ 72), Processing Speed (76), executive (Trails B , 55, Wisconsin Card Sorting Test; [WCST]

perseverations ¼ 90), and language functioning (FAS ¼ 60) were impaired 1 month after CA. Memory (Wechsler Memory

Scale-Fourth Edition [WMS-IV] Delayed Memory ¼ 82, Immediate ¼ 83), Processing Speed (84), executive (Trails ¼ 85,

WCST perseverations ¼ 97), and language (FAS ¼ 85) functioning improved significantly at follow-up. Conclusion:

Anoxic encephalopathy after CA produces characteristic marked impairment of memory, executive function, and processing

speed that can be seen at the post-acute stage of recovery and typically has a poor prognosis. However, good recovery of cog-

nitive functions appears to occur in some cases. Prognosis may be mediated by age, gender, and cerebral reserve. Working

memory and intelligence are relatively resistant to hypoxic encephalopathy, and reading vocabulary appears to provide a

reasonable estimate of premorbid ability that remains stable during recovery.

C-19Gender Differences in Individuals with Cerebrovascular Disease

Zimmerman A, Mazur-Mosiewicz A, Roberds E, Dean R

Objective: The present study examined gender differences in the comorbidity rates of psychiatric disorders occurring in indi-

viduals diagnosed with cerebrovascular disease (CVD). Methodology: The 52 participants were individuals with a primary

diagnosis involving cerebrovascular disease. All of the diagnoses were classified according to the International

Classification of Diseases, Ninth Revision (ICD-9, 1998). There were a total of 28 male participants (mean age ¼ 51.86,

SD ¼ 19.64) and 24 female participants (mean age ¼ 51.81, SD ¼ 18.01). The participants were interviewed and evaluated

by neuropsychologists independently. Results: The results of the analysis indicated significant differences between males

and females in rates of comorbid psychiatric disorders. Overall, 42.3% of individuals in the present study had a secondary

psychiatric diagnosis with 28.6% of males and 58.3% of females having a comorbid psychiatric diagnosis. Specifically,

14.3% of the males and 20.8% of the females had a secondary mood disorder, 10.7% of males and 33.3% of females had a

comorbid anxiety disorder, and 3.6% of males and 4.2% of females had a diagnosis of learning disorder NOS.

Conclusions: Past research suggests that the occurrence of mental health issues in general population is about 5%–14%.

Yet, these statistics seem to increase drastically for individuals with CVD. According to our findings, despite increase in preva-

lence, the gender prevalence rates seem similar to those found in general population. Indeed, female risk for psychiatric


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complications seems to almost double of this in males. The implications point toward clinical preventive programs targeting the

CVD patients, with consideration of gender risk.

NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER

C-20

Processing Speed and Working Memory in Multiple Sclerosis (MS): Comparison of the Relative and Independent

Consequence ModelsAnderson C, Parmenter B

Objective: The goal of this study was to investigate the application of the relative and independent consequence models

(DeLuca et al., 2004) in explaining the relationship between processing speed (PS) and working memory (WM) impairments

in MS. Method: Participants included 45 MS outpatients (33 females) and 29 healthy controls (15 females). The groups did not

differ for education, but did for age (MS: M ¼ 46.87, SD ¼ 9.13; controls: M ¼ 36.10, SD ¼ 13.81). Participants completed

the n-back task as part of a larger neuropsychological battery along with questionnaires measuring fatigue and depression.

Reaction time (RT) and percentage of dyad responses were measures of PS and WM, respectively. Total consecutive responses

(CR) were calculated to evaluate task approach (i.e., if participants responded to items consecutively or skipped items inter-

mittently). Using path analysis, separate models were created for the 1- and 2-back conditions, with RT and CR included as

endogeneous variables and percentage of dyad responses as the outcome variable. Results: For the MS group, path models

demonstrated that in the 2-back condition, PS was directly related to WM performance as well as indirectly related to WM

performance through total CR (all standardized coefficients p , .05). These results were not replicated in the models examin-

ing control participants. Conclusions: Results of the present study provide support for the relative consequence model, as

impaired PS was found to predict impaired WM in the MS group, but not the control group. The importance of examining

task approach was also demonstrated, as total CR partially mediated the relationship between PS and WM.

C-21

Relationship between Depressive Symptoms and Neuropsychological Performance in Acquired Brain InjuryBlackwell E, Silverberg N

Objective: Teasing apart the cognitive effects of acquired brain injury (ABI) and depression is an important clinical task. There

is considerable evidence that depression impacts cognition, but the nature and strength of this relationship in patients with ABI

is unclear. The present study aimed to investigate how depressive symptoms relate to neuropsychological performance in this

patient group. Method: Forty-six neurorehabilitation outpatients with ABI (40% traumatic brain injury, 42% stroke, 18% other;

mean age 41 + 13) underwent comprehensive neuropsychological assessment as part of standard care. Neuropsychological

test scores were aggregated into indices of learning, memory recall, processing speed, working memory, and executive func-

tioning. Depressive symptoms were measured with the Beck Depression Inventory (BDI-II). Results: Depressive symptoms

correlated modestly with the learning index (r ¼ 2.28, p ¼ .06) and minimally with the other index scores (r ¼ .01 to .16).

In a multivariate analysis of variance (MANOVA), depressed patients (BDI-II .13) performed lower than non-depressed

patients (BDI-II ≤ 13) on the set of neuropsychological index scores (F ¼ 2.85, p ¼ .03). However, the pattern of univariate

contrasts again suggested that this effect was entirely confined to learning (Cohen’s d ¼ .71). Depressive symptoms were simi-

larly related to immediate recall scores on the California Verbal Learning Test-II and Wechsler Memory Scale-III Logical

Memory, the two measures that comprised the learning index. Conclusion: Depressive symptoms were modestly related to

learning inefficiency in our sample. Our findings are limited to ABI patients with mild-to-moderate depressive symptoms

and are only partly in keeping with prior research.

C-225-HTTLPR Genotype and the Effects of Adverse Childhood Experiences on Risk of Antisocial Personality Disorder

Douglas K, Gassermar M, Kranzler H, Chan G, Gelenter J, Arias A, Farrer L

Objective: Antisocial personality disorder (ASPD) frequently co-occurs with substance dependence (SD). A polymorphism

(5-HTTLPR) in the gene encoding the serotonin transporter (SLC6A4) has been widely studied as a risk factor for a variety of psy-

chopathologic conditions, including aggressive/violent behavior. Childhood abuse is also an important predictor of ASPD. We

examined 5-HTTLPR genotype and adverse childhood events (ACEs) as risk factors for ASPD in an SD sample. Method: A

total of 1,381 participants, including 602 European Americans (EAs) and 779 African Americans (AAs), were interviewed to

obtain lifetime diagnoses of ASPD and SD and information on ACEs. Tri-allelic genotypes for 5-HTTLPR were obtained using

standard methods. We used logistic GEE regression to examine ACEs and 5-HTTLPR genotype and their interaction as predictors


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of ASPD. Results: Among the participants, 203 (14.7%) were diagnosed with ASPD. The frequency of the low-functioning

5-HTTLPR S′ allele did not differ between the ASPD and non-ASPD groups, and there was no overall 5-HTTLPR × ACE inter-

action. However, among EAs, male sex (OR ¼ 3.36; p , .001) and ACE history (OR ¼ 1.47; p ¼ .002) were significant predictors

of ASPD. Among AAs, there was a significant interaction of sex × 5-HTTLPR genotype × ACEs (x2 ¼ 13.92, p , .001). Among

AA men, each additional ACE significantly increased the odds of ASPD irrespective of genotype, whereas among AA women, the

effect of ACEs on ASPD was significant only among S′ homozygotes. Conclusions: Childhood maltreatment contributes to the risk

of antisocial personality disorder, an effect that in AA women may be moderated by 5-HTTLPR genotype.

C-23

Memory Outcomes after Surgery for Intractable Temporal Lobe Epilepsy

Giummarra J, Bowden S, Cook M, Murphy M

Objective: Anterior temporal lobectomy (ATL) is an established treatment for refractory temporal lobe epilepsy (TLE), and

memory deficits are one of the primary adverse neuropsychological consequences reported of the procedure. In addition, the

question of the relative sensitivity of verbal and visual memory indexes has been debated because of inconsistent findings regard-

ing post-operative memory status. This study reports a sample of patients with TLE all of whom had unilateral hippocampal scler-

osis (HS) identified with volumetric MRI prior to ATL. All patients were assessed with verbal and visual memory indexes from

the Wechsler Memory Scale-Third Edition (WMS-III). Method: The present study included WMS-III Index data collected in 100

patients (52 left TLE, 48 right TLE) who completed pre- and post-operative memory assessment between 1997 and 2010. Results:

There were no statistically significant differences in verbal or visual memory (immediate and delayed recall) indexes between

patients with left- versus right-sided HS prior to ATL (all p . .1). After surgery, patients with left ATL showed significantly

poorer verbal immediate (t(98) ¼ 22.17, p ¼ .03) and verbal delayed (t(97) ¼ 22.91, p , .01) memory indexes relative to

patients after right-sided surgery. The reverse was also found, as patients with right ATL revealed significantly poorer visual

immediate (t(97) ¼ 2.46, p , .02) and visual delayed (t(97) ¼ 2.90, p , .01) memory indexes relative to patients after left-sided

surgery. Conclusions: In this relatively homogenous sample of patients with HS identified prior to surgery, small but statistically

significant changes in verbal and visual memory ability were evident after left or right ATL, respectively.

C-24

Exacerbation History is Associated with Medication and Appointment Adherence in Multiple Sclerosis

Hancock L, Bruce J, Peterson S, Tyrer J, Murphy M, Jacobson J, Lynch S

Objective: Although there is no cure for Relapsing-Remitting Multiple Sclerosis (RRMS), treatment with disease-modifying

therapies (DMT) can reduce exacerbations and preserve overall quality of life. Nevertheless, more than 25% of RRMS patients

do not adequately adhere to DMTs. Medical patients who fail to actively engage in treatment by attending appointments and

adhering to prescribed medication regimens have poorer disease outcomes. This is the first study to examine the association

between exacerbation history and medication/appointment adherence in MS. Method: Medical charts for 75 RRMS patients

were reviewed to obtain information regarding disease and appointment adherence for approximately a 6-year period prior

to participant’s enrollment in the study. DMT medication adherence was assessed retrospectively by self-report and also mon-

itored prospectively for 8 weeks using Medication Event Monitoring System (MEMS) caps and a medication diary. Results:

Patients with higher annualized relapse rates had fewer missed doses per MEMS (r ¼ 2.327, p , .01), diary (r ¼ 2.312, p ,

.01), and self-report (r ¼ 2.383, p , .01). Patients with higher annualized relapse rates were less likely to miss (r ¼ 2.490, p

, .01), cancel (r ¼ 2.505, p , .01), and no-show to appointments (r ¼ 2.293, p , .05). Conclusion: Higher annualized

relapse rates were associated with better medication and appointment adherence. In contrast, patients who experienced a rela-

tively stable disease course frequently failed to adhere to both DMT and scheduled clinic appointments. Given recent evidence

highlighting the importance of early, preventative treatment, clinicians should consider discussing the implications of remain-

ing adherent during relatively asymptomatic periods of MS.

C-25

Neuroimaging as a Diagnostic Tool for Children and AdolescentsHolder C, Mauseth T, Robillard R

Objective: The past 8 years have seen a significant increase in interest concerning the use of imaging techniques for neurop-

sychological purposes. Researchers working with children and adolescents, in particular, have found this a salient issue

because of the belief that there is a neurological element to most prevalent childhood Axis I disorders. The idea that an objec-

tive assessment could be made with reliability across population samples is indeed an intriguing notion. This poster will present

a review of the current literature addressing the diagnosing of Axis I behavior disorders in children and adolescents through the


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use of imaging techniques. Data selection: Empirical studies utilizing SPECT, CT, QEEG, MRI, and fMRI techniques with

children and adolescents suffering from prevalent Axis I disorders (e.g., Attention-deficit/Hyperactivity Disorder; ADHD,

bipolar disorder) were examined. Those which directly addressed the use of imaging as a diagnostic tool, or suggested diag-

nostic usefulness, were included in the review. Data synthesis: Empirical studies attempting to diagnose disorders based on

imaging have had some success in identifying those with the disorder, but also return a high rate of false-positives. Some

studies failed to find any reliable neurological differences. Many studies have been conducted which attempt to isolate the

neurological differences which characterize these disorders and assist in building the foundation of knowledge that is essential

for diagnosis. Conclusions: Imaging studies have contributed to the understanding of childhood behavior problems, but have

not been able to offer reliable and consistent differential diagnoses for neurological disorders at this time.

C-26Traditional Versus Computerized Finger Tapping in Patients with Parkinson’s Disease

Langill M, Roberts R, Iverson G, Appel-Cresswell S, Stoessl A

Objective: The purpose of this study was to compare the CNS Vital Signs computerized finger tapping speed with the

traditional Finger Tapping Test in patients with Parkinson’s disease (PD). It was hypothesized that the participants would

be faster on the computer due to having less strict tapping criteria and no administration monitoring, thereby allowing

the PD patients to compensate somewhat for their motor disturbances. Methods: Participants were 33 outpatients with

probable or definite PD. The sample was 67% males, their average age was 63.9 (SD ¼ 9.8) years, and their average

education was 16.1 (SD ¼ 3.7) years. They had been diagnosed with PD 7.5 years prior (SD ¼ 5.7, range ¼ 1–26).

Mean Unified Parkinson’s Disease Rating Scale motor scores (part III; on-medication) and Modified Hoehn and Yahr

Scale scores were 14.1 (SD ¼ 6.9) and 2.1 (SD ¼ .5), respectively. Results: Participants tapped faster on the computer

with their right (p , .002, Cohen’s d ¼ .66) and left (p , .001, d ¼ 1.03) hands. The differences between computerized

and traditional tapping attenuated when comparing normative scores (right hand, p , .30, d ¼ .22; left hand, p , .001,

d ¼ .60). The percentages of patients with scores below the 10th percentile were 33.3% and 39.4% for the right- and

left-hand traditional tapping, and 24.2% and 27.3% for the computerized tapping. Conclusions: Patients with PD were

able to tap faster on the computer than on the traditional finger tapper. The differences attenuated, but did not disappear,

when comparing normative scores.

C-27How Confident Can We Be in the Reporting of Evidence-Based Diagnostic Validity Statistics?

Macleod L, Bowden S

Objective: The aim of this study was to review the reporting of evidence-based diagnostic validity statistics in the neuropsy-

chological and psychological literature. In 1999, the American Psychological Association (APA) Task Force on Statistical

Inference recommended routine use of confidence intervals (CI) when reporting study results. Despite the shift toward interval-

based estimation, it is unclear whether these recommendations are being adopted for the reporting of evidence-based statistics.

Data selection: The PsycINFO (CSA) database was searched for studies reporting the combination of terms “sensitivity” and

“specificity” in the “Title” or “Abstract” fields between January 1, 2009 and April 24, 2010 inclusive. Thirty peer-reviewed

articles and one dissertation were identified. Eighteen articles met broad inclusion criteria for a diagnostic validity study.

Articles not in English were excluded, as were those that did not numerically quantify sensitivity and specificity statistics.

Data synthesis: Only 2 of the 18 articles (i.e., 11%) reviewed reported sensitivity and specificity values bounded by CIs.

Eleven of the articles focused on a neuropsychological population or hypothesis and these 11 included the 2 articles reporting

CIs. Consideration of CIs would have altered the interpretation of results in a proportion of the studies, sometimes radically.

Conclusions: Most neuropsychological and psychological studies included in this brief review, which explicitly report sensi-

tivity and specificity statistics in the Title or Abstract, have not reported CIs. In some studies, conclusions regarding diagnostic

validity would have changed if CIs were considered. This review highlights the need to improve the practice of reporting diag-

nostic validity statistics to improve the accuracy of inferences in evidence-based practice.

C-28

Utilizing the Minnesota Multiphasic Personality Inventory-2 and Millon Clinical Multiaxial Inventory-III to Predict

Epileptic and Non-Epileptic Seizure PatientsPartridge R, Webster B, Heinrichs R, Baade L

Objectives: Patients may have either epileptic seizures (ES) with EEG correlates or non-epileptic seizures (NES) which

appear clinically similar but lack EEG correlates. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is


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routinely used in seizure patients to identify psychopathology and to aid identification of patients with NES. This study

examined the ability of several of the MMPI-2 validity and clinical scales in conjunction with the Millon Clinical

Multiaxial Inventory-III (MCMI-III) Dependent scale to differentiate between ES and NES. Data selection: This

study includes 64 inpatients on a video-EEG unit of a comprehensive epilepsy center. The MMPI-2 and MCMI-III

were administered, and an epileptologist, based on video-EEG data, diagnosed 21 patients with ES and 43 with NES.

A logistic regression analysis was performed with type of epilepsy diagnosis as the dependent variable (DV) and

MMPI-2 clinical scale 1, MMPI-2 clinical scale 3, MMPI-2 validity scale FBS, and MCMI-III scale 3 as predictor vari-

ables. Data synthesis: A total of 64 cases were analyzed and the full model significantly predicted type of epilepsy diag-

nosis (omnibus chi-square ¼ 11.508, df ¼ 4, p ¼ .021). MMPI-2 scale 3 and the FBS scale were the significant predictors

in this model. Conclusions: This study suggests that patients presenting with higher scores on the dependent scale of the

MCMI-III in conjunction with higher scores on scales 1 and 3 of the MMPI-2 should be examined for increased scores

on the FBS scale. Specifically, patients whose profiles have higher FBS scores are more likely to have ES; conversely,

profiles with lower FBS scores appear predictive of NES.

C-29Examining the Influences of Age, Education, and the Wechsler Adult Intelligence Scale-Third Edition FSIQ on the

Benton Visual Retention Test Multiple Choice

Sandhu K, Padua M, Long M, Moses J

Objective: Performance on the Benton Visual Retention Test (BVRT) Multiple Choice is related to recognition memory.

However, by analyzing the impact of demographic variables, age, education, and intelligence, it was found that these

factors influence how well a person performs on the test. Method: This sample comprised of 150 unselected mixed clinical

and medical patients that were given the Benton Visual Retention Multiple Choice (MCVRT) and the Wechsler Adult

Intelligence Scale-Third Edition (WAIS-III) as part of a psychological assessment. Both the test variables and demographic

variables were individually factored in and used to create factor scales: age, education, the WAIS III FSIQ, and the BVRT

Multiple Choice Items broken into groups of 4 (MCVRT items #1–4, MCVRT items #5–8, MCVRT #9–12, and MCVRT

#13–16). Results: Factor analyses indicated that education and FSIQ were not related to age but did relate to the level of

performance (defined as the number of items correctly recognized) on the last quarter of the test (MCVRT #13–16) and

moderately impacted MCVRT items #9–12. Performance on MCVRT items #1–4 and MCVRT items #5–8 was instead

determined primarily by age. These analyses specify that the first half of the BVRT Multiple Choice inversely relates to

age, whereas the last half of the BVRT Multiple Choice loads on years of education and FSIQ. Conclusion: Knowing that

demographic variables have various influences on different portions of the BVRT Multiple Choice, future interpretation of

the BVRT Multiple Choice should acknowledge the impact of these variables as to reflect a component-based globalized

measure of intelligence.

C-30

Descriptive Neuropsychological Assessment Data for a Sample of Patients with Parkinson’s DiseaseSchmitt A, Werry A, Hu S, Stewart R, Livingston R, Deitrick S, Doyle K, Smernoff E

Objective: The objective was to examine the neuropsychological assessment profile of a group of patients with

Parkinson’s disease. Method: The study sample consisted of 60 participants (38 men) with a mean age of 64.7

(SD ¼ 9.7) and mean education of 14.3 years (SD ¼ 3.0). The sample was comprised of individuals living in the com-

munity with advanced Parkinson’s disease involving motor fluctuations (wearing off and dyskinesia). Group means,

standard deviations, and ranges were explored. Results: The group mean for the Repeatable Battery for the

Assessment of Neuropsychological Status (RBANS) Total Scale score was 85.8 (SD ¼ 15.7). RBANS index scores

were as follows: Immediate Memory ¼ 87.1 (SD ¼ 16.4); Visuospatial/Constructional ¼ 90.0 (SD ¼ 18.6);

Language ¼ 91.4 (SD ¼ 10.2); Attention ¼ 86.3 (SD ¼ 18.1); and Delayed Memory ¼ 90.5 (SD ¼ 17.0). Group

means presented as T-scores included the Wisconsin Card Sorting Test (T ¼ 44.9; SD ¼ 10.9), Trails A (T ¼ 39.4;

SD ¼ 10.7), Trails B (T ¼ 38.4; SD ¼ 10.8), Letter Fluency (T ¼ 44.8; SD ¼ 10.8), and Category Fluency (T ¼ 47.5;

SD ¼ 12.7). The mean raw score on the Mini-mental State Examination (MMSE) was 27.6 (SD ¼ 2.6). Conclusion:

Although group means were below normal population means, scores on most of the neuropsychological variables

were within 1 SD of normal controls. However, considering the relatively high level of education in this sample,

these scores are likely indicative of significant cognitive decline from premorbid levels for many individuals in this

sample.


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C-31

Pre-surgical Wechsler Adult Intelligence Scale-Fourth Edition: Functioning among Selected Right and Left Temporal

Lobe Epilepsy PatientsSchoenberg M, Rinehardt E, Mattingly M, Borzog A, Rodgers-Neame N, Vale F, Frontera A, Benbadis S

Objective: Epilepsy is a common neurological disorder with cognitive and psychiatric comorbidity. About 30% of patients

with complex partial seizures had medication refractory epilepsy. Patients with temporal lobe epilepsy (TLE) can exhibit

cognitive deficits, and these are predictive of surgical outcome. However, there are little data regarding the performance

of patients with known neurological disease on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). This

study compares the pre-surgical performance of left and right TLE patients on the WAIS-IV. Method: Patients completing

a pre-surgical evaluation for medically refractory epilepsy. Participants: Nineteen patients met study inclusion and exclusion

criteria. There were 9 left TLE and 10 right TLE patients. Variables/measure(s): all participants completed comprehensive

neuropsychological evaluations. Results: The mean age of left TLE sample was 34 (SD ¼ 9.8) and had 12.8 years of edu-

cation. The mean age of right TLE group was 32 (SD ¼ 10.7) and had 14.1 years of education. The average FSIQ, VCI, and

PRI of the left TLE and right TLE groups did not significantly differ from a mean of 100 (left TLE: FSIQ ¼ 91.3, VCI ¼

92.9, PRI ¼ 92.9, WMI ¼ 93.6, PSI ¼ 93.1; right TLE: FSIQ ¼ 91.0, VCI ¼ 90.5, PRI ¼ 93.7, WMI ¼ 97.4, PSI ¼ 93.7).

Analysis of variance (ANOVA) found no significant differences in WAIS-IV index scores between the left and right

TLE groups. Conclusion(s): While preliminary, there was no significant difference between patients with left TLE

versus those with right TLE. Previous data with prior versions of the Wechsler Adult Intelligence Test has also failed to

reliably lateralize patients with known left or right TLE. Implications for surgical treatment and cognitive outcome are

discussed.

C-32

Longitudinal Analysis of Fatigue and Cognition in Multiple Sclerosis

Ukueberuwa D, Arnett P

Objective: Approximately 50% of patients with multiple sclerosis (MS) experience cognitive impairment, which has a

negative impact on performance of daily activities. Although patients report that fatigue contributes to cognitive difficul-

ties, previous empirical studies have not found a clear linear association. This study assessed coping style as a moderator

of the relationship between fatigue and cognition in a longitudinal MS sample. We hypothesized that patients with high

fatigue who use more adaptive coping would have better cognitive functioning than patients who use less adaptive

coping. Method: Fifty participants (39 females) with a clinical diagnosis of MS completed fatigue, coping, and cognitive

measures and were reassessed 3 years later. Scores on the Fatigue Impact Scale at time 1 and an adaptive coping index (a

composite index of the difference between the active and avoidant scales on the COPE) at time 2 were used to predict

performance on a battery of cognitive tests known to be sensitive to MS. Results: There were significant main effects of

fatigue (R2 ¼ .13, p ¼ .008) and coping style (R2 ¼ .09, p ¼ .018) on cognition. There was also a significant interaction

between fatigue and the adaptive coping index (p ¼ .004), which accounted for an additional 11.5% of the variance in

cognition. Conclusions: Patients with high fatigue who used more adaptive coping had substantially better cognitive func-

tioning than patients who used less adaptive coping. Patients with low fatigue experienced good cognitive functioning

regardless of coping style. These results suggest that learning adaptive coping strategies may lessen the negative

impact of fatigue on cognition for patients with MS.

C-33Attributional Style in Multiple Sclerosis

Vargas G, Riordan P, Arnett P, Lipinski D, Sawyer J, Brewer V

Objective: Past studies have shown that attributional style is related to depression in multiple sclerosis (MS) patients, but

it is unclear whether attributions for MS and non-MS-related events operate similarly. This study sought to describe attri-

butional style and its correlates in an MS population. Methods: Fifty-two community-dwelling MS patients were admi-

nistered the Attributional Styles Questionnaire (ASQ; using only negative events), the Chicago Multiscale Depression

Inventory (CMDI), the Multiple Sclerosis Attitudes Index (MSAI), and the Expanded Disability Status Scale (EDSS).

Results: Patients with more depressogenic attributional styles overall were significantly (p , .01) more depressed.

More specifically, stable (p , .05) and global (p , .01) attributional styles were related to higher depression scores

on the CMDI. Additionally, more disabled patients (higher EDSS) attributed more events to MS-related causes (p ,

.05) and felt more helpless (MSAI) toward their MS (p , .01). The more internal attributions patients made about

MS-related causes, the less helpless they felt toward their MS (p , .05). In contrast, the more internal attributions


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patients made about non-MS-related causes, the more helpless they felt (p , .05). Conclusion: These data show that

attributional style is associated with depression in MS. Internal attributions, however, appear to be related to lower help-

lessness when in reference to disease-related events and higher helplessness in relation to non-MS-related events. Also,

more disabled patients were more likely to attribute hypothetical events to their MS and to feel helpless toward their

disease.7

C-34

Relationship of Subjective Patient Complaints to Neuropsychological Test Performance and DiagnosisViner K, Lee G

Objective: Patients with suspected memory loss based on subjective complaints constitute the majority of referrals to

most neuropsychological practices. Differentiating between objective and subjective impairment, and understanding

how complaints are related to diagnosis, can facilitate understanding of underlying pathology and contribute to effective

treatment. Method: One hundred and seventeen adults referred for evaluation due to memory complaints who had no clear

neurologic cause for their complaints (e.g., absence of structural lesion) served as participants. Comprehensive cognitive

assessment was completed which included a structured clinical interview of subjective (6 cognitive, 9 sensorimotor, and

10 vegetative) complaints. Patients were classified into one of the three groups based on their test performance: 33

patients displayed true memory dysfunction, 48 showed normal memory, but impairment in other domain(s), and 36

had no cognitive deficit. Patients were then evaluated using history and current psychological functioning to uncover

potential etiologies for presenting concerns. Results: Twenty-six of 33 (79%) patients with bona fide memory dysfunction

demonstrated symptoms related to probable neuropathology versus psychopathology, whereas 26 of 48 (54%) patients

with other domain impairment showed the reverse (p ¼ .006). Patients with other domain impairment demonstrated

the highest percentage of complaints overall, with individuals having concurrent neurologic and psychiatric disease

acknowledging the most. Complaints of vegetative symptoms were most effective in differentiating neurologic from psy-

chiatric etiology; psychiatric etiologies having more vegetative complaints. Conclusions: A small percentage (28%) of

patients referred for evaluation of subjective memory complaints had actual memory impairment. Psychopathology

was associated with an increase in subjective complaints. Subjective complaints can help to inform testing decisions

and offer valuable information about potential diagnosis.

C-35Self and Informant Ratings of Cognition in Multiple Sclerosis (MS) and Healthy Controls: Relationship to Objective

Measures

Walker L, Berrigan L, Ress L, Cheng A, Freedma M

Multiple sclerosis (MS) often leads to objective deficits in information processing speed (IPS), memory, and executive

functioning. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a brief questionnaire that allows indi-

viduals with MS and informants to subjectively rate extent and impact of MS-related cognitive impairment. Objective: To

determine whether a greater degree of correlation with objective cognitive performance is found with informant over self-

ratings. Self-ratings were expected to show stronger correlations with depression. Method: Fifty-five individuals with MS

and 26 demographically matched healthy controls (HC) underwent neuropsychological evaluation including the MSNQ

and the Beck Depression Inventory-Fast Screen (BDI-FS). Results: Self and informant MSNQ ratings significantly dif-

fered from each other for both MS and HC groups, although the MS and HC groups did not differ regarding their

ratings on either form. Although both self and informant forms in the MS group correlated with some objective measures

of cognition, as expected, the relationship was stronger with the informant form. The self-form positively correlated with

scores on the BDI-FS in the MS group. Objective measures of IPS were the most sensitive to impairment in MS and HC

groups. Conclusions: Subjective ratings of cognition in individuals with MS correlate with depression and less so with

cognition, whereas informant ratings demonstrate stronger correlations with cognition and none with depression.

Controls demonstrate a similar pattern of correlations for cognitive measures but not for depression. Utility of the

MSNQ as a screening tool in a clinical setting is discussed.

C-36

Learning Disorders and Temporal Lobe Epilepsy: A Case StudyHellings J, Whiteside D, Brown J

Objective: This case study describes the relationship between left temporal lobe epilepsy (TLE) and learning disabilities in a

26-year-old male college student. The client developed seizures following an episode of mycoplasma encephalitis at the age of


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7. The client underwent a left temporal lobectomy involving resection of the left mesial temporal lobe, amygdala, hippo-

campus, and part of the brain stem 6 years prior to the current evaluation in an attempt to address the frequency of the seizures.

The surgery was extensive, including neocortical resection extending posterior to the vein of Labbe along the inferior temporal

gyrus. The lobectomy reportedly successfully eliminated the seizures and the need for anti-seizure medications, but no neuro-

logical or neuropsychological follow-up occurred until 2009 when he was referred by his academic program for an evaluation

of learning disabilities. Method: The client participated in a comprehensive neuropsychological evaluation at a university-

based training clinic. The evaluation consisted of extensive neuropsychological, academic, and personality assessment.

Results: Results of the neuropsychological evaluation indicated significant expressive language functioning deficits, with gen-

erally better preserved receptive language. Conclusions: Compared with a pre-surgical neuropsychological evaluation, there

was evidence for subtle to mild improvement in several aspects of cognitive functioning, likely due to seizure elimination

and discontinuation of the anti-seizure medication. Nonetheless, his deficits resulted in significant functional impact on his

academic abilities, which required extensive academic accommodations.

C-37Multiple Chemical Sensitivity (MCS) is a Neuropsychological Disease

Singer R

Multiple chemical sensitivity (MCS) is an orphan disease, shunned by its rightful parents, neuropsychology and medicine.

MCS has medical, immunological, toxicological, neuropsychological, and psychological aspects. An extensive literature on

the topic has been developed since WWII, including: MCS is an international condition, with prevalence studies of up to

46% in an Italian population sample. A quasi-experimental study showed that after accidental exposure of workers for 2

months to gasoline-contaminated soil in a tunnel, 1/4 of the men developed persistent MCS. Temporomandibular joint implants

patients develop MCS after surgery. Statistically significant responses were found in MCS subjects (all measures, p,0.02) in

tonic electrodermal response to test substances compared with controls, and compared with the control substance. SPECT

found that MCS cases presented poorer neurocognitive function at baseline, and neurocognitive worsening after chemical

exposure. Chemical exposure caused neurocognitive impairment and SPECT brain dysfunction particularly affecting odor-

processing areas. Neuropsychologists are ideally suited to research, diagnose and treat people with this condition. While

some patients or claimants presenting with multiple chemical sensitivity will have hypochondriacal overtones, others are actu-

ally suffering from a sensitivity, akin to allergy. The best available diagnostic tool for MCS is a comprehensive neuropsycho-

logical evaluation, assessing cognitive and executive function, personality and emotional disorders, as well as effort and

malingering, along with a medical and historical record review. Neuropsychologists performing this evaluation should be fam-

iliar with the extensive literature documenting the reality of multiple chemical sensitivity as a neurotoxic/neuropsychological

disorder.

C-38

HIV Infection is Associated with Comparable Deficits in Time- and Event-based Prospective MemoryWoods S, Weber E, Cameron M, Dawson M, Grant I, The HNRC Group

Objective: According to McDaniel and Einstein’s (2000) multi-process theory of prospective memory (ProM; i.e., “remember-

ing to remember”), time-based tasks rely more heavily on strategic processes dependent on prefrontal systems than do event-

based tasks. Given the prominent frontostriatal pathophysiology of HIV infection, one would expect that HIV-infected indi-

viduals would demonstrate greater deficits in time- versus event-based ProM, but the two prior studies that have examined

this question produced variable results, perhaps due to small sample sizes and measurement differences. Method:

Participants included 143 individuals with HIV infection and 43 demographically similar seronegative adults

(HIV-negative) completed a comprehensive neurocognitive, psychiatric, and medical evaluation. Individuals with severe psy-

chiatric illness, neurological disease, or current substance dependence were excluded. All participants also completed the

Memory for Intentions Screening Test (MIST), which yields psychometrically parallel subscales of time- and event-based

ProM. Results: A repeated-measures analysis of variance (ANOVA) revealed main effects of HIV serostatus (p ¼ .016) and

cue type (p , .001), but no interaction between serostatus and cue (p ¼ .861). Planned pair-wise comparisons showed a sig-

nificant HIV effect on time-based ProM (p ¼ .016, Cohen’s d ¼ .48) and a trend-level effect on event-based ProM (p ¼ .074,

Cohen’s d ¼ .36). Conclusions: Findings from this study suggest that HIV infection is not associated with a disproportionate

effect on time- versus event-based ProM. Whether such comparable deficits reflect a common dysregulation of strategic moni-

toring and retrieval processes or separate underlying mechanisms remains to be determined. In addition to their theoretical

value, such investigations are of clinical importance because HIV-associated ProM deficits are strongly linked to everyday

functioning outcomes, such as medication non-adherence.


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NEUROPSYCHOLOGICAL DOMAINS: EXECUTIVE FUNCTIONS

C-39The Relationship between Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ and Neuropsychological Test

Performance

Frisch D, Brzinski B, Golden C

Objective: The purpose of the present study was to generate data on the relationship between intelligence, as measured by the

new Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) FSIQ, and a variety of commonly used neuropsychological

tests as a replication of earlier studies using earlier versions of the test. Method: The sample consisted of 30 individuals (14

males). The mean age of the sample was 32.86 years (SD ¼ 13.89) and the mean education was 12.78 years (SD ¼ 2.32).

Correlations were run between the WAIS-IV Full Scale IQ (FSIQ) and the Indices of the Wechsler Memory Scale-Fourth

Edition (WMS-IV), the Stroop Color-Word Test, the Trail Making Test, the Wisconsin Card Sorting Test, the Category

Test, Finger Tapping Test, and the Tactual Performance Test (TPT). Results: Significant correlations (df ¼ 28) were found

between the WAIS-IV FSIQ and the WMS-IV Auditory Memory Index (r ¼ .52), Visual Memory Index (r ¼ .65), Visual

Working Memory Index (r ¼ .71), Immediate Memory Index (r ¼ .77), Delayed Memory Index (r ¼ .56), Stroop Color

(r ¼ .42), Stroop Color-Word (r ¼ .48), Trails A (r ¼ .46), Trails B (r ¼ .51), Category Test (r ¼ .56), TPT-Dominant

Hand (r ¼ .48), TPT-Non-Dominant Hand (r ¼ .59), TPT-Both (r ¼ .60), and TPT-Location (r ¼ .48). All correlations

were significant at the p , .05 level. Conclusion: Results revealed significant correlations between the WAIS-IV FSIQ and

measures of memory, concentration, set-shifting, cognitive flexibility, non-verbal concept formation, and sensory and motor

functions. These results are comparable to studies using earlier versions of the WAIS.

C-40

Anxiety and Cognitive Performance: A Neuropsychological Assessment of Patients Undergoing Coronary Artery

Bypass Graft SurgeryHutton J, Vidal O, Puente A

Since the advent of coronary artery bypass graft (CABG) surgery, neurological complications, including strokes, seizures, and

cognitive impairments, have been associated with the procedure. Recent studies have indicated that certain characteristics of

patients pre-operatively may predict post-operative complications (Keith, Puente, Malcolmson, Tartt, Coleman, & Marks,

2002; Morrill, Richardson, Keith, & Puente, 2006). Based on these findings, it was hypothesized that pre-operative anxiety

may put patients at a higher risk of post-operative cognitive impairments. Participants were assessed pre- and post-operatively

to measure cognitive function and level of anxiety. Tests of cognitive function included the Stroop Color and Word Test, Trail

Making Test Parts A and B, and the Symbol Digit Modalities Test. The State Trait Anxiety Inventory was used to assess

anxiety. Results indicated that participants did not experience significant cognitive decline from pre- to post-surgery.

Furthermore, although situational state anxiety did not correlate significantly with performance on any neuropsychological

tests, general trait anxiety showed a significant negative relationship with performance, indicating that higher general

anxiety leads to poorer performance on neurocognitive tests. The second part of the study involved comparing scores on

the State Trait Anxiety Inventory to cortisol levels from saliva samples obtained once testing sessions had been completed.

The purpose of this part of the study was to (a) examine correlations between a self-report and physiological measure of

anxiety and (b) review the literature to examine which technique would provide a more accurate reading of anxiety. Results

indicated that neither state nor trait anxiety scores correlated significantly with salivary cortisol levels.

C-41

Executive Functioning as a Potential Link between Attention-deficit/Hyperactivity Disorder and Developmental

DyslexiaKlaver J, Lee S, Kibby M

Objective: The purpose of this study was to examine potential differences in executive functioning (EF) among children with

Attention-deficit/Hyperactivity Disorder-Predominately Inattentive type (ADHD-PI), ADHD-Combined type (ADHD-C), and

developmental dyslexia (DD). While deficits in EF are not commonly associated with DD, some literature suggests they may

have executive dysfunction and, thus, EF may be a potential source of comorbidity between DD and ADHD. Method:

Participants included 146 children, aged 8–12 years, with ADHD-PI (n ¼ 28), ADHD-C (n ¼ 19), DD (n ¼ 35), comorbid

ADHD/DD (n ¼ 17), and controls (n ¼ 47). Groups were equated on age, gender, ethnicity/race, and non-verbal IQ (Test of

Nonverbal Intelligence-Third Edition; TONI-3). They performed several measures as part of a university-based, NIH/

NICHD-funded project (R03 HD048752) including the Wechsler Intelligence Scale for Children, Wisconsin Card Sorting Test,


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and NEPSY Design Fluency and Tower. Results: Initial statistics compared the five groups on EF measures using multivariate

analysis of variance (MANOVA). ADHD-PI and ADHD-C performed highly comparable to each other; thus, 2 (ADHD or

not) × 2 (DD or not) MANOVA was used in order to determine if there was an interaction between ADHD and DD. No interactions

were found. Children with DD performed worse on NEPSY Design Fluency (F(1, 142) ¼ 10.23, p ¼ .002), Wechsler Intelligence

Scale for Children-Fourth Edition (WISC-IV) Letter-Number Sequencing (F(1, 82) ¼ 7.66, p ¼ .007), total number of categories

achieved on the WCST (F(1, 139)¼ 6.97, p ¼ .009), and WISC Digit Span Forward (F(1, 141)¼ 6.88, p ¼ .010) and Digit Span

Backward (F(1, 141) ¼ 7.05, p ¼ .009) than those without it. The ADHD group tended to perform worse than those without it on

Design Fluency (F(1, 142) ¼ 3.80, p ¼ .053). Groups did not differ on the NEPSY Tower. Conclusions: Our study suggests that

executive dysfunction may contribute to the problems seen in children with DD.

C-42Executive Functioning and Blood Glucose Levels of Adolescents with Type 2 Diabetes

Mireles G, Anderson B, Davis J

Objective: This pilot study examines the relationship among executive functioning and blood glucose levels in adolescents with

type 2 diabetes. Method: Participants for this study were recruited from a large pediatric hospital in an urban setting. The total

sample of participants was 9. The participants had a mean age of 14.3 years (SD ¼ 1.7). The sample included predominantly

females (66%) and was predominantly Hispanic (77%). Adolescents with type 2 diabetes completed the Behavior Rating

Inventory of Executive Function (BRIEF) Self Report, whereas their parents completed the BRIEF-Parent Form

(BRIEF-Parent Form). Participants completed the BRIEF during their regular outpatient visit to the Diabetes Clinic at this

pediatric hospital. The participant’s glycosylated hemoglobin (HbA1c)—the average blood glucose over the last 2–

3-month period—was used as a measure of metabolic control. Spearman rank correlation was calculated to examine the cor-

relation between executive functioning and metabolic control. The eight individual indices of the BRIEF, the two broader

indices, and the composite score were examined in relation to the HbA1c levels. Results: A statistically significant correlation

(p ¼ .048) was found between parent rating of planning/organization and HbA1c. No other significant correlations were found

on any of the other indices assessed as reported by the adolescents or their parents. Conclusions: Adolescents’ self-rating of

executive functioning was not related to level of metabolic control. Interestingly, parent’s report of the adolescent’s ability to

manage current and future-oriented task demands within the situational context was significantly correlated with a measure of

average blood glucose levels over the past 3 months.

C-43

Predictive Ability of Executive Functions on Full Scale IQ

Rosen S, Scarisbrick D, Brzinski B, Golden C

Objective: The current study attempted to evaluate the ability of executive functions to predict Full Scale IQ (FSIQ) in individuals

with average to superior intelligence. Method: In a sample of 165 normal volunteer participants, there were 87 participants in the

average FSIQ range and 79 participants in the above average to superior range of intelligence. Executive functioning was measured

using the total time to complete part B of the Trail Making Test (TMT), the total number of perseverative errors on the Wisconsin

Card Sorting Test (WCST), and the total number of trials to complete the WCST. Intelligence was assessed using the prorated Full

Scale IQ score on the Wechsler Adult Intelligence Scale-3rd Edition. A linear regression was conducted for each group of FSIQ

scores. Results: The regression indicated that 6.3% (r ¼ .25, p . .05) of the variance was accounted for by executive functions,

particularly time to complete TMT part B in participants with above average to superior intelligence.The second regression indi-

cated that 13.7% (r ¼ .37, p , .05) of the variance was accounted for by executive functions in participants with average intelli-

gence. Conclusion: Executive functioning was thought to predict FSIQ in all individuals; however, it appears that it is less likely to

predict FSIQ in individuals with above average to superior intelligence. These effects may be accounted for by differences in pro-

cessing speed. Processing speed is probably higher in individuals with higher IQ scores. Overall executive functions were signifi-

cant in predicting FSIQ only in the participants with average intelligence.

C-44A Meta-Analytic Review: Verbal Fluency as a Measure of Executive Function in Individuals with Autism Spectrum

Disorders

Simek A, Vaughn C, Wahlberg A, Yoon H, Riccio C

Objective: Research has suggested that deficits in executive function (EF) are exhibited by individuals with autism spectrum

disorders (ASDs). The purpose of this meta-analysis was to provide a review of the literature on tasks that assess verbal fluency

as a measure of EF in individuals with ASDs. Data selection: Searches on Medline and PsychInfo with keywords including


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“verbal fluency,” “executive function,” and “Autism Spectrum Disorders” identified the studies for the analysis. Additional

references were generated from the review of the cited articles. Only articles that could be obtained in English and that indi-

cated the use of a measure of verbal fluency in the assessment of ASDs were included in the analysis. Data synthesis: Cohen’s d

effect size was calculated for each verbal fluency variable used. Results indicated that generativity attributes of individuals with

ASDs are not consistent across verbal fluency tasks. Effect sizes, on average, were medium, but differences in effect sizes

appeared between semantic verbal fluency tasks and phonemic verbal fluency tasks. Effect sizes were larger when individuals

with ASD were compared with age- and ability-matched control groups. Conclusions: The findings of the analysis suggest that

impairments in executive function in individuals with ASDs can be measured by verbal fluency tasks taking into consideration

the task and the composition of the comparison group. Measures of verbal fluency are recommended as part of a comprehensive

assessment for individuals with ASDs.

C-45

Psychological Impact of Emotions in Chess Players’ Cognitive Performance

Steger A, Nemeth D

Objective: Schwarz et al. (2002) analyzed tournament chess players who reported their emotional states after each move and

found that feelings of hopelessness and helplessness correlated with high heart rate variability. The impact of one’s emotional

state on chess-playing ability, however, is less studied. The goals of this study were to correlate emotions with chess perform-

ance and to examine the impact of personality traits on how chess players perform. It is hypothesized that mistakes associated

with changes in chess players’ emotional states will be of greater magnitude than mistakes that are not associated with changes

in their emotional states. Also, players who have maladaptive personality traits are likely to make more mistakes than will

players with adaptive personality traits. Method: Twenty participants (19 males and 1 female, aged 16–65) with U.S.

Chess Federation ratings were matched against each other via the Internet Chess Club. Time control was 45 min for each

side, with a 45-s increment. After playing each move, participants completed the International Positive and Negative Affect

Schedule Short-Form (I-PANAS-SF). Participants submit the game online, and their moves were then analyzed using the

Rybka 3 computer chess engine at a fixed search depth of 12 plies. The participants also completed the PsychEval

Personality Questionnaire (PEPQ). Results: Chess players with adaptive personality characteristics and low levels of

anxiety made fewer errors than did their counterparts who exhibited reactive personality characteristics and high levels of

anxiety. Conclusions: Chess players must learn to manage stress effectively in order to improve their cognitive performance.

C-46

Negative Emotional Distracters Impair Set Maintenance in a Switching Task

Thorgusen S, Suchy Y, Rau H, Williams P

Objective: Emotional distracters have been shown to alter performances on various cognitive measures, including task switching

(Wang & Guo, 2008). The present study investigated the effects of emotional distracters on set maintenance and switching costs in a

spatial and a verbal version of a switching task. Method: Two hundred and nineteen college-age students were recruited from under-

graduate psychology classes. Participants completed two switching tasks, one requiring that they switch between classifying stimuli

as vowels/consonants versus capital/lower case letters, and one requiring that they switch between classifying locations of stimuli

on the screen along a diagonal versus vertical axis. Each stimulus consisted of a letter of the alphabet superimposed over a grayscale

image with smiling (positive) or crying (negative) facial expressions. Switching costs and set maintenance costs were computed by

subtracting baseline performances from switch and set maintenance trials. Results: A repeated-measures analysis of variance

(ANOVA) using (a) response latencies as dependent variables and (b) distracter type (positive vs. negative), cost type (switch

vs. set loss), and task type (verbal vs. spatial) as within-subjects factors yielded a significant three-way interaction between task

type, distracter type, and cost type (F(1, 218) ¼ 77.48, p , .001), such that only negative (but not positive) distracters had deleter-

ious effects, which were evident only on set maintenance (not switch) costs and only for the spatial task (t(1, 211) ¼ 12.05, p ,

.001). Conclusions: Negative emotional distracters may occupy attentional resources in the right hemisphere that are needed for

adequate set maintenance during performance on spatial tasks.

C-47

A Meta-Analytic Review of the Use of the Wisconsin Card Sorting Test with Individuals with Autism Spectrum

DisordersWahlberg A, Yoon V, Simek A, Vaughn C, Riccio C

Objective: Research suggests that deficits in executive functioning including strategic planning, organized searching, set shift-

ing, goal attainment, and inhibition are common to both Attention-deficit/Hyperactivity Disorder (ADHD) and Autism


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Spectrum Disorders (ASD). The purpose of this meta-analysis is to provide a review of the extant ASD literature with regard to

tasks frequently used in the assessment of ADHD, namely the Wisconsin Card Sorting Test (WCST), and to lend support to the

notion that measures traditionally used in the assessment of ADHD may also be effective in the diagnosis of ASD. Data selec-

tion: Studies included in the meta-analysis were identified through a search of PsychInfo and Medline. Search terms included

“autism,” “Asperger,” and “pervasive developmental disorder.” From the generated search and subsequent review of cited

articles, only those that could be obtained in English and contained data for more than one group were included in the analysis.

Data synthesis: Cohen’s d was calculated for each reported variable (categories achieved, trials, errors, and perseverative

errors) based on the information provided in each article. Results indicate moderate-to-large average effect sizes on the

reported variables. Conclusion: Although traditionally used to assess ADHD, the WCST is also sensitive to the executive func-

tioning deficits found in ASD and can effectively discriminate between individuals with ASD and normal controls. Based on

the available studies, the use of the WCST as part of a comprehensive assessment of individuals with suspected ASD is

recommended.

C-48Relationships between Executive Functioning and Behavioral Rating Inventory of Executive Function (BRIEF) Scores

in a Pediatric Epilepsy Sample

Whitman L, Bender H, Granader Y, Freshman A, MacAllister W

Objective: The Behavioral Rating Inventory of Executive Function (BRIEF) is a questionnaire that assesses “real-world”

executive functioning in children and adolescents. Although the relationship between BRIEF scores and executive func-

tioning test performance has not been consistently borne out in a variety of pediatric neurological subgroups, a prior study

in a pediatric epilepsy sample demonstrated this link (Parrish et al., 2006). In an effort to replicate this finding, the current

study investigated the relationship between BRIEF scores and performance on executive functioning tasks in children

diagnosed with partial or generalized epilepsy. It was hypothesized that scores on BRIEF clinical scales would predict

neuropsychological performance across selected executive functioning tasks. Method: Participants included 25 children

(mean age ¼ 11.36; 14 females and 11 males) consecutively evaluated children with partial or generalized epilepsy.

Mean age of epilepsy onset was 6.18 (SD ¼ 4.40). Mean number of AEDs was 1.52 (SD ¼ 0.87). Variables included

all BRIEF clinical scales and performance on Trail-making, Digit Span (forward and backward), and Tower of

London. Pearson product–moment correlations between neuropsychological performance and BRIEF clinical scales

(standard scores) were completed. Results: The working memory clinical scale was correlated with Digits Backward

(r ¼ 2.491, p ¼ .013), although no other clinical scales correlated with performance on other neuropsychological

tests. Conclusion(s): Despite common assumption that parent-reported executive functioning and neuropsychological

test performance are linked, results suggest that some behavioral and cognitive measures of executive functioning in chil-

dren diagnosed with epilepsy are not strongly related and thus are likely separable constructs.

C-49Clinical Utility of the Biber Cognitive Estimation Test in a Pediatric Epilepsy Sample

Freshman A, Bender H, Whitman L, Granader Y, MacAllister W

Objective: Cognitive estimation tests involve generating reasonable answers to questions for which certain facts, but not defini-

tive answers, are available. Executive functions (EFs) including planning, working memory, mental control, and self-

monitoring are required for successful completion of these tasks. This study assesses cognitive estimations in childhood epi-

lepsy and examines its relationship with intellectual functioning and tests of EFs. Method: Twenty-five children with epilepsy

(mean age ¼ 11.36, mean age at seizure onset ¼ 6.18) were administered the Biber Cognitive Estimations Test (BCET), which

assesses estimation of quantity, time, weight, and distance. Measures of intellectual functioning, the Tower of London, and the

Trail Making Test were also administered. Correlational analyses examined the relationship between the BCET, epilepsy vari-

ables, and the other cognitive measures. Results: Quantity and weight estimation were impaired in 36% and 40% of partici-

pants, respectively, when compared with normative means. Time and distance estimation were less impaired (19% and

16%, respectively). Forty-four percent had impaired BCET total scores. BCET total score was significantly correlated with

age of seizure onset (r ¼ .438, p ¼ .029); other epilepsy variables were non-significant. BCET was also correlated with

overall intellectual functioning (r ¼ .715, p , .001), Digit Span Forward (r ¼ .438, p ¼ .029), and Backward (r ¼ .551,

p ¼ .004). Other EF tests were non-significant. Conclusions: Cognitive estimation ability is impaired in childhood epilepsy

and appears to be related to age of onset and intellectual functioning. The BCET correlates to several, but not all EF tests

with well-established validity, reliability, and utility in this population, suggesting that the BCET may be tapping a unique

construct not assessed by other EF tests.


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C-50

A Meta-Analytic Review of the Use of Tower Test with Autism Spectrum Disorder

Yoon V, Simek A, Vaughn C, Wahlberg A, Riccio C

Objective: Executive function deficits are one of the most frequently reported symptoms of autism spectrum disorders (ASD).

The tower tasks are a widely used measure of executive functioning. In relation to tower tasks, the problem-solving process

requires executive functioning include goal-focused behavior, the ability to plan and carry out organized sequence of steps,

and the ability to form a mental representation of a task. The purpose of this meta-analysis is to provide a review of the existing

ASD literature with regard to the discriminating power of the tower tasks in measuring executive functioning between individ-

uals with autism spectrum disorder and a control group. Data selection: Studies for inclusion were identified through a search of

PsychInfo, Medline, and EBSCO with the task names “Tower of London” or “Tower of Hanoi” in combination with the terms

“Autism,” “Aspergers,” and “High Functioning Autism.” The resulted articles that could be obtained in English and contained

data for more than one group were included in the analysis. Data synthesis: Cohen’s d was calculated for each reported variable

(execution time, decision time, number of trials, rule violation, time violation, and total scores) on the information provided in

each article. Results indicate moderate-to-large effect sizes on the reported variable. Conclusion: Widely used to assess execu-

tive functioning in ASD, tower tests are sensitive in detecting executive functioning deficits in autism and has discriminating

power between individuals with ASD and normal control groups.

NEUROPSYCHOLOGICAL DOMAINS: MEMORY AND AMNESIA

C-51

Normative Data for Logical Memory Story A in Alzheimer’s Disease and Normal ControlsNoll K, Cullum C, O’Bryant S, Hall J, Simpson C

Objective: Story A from the Logical Memory (LM) subtest of the Wechsler Memory Scale-R/III (WMS-R/WMS-III) is some-

times administered in isolation for screening or research purposes. Cutoffs for impairment have been proposed for Story A, but

no data have been presented demonstrating the equivalence of Story A and the standard version. Method: Three hundred and

eighty participants with Alzheimer’s disease (AD) and 152 healthy controls of similar age and education were administered

either Story A or the full version of the WMS-R/III LM I and II subtests as part of a larger neuropsychological battery.

Individual story scores and retention rates were compared across groups with analysis of variance (ANOVA). Results:

Controls demonstrated significantly better Story A delayed recall (13.3 vs. 11.8) and percent retention (91.7% vs. 77.7%, p

, .05) when administered Story A alone compared with those who were administered the full LM subtest. A similar

pattern for retention rates was seen in the AD sample (41.4% vs. 31.8%), but was not significant. Conclusion: LM Story A

delayed recall and retention rates were lower when Story A was administered along with Story B in the standard format com-

pared with Story A alone in older controls and Ss with AD, suggesting interference effects related to Story B. As such, impair-

ment cutoffs (e.g., 1 SD below M) need to be adjusted when Story A is administered in isolation (e.g., ,9 vs. ,7). These

results highlight the impact changes in administration procedures can have on test performance.

C-52

The Benton Visual Retention Test and Mediating Learning Variables: Distinguishing Item SophisticationPadua M, Long M, Sandhu K, Moses J

Objective: Intelligence combined with age and education was found to influence performance on varied neuropsychological

tests, however the extent to which these learning variables mediate memory is not clearly established within the Benton

Visual Retention Test (BVRT). The purpose of the study is to elucidate the role of the Wechsler Adult Intelligence

Scale-Third Edition (WAIS-III) (Verbal Comprehension Index/VCI, Working Memory Index/WMI, Perceptual

Organization Index/POI), age, and years of formal education on the BVRT. Method: U.S. veterans within the Palo Alto VA

Healthcare System were randomly and consecutively referred for neuropsychological assessment. No exclusion criteria

were used. These veteran patients exhibited mixed medical and neuropsychiatric diagnoses. They were administered the

WAIS-III and the BVRT; factor scales were composed. To clarify the influence of age and education on memory, the

WAIS-III was removed from the analyses. Results: The analyses revealed that VCI, WMI, and education factored together,

whereas age negatively correlated with items 3–10 on the BVRT. POI factored together with both verbal and non-verbal

items on the BVRT. Age was found to be uniquely related to BVRT items 3–10 (non-verbally mediated/memory) and had

a mild influence on items 1 and 2 (verbally mediated/memory). Consequently, education influenced items 1 and 2 on the

BVRT. Conclusion: The results, in this sample, suggested that education mediated the verbal learning strategy on items 1

and 2 and that the latter items do not adhere to this construct. Furthermore, the BVRT items 3–10 have a sophisticated


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crystallized component, as POI contributed to an age-related non-verbal learning intellectual strategy, which describes a more

complex memory structure.

C-53

Relationship of Working Memory When Compared to Memory Indices Measuring a Related ConceptScarisbrick D, Holster J, Corsun-Ascher C, Golden C

Objective: The authors studied the relationship between Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and

Wechsler Memory Scale-Fourth Edition (WMS-IV) measures of working memory. Method: Participants consisted of 20

adults aged 19–68 years (M ¼ 34.20, SD ¼ 13.87) from a clinically referred population. The sample was 65.0% females,

60.0% Caucasian, and had an average education level of M ¼ 13.38 years (SD ¼ 2.06). Index scores from the WMS-IV including

Visual Working Memory, Visual Memory, and Auditory Memory (AMI) and WAIS-IV including Working Memory (WMI) were

utilized in analyses. Results: Moderate positive linear relationships were found between WMS-IV Visual Working memory and

WMS-IV Visual Memory (r(20) ¼ .572) and WAIS-IV Working Memory and WMS-IV Visual Working Memory (r(20) ¼

.686). There were no significant correlations between the AMI and the WAIS WMI. Conclusions: The authors of the new revi-

sions of the Wechsler Memory and Intelligence scales have indicated that the Working Memory subtests were divided between

the two tests because the WAIS was supposed to measure Auditory Working Memory, whereas the WMS was supposed to

measure Visual Working Memory. It was hypothesized that these processes should relate to their counterpart memory tests

the Auditory Memory Index and the Visual Memory Index of the WMS-IV. The hypothesis was partially supported.

Significant correlations were noted between the VWMI and the VMI, but there was no significant correlations between the

AMI and the WAIS WMI. It was initially thought that the processes involving working memory should relate because they

are involved in the client’s initial ability to consolidate memory, but this was not found.

C-54Relations of Depression Factors in Encoding Strategies and Verbal Memory

Stang B, Trettin L, Rogers E, Saleh M, Che A, Tennakoon L, Keller J, Schatzberg A, Gomez R

Objective: Little research has examined the relationship between factors of depression and their relationship to encoding strat-

egies and verbal memory performance. Depression factors created through a factor analysis will be examined to determine

what aspects of depression predict deficits of encoding and verbal memory ability. Methods: Forty-five depressed patients

and 41 healthy control adults participated in the study. The 24-item Hamilton Depression Rating Scale (HDRS) was used

to measure depression severity, and the California Verbal Learning Test-Second Edition (CVLT-II) was used to measure

encoding strategies (semantic, subjective, and serial clustering) and verbal memory performance (CVLT-II Trials 1–5).

Results: Based on preliminary results, six factors were created from the HDRS through factor analysis, which explained

75.6% of the variance. Correlations between the depression factors and the verbal memory and encoding scores indicated

that only the sleep/cognitive factor was consistently related to these CVLT-II scores. A multiple regression with the sleep/cog-

nitive factor and the three encoding strategies significantly explained 54% of the variance for verbal memory. The sleep/cog-

nitive factor was partially mediated by encoding strategies in predicting verbal memory. This depression factor

(Beta ¼ 2.162), semantic clustering (Beta ¼ .703), and serial clustering (Beta ¼ .445) were found to be unique predictors

(p , .05). Subjective clustering (Beta ¼ .470) did not have significant unique contributions to the regression model

(Beta ¼ .191, p ¼ .19). Conclusions: Only one of the six factors of depression (specifically sleep/cognitive) predicted encoding

strategies and verbal memory performance. These findings suggest that depression is not a unitary construct and that only

specific depression symptoms affect a patient’s ability to encode and remember verbal information.

C-55

Factor Analysis between Wechsler Adult Intelligence Scale-Third Edition and California Verbal Learning Test-SecondEdition Show Common Working Memory Pathways in Adult Brain Functions

Tayim F, Moses J, Morris R

The California Verbal Learning Test-Second Edition (CVLT-II) is a widely used test that measures different measures of

memory encoding and retrieval. This study looks at a quantitative and qualitative, comprehensive comparison of the

primary CVLT-II factors: verbal comprehension (verbal attention without attention span), perceptual organization (non-verbal

intellectual ability), and speed/attention/concentration (freedom of distractibility). When the main components of this test were

analyzed using factor analyses, it was found that memory retrieval factors correlated highly between primacy and serial vari-

ables, education with verbal comprehension and ability, perceptual organization with age, and freedom from distractibility

combined to explain 77.37% of the variance. When these factors were juxtaposed with Wechsler Adult Intelligence


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Scale-Third Edition (WAIS-III) variables, it was found that there is an overlap with 77.7% of the variables explaining variance.

There appears to be a working memory component that is shared by the CVLT-II and WAIS-III variables when both primacy

and serial processing are included in the factor analyses. As the CVLT-II is primarily a verbal attention and retention task, there

is no clear separation between how many words are recalled in order to distinguish what is primarily identified as “primacy,” or

“recency.” The related factors of attention and working memory played a key role in determining how accurately the patient

recalled words from the CVLT-II.

C-56Memory Profile Patterns Across Developing Youth: An Examination of the Test of Memory and Learning

Thaler N, Lechuga D, Cross C, Salinas C, Reynolds C, Mayfield J, Allen D

Objective: In order to understand atypical memory patterns in children and adolescents today, it is crucial to first understand

normative memory development patterns. The current study examined raw scores of the Test of Memory and Learning’s

(TOMAL) standardization sample in order to ascertain how and when memory components progress across children and ado-

lescents. Method: Participants included 1,121 youth between 5 and 19 years of age selected from the TOMAL standardization

sample. Subtest raw scores were analyzed in an exploratory two-step cluster analysis to determine age-segregated clusters.

Descriptives of these clusters then served as a base to run a series of bootstrap discriminant function analyses.

Classification rates were compared to establish the age ranges that best captured differential memory patterns. Results: The

two-step analysis extracted three clusters that differed on age (p . .01) but not on gender or ethnicity. Clusters had mean

ages of 7.1 (SD ¼ 1.8), 11.1 (SD ¼ 2.7), and 13.5 (SD ¼ 2.9). Repeated discriminant function analyses indicated that age

ranges between 5 and 8 years, 9 and 11 years, and 12 and 19 years best represented differential memory development patterns

across age with an overall 77.1% classification rate. The cutoff ages of 9 and 12 concord with existing theory, and inspection of

raw subtest scores suggest that several subtests of both visual and verbal modality improve markedly at these age points.

Discussion: Results provide preliminary evidence that overall normative memory development progresses rapidly between

5 and 8 years of age, somewhat more slowly between 9 and 11 years of age, and levels off between 12 and 19 years of age.

C-57Assessment of Memory: Utility of the Mini-mental State Examination Three-Word Recall Task

Webster B, Partridge R, Heinrichs R, Badde L

Objective: This study examined patients on a geriatric psychiatric unit who passed the Mini-mental State Examination (MMSE)

(total score greater than 24), but achieved scores on the Repeatable Battery for the Assessment of Neuropsychological Status

(RBANS) delayed memory index which suggested memory impairment. The MMSE three-word recall task was examined to deter-

mine if performance on this task helped identify the memory impaired individuals. Data selection: Participants were 76 senior

adults (mean age ¼ 76.13, SD ¼ 8.9; mean education ¼ 11.94, SD¼ 2.3) hospitalized on a rural geriatric psychiatry unit and

earning an MMSE Total Score greater than 24 at admission. Patient’s scores on the RBANS Delayed Memory Index were examined

using independent sample t-tests for differences relative to their MMSE three-word recall task score. Patients scoring a 0 comprised

group 1 and patients scoring a 3 comprised group 2. Data synthesis: Patients scoring a 0 on the MMSE three-word recall task scored

on average more than 3 SD below the mean on the RBANS Delayed Memory Index (M ¼ 61.81). Patients scoring a 3 were on

average 1 SD below the mean on this index (M ¼ 81.27). This mean difference was statistically significant (t ¼ 23.901, df¼

74, p , .0001). Conclusions: In a hospitalized geriatric population, approximately 40% of the patients passing the MMSE have

impaired short-term memory. The MMSE three-word recall score helps to identify these patients. This study suggests that the

MMSE is most useful if individual domains are examined and not just the total score.

C-58

Improved Memory Functioning Subsequent to Diffuse Bilateral Hippocampal Damage from Predominantly CA1Involvement: A Case Study

Weiss E, Antoniello D, McGinley J, Gomes W, Masur D

Objective: The relationship between hippocampal function and memory has long been a cornerstone of neuropsychological

investigation. Anoxia is a well-known cause of hippocampal damage, and bilateral hippocampal damage has been associated

with enduring memory impairment. However, there exist relatively few cases of documented bilateral hippocampal damage in

patients who have not suffered traumatic brain injury or other progressive neurological disease, and who have demonstrated

improvement of function. Method: We report the case of a 56-year-old woman who presented with initial retrograde and ante-

rograde amnesia as a result of attempted suicide by drug overdose that resulted in bilateral hippocampal damage from hypoten-

sion and anoxia. Patient Mrs. K was assessed at bedside during her initial hospitalization, followed by a full neuropsychological


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evaluation as an outpatient 2 months later, with a short follow-up visit completed at 5 months. MRI and neurological infor-

mation were also available. Results: In the hospital, personally relevant autobiographical and public memory related to

events within the past few years was impaired. Mrs. K was unable to learn new verbal information and did not appear to

benefit from repetition or priming. MRI showed evidence of bilateral diffuse hippocampal infarction predominantly involving

CA1. At 2 months, Mrs. K evidenced improvement but still deficient verbal memory performance. She now appeared to benefit

from repetition and priming, and evidenced low-average to average intelligence with relatively preserved verbal abilities. Five

months after initial evaluation, Mrs. K continued to show general improvement. Conclusion: This case provides evidence that

limited recovery of memory function is possible after bilateral hippocampal damage.

C-59

Refining the Clinical Interpretation of Memory Assessment on the Wechsler Memory Scale-Fourth Edition (WMS-IV):Base Rates of Low Demographically Adjusted Memory Scores

Brooks B, Holdnack J, Iverson G

Demographically adjusted normative data are used to improve the accuracy of clinical inferences relating to acquired memory def-

icits. The purpose of this study was to present the prevalence of low demographically adjusted scores on the Wechsler Memory

Scale-Fourth Edition (WMS-IV; Wechsler, 2009) for healthy adults. Participants included 686 healthy adults (16–69 years of

age) who were part of the WMS-IV standardization sample and had demographically adjusted normative scores (i.e., adjusted

for sex, age, education, and ethnicity). The WMS-IV contains four tests of learning and memory (logical memory, verbal

paired associates, designs, and visual reproduction) that provide eight scaled scores. Base rate analyses involved consideration

of these subtest scores simultaneously, stratified by Test of Premorbid Functioning (TOPF)-demographic predicted intelligence.

Considering below the 10th percentile as a cutoff (SS ≤ 6), one or more low demographically adjusted WMS-IV scores occurs

in 64.7% with unusually low, 37.0% with low average, 36.7% with average, 29.7% with high average, and 20.0% with

superior/very superior predicted intelligence. When considering only delayed memory scores, one or more scores ,10th percentile

is found in 35.3% with unusually low, 30.1% with low average, 28.1% with average, 22.9% with high average, and 20.0% with

superior/very superior predicted intelligence. Using demographically adjusted normative data essentially eliminates the role of

age, sex, and education, and lessens the moderating effects of intelligence, on memory test scores. These results have important

implications for identifying memory impairment using existing diagnostic criteria.

C-60Using Virtual Reality to Study Prospective Memory and Executive Functioning in Healthy Adults

Banville F, Nolin P, Henry M, Lalonde S, Dery M, Cloutier J

Traditional neuropsychological assessment is presently known for its weakness in diagnosing executive disorders such as those

we can see in daily life. In response to this criticism, some researchers have used virtual reality to develop assessment protocols

for prospective memory or executive function disorders (McGeorge et al., 2001; Sweeney et al., 2009). In the same manner,

this poster presentation aimed to demonstrate how virtual reality can be complementary to traditional neuropsychological tools

in the assessment of prospective memory. In order to attain this objective, we have assessed 94 healthy adults who have accom-

plished prospective memory tasks both in a virtual apartment and in laboratory conditions. The surprising results obtained after

the first experiment showed no correlation between laboratory and virtual reality tasks. In order to determine the best method

for interpreting this finding, we have conducted a PAF analysis. This method has revealed the presence of two different factors

that makes the distinction between virtual and laboratory measuring. Our second experiment aims to understand where the

differences between these two measurements are. We have assessed 52 healthy adults in conditions similar to those of exper-

iment 1 with the variable being the elimination of the ongoing task. The results have demonstrated that our virtual reality pro-

tocol can assess multitasking capacities much in the same way as a Multiple-Errands Test (Shallice & Burgess, 1996). Finally,

one drawback in the experiment is the ease with which the prospective memory tasks can be accomplished. One advantage to

this assessment is its ecological value and capacity to detect subtle executive problems.

PROFESSIONAL ISSUES: TEST DEVELOPMENT AND METHODS

C-61

Neuropsychological Evaluation Outcomes for Children and Adolescents with Learning DisabilitiesGreen J, Sokol D, Lowery K, Hole M, Helmus A, Teat R, DelMastro C, Paquette B

Objective: This study investigates academic, social, and emotional functioning in children with learning disabilities fol-

lowing neuropsychological evaluations (NEs). Method: Participants are parents of school-aged children completing NEs


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for learning disabilities at a private practice. Fifteen parents completed surveys at intake and 28 completed surveys fol-

lowing NEs. Children’s functioning was measured using the Achenbach Child Behavior Checklist (CBCL) and a newly

constructed Academic Scale. Parents were asked about their satisfaction, adherence to recommendations, and how well

they understood their child’s needs. Data collection is still underway; final results will include a longitudinal sample com-

paring data from the same parents at intake and following NEs. Results: Preliminary factor analysis of the academic scale

indicates three factors: academic skills (reading, writing, math), attention/executive functioning, and social skills. No

differences were found between academic scale scores at intake versus follow-up. Parents at follow-up more often

reported that they “definitely” understood their child’s academic/learning needs (43%) than parents at intake (13%).

Similarly, parents at follow-up more often reported that they “definitely” understood their child’s behavior (39%) than

at intake (13%). CBCL scales indicated greater concerns about children’s emotional functioning at intake. At follow-up,

parents reported that they were “very satisfied” (82%) or “mostly satisfied” (18%) with the evaluation and that they fol-

lowed recommendations (82%). Conclusions: Longitudinal data from a larger sample are currently being collected to

address research questions. Preliminary results indicate that parents of children who completed NEs report a better

understanding of their child’s needs and report fewer emotional symptoms than parents just beginning the evaluation

process.

C-62Abbreviated Category Fluency: 30 Seconds is All You Need

Grosch M, Hynan L, Graham L, Parikh M, Weiner M, Cullum M

Objective: Because patients often generate most of their responses early in verbal fluency tests, we assessed the compar-

ability of a shortened measure of category fluency. Participants and methods: Using scores from the traditional 1-min

animal fluency test, we studied 30- and 60-s scores in 447 SS with Alzheimer’s disease divided into two groups (a train-

ing group [N ¼ 223] and validation group [N ¼ 224]). Using a regression model and the data from the training group,

initial 30-s scores were used to predict 1-min total scores; the regression weights from the training set were then

applied to the validation group. Both estimates were then compared with the actual total score in both groups.

Results: The training and validation groups were similar in age, education, age at onset of illness, and Mini-mental

Status Examination (MMSE). Estimated and obtained total scores in the training set were highly correlated (r ¼ .938)

and had high agreement (ICC ¼ .936) with the means for the estimated and obtained scores of 10.06 and standard devi-

ations of 4.99 and 5.32, respectively. When the weights from the training group regression model were used to estimate

scores in the validation group, results were identical, with high correlations (r ¼ .937), agreement (ICC ¼ .937), and

equality (t ¼ 21.35, p ¼ .1793) with means for the estimated and obtained scores in this validation group 10.13

(SD ¼ 4.95) and 9.97 (SD ¼ 5.04), respectively. Conclusion: We found high agreement between the score for the first

30 s and 1 min on animal fluency, suggesting that in dementia patients, using the first 30 s provides a reasonable assess-

ment of category fluency.

C-63

Older Adults’ Learning, Memory, and Copy Performance on the Rey-Osterrieth and Modified Taylor Complex Figures

Hubley A

Objective: The Rey-Osterrieth (ROCF) and modified Taylor (MTCF) complex figures generally produce comparable accu-

racy scores on learning, memory, and copy in adults, although Hubley (2010) raises questions about the comparability of

copy scores in older adults. The purpose of this study was to examine, in older adults, whether the two figures show

comparable (a) accuracy scores on learning, memory, and copy, (b) performance by gender, and (c) correlations

between accuracy scores and both age and education. Method: The sample consisted of 86 adults (18 men, 68

women), aged 55–78 with 8–21 years of education, recruited from the general community. A between-groups design

was used wherein participants received either the ROCF or the MTCF. An intentional memory procedure (four learning

trials, delayed recall, and copy) was employed. Figures were scored using the standard accuracy scoring systems (see

Lezak et al., 2004). Results: Independent sample t-tests and Mann–Whitney U-tests (as appropriate depending on the

normality of the data) indicated that there were no significant differences between (a) the ROCF and MTCF on learning,

memory, or copy trials, or (b) men and women on any trial for either figure. Correlations between age and accuracy scores

were low (r ¼ 2.09 to 2.39) and correlations between education and accuracy scores were low to moderate (r ¼ .28 to

.51). Using Fisher’s Z-test, there were no significant differences between the two figures in these correlations.

Conclusions: The results of this study support the comparability of learning, memory, and copy accuracy scores on

the ROCF and MTCF in older adults.


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C-64

Exploration of the Validity of the Neuropsychological Symptom Inventory in a Sample of Renal Patients

Lutz J, Dean R

Objective: The Neuropsychological Symptom Inventory (NSI; Dean, 1989) is a self-report measure of neurological and psy-

chiatric symptoms. The present study seeks to provide evidence for the validity of this instrument as a measure of neuropsy-

chological impairment by evaluating its ability to predict scores on the L, F, and K scales of the Minnesota Multiphasic

Personality Inventory (MMPI) (Hathaway & Mckinley, 1967). Method: The sample consisted of 61 adults with renal

disease. This sample was selected because renal patients are known to exhibit neuropsychological deficits (Brown &

Brown, 1995). Patients completed the MMPI and the NSI. Linear regression analyses were conducted to evaluate the relation-

ship between the severity of neuropsychological symptoms as measured by the NSI and scores produced on the L, F, and K

scales of the MMPI. Note that lower scores on the NSI indicate greater impairement. Results: Linear regression analysis

revealed that NSI scores accounted for 38% of the variance in scores on the F scale (B ¼ 2.140, p , .001), 36% of the var-

iance in scores on K scale (B ¼ .124, p , .001), and 28% of the variance in scores on the L scale (B ¼ 2.130, p , .001).

Conclusions: These findings suggest that as the severity of symptoms reported on the NSI increase, so do scores on the

MMPI’s F scale. This lends credence to the NSI as a measure of psychological symptomatology. Significance of the relation-

ship between the NSI and the L and K scales will also be discussed, as will future research considerations and clinical appli-

cations of the NSI.

C-65

An Examination of the Factor Structure of Responses to the Center for Epidemiological Studies Depression Scale

(CES-D) in Chronic Kidney Disease PatientsPaterson T, O’Rourke N, Thornton W

Objective: Chronic kidney disease (CKD) is an increasingly common illness among middle-aged and older adults, and is

associated with cognitive decline and depression. The Center for Epidemiological Studies Depression Scale (CES-D) is a

widely used self-report screening measure on which responses generally conform to a four-factor structure, with each factor

loading onto a higher-order depression factor. The current study examines whether this structure is supported among CKD

patients. Method: CKD patients (n ¼ 225; ages 19–89) and healthy controls (n ¼ 230; ages 19–91) were recruited from

Vancouver General Hospital and the community. Inclusion criteria were English fluency and a minimum of a 6th grade edu-

cation. Exclusion criteria included psychosis, acute illness, neurological disorder, or other organ failure. Results: Confirmatory

factor analytic models were computed for CKD and control participants. Results support the four-factor structure of CES-D

responses in CKD (x2[df ¼ 155] ¼ 196.25, p ¼ .01, power ¼ .99) and control participants (x2[df ¼ 162] ¼ 199.67, p , .05,

power ¼ .99). The hierarchical structure of CES-D responses also appears invariant between groups (x2[df ¼ 318] ¼

401.72; CFI ¼ .97; SRMR ¼ .044; RMSEA ¼ .024, .016 , RMSEA CL90 , .031). Factor structure was similar between

groups; only for depressive affect was the strength of association for the second-order factor greater among CKD than

control participants (Dx2[Ddf ¼ 1] ¼ 5.43, p . .05; CFI ¼ .96; SRMR ¼ .054; RMSEA ¼ .030, .023 , RMSEA CL90 ,

.036). Conclusions: Findings support the similarity of CES-D factor structures between CKD and non-kidney disease partici-

pants. Results also suggest that the CES-D’s four factors contribute to measurement of a higher-order depression factor in both

groups. Furthermore, three of the four factors appear invariant between groups. Results suggest that the CES-D may be used

confidently with CKD patients.

C-6610-Year Publication Trends in the Archives: Moving Toward a Positive Neuropsychology?

Randolph J

Objective: The field of positive psychology—emphasizing strengths and aptitudes to promote mental health—has gained con-

siderable momentum recently. Despite tremendous growth in the neuropsychology literature over the past 10 years, few studies

address positive neuropsychology (PNP)—the study, promotion, and enhancement of cognitive health. The present study

aimed to examine 10-year publication trends in Archives of Clinical Neuropsychology to determine whether there has been

a noticeable shift in publication of PNP-oriented manuscripts. Data selection: Titles and abstracts from all empirical papers

published in the Archives in 1999, 2004, and 2009 (N ¼ 145) were reviewed and classified into categories based on

primary study aims. Primary manuscript categories included deficit characterization, symptom validity testing, new/existing

measure validation, general methodological research, examination of normative cognitive functioning, neuroimaging, diver-

sity, intervention effects on cognition, and cognitive rehabilitation in normal and patient groups. Data synthesis: Review of

Archive papers across the sampled years indicated a predominant focus on characterizing deficits in neurological conditions


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(31%), validating new neuropsychological measures (31%), validating symptom validity measures and procedures (13%), and

statistical/methodological issues (9%). Although there was a trend toward increased publication of normative cognitive func-

tioning studies, there was no other increase in PNP-related publications in the 10-year period sampled here. Conclusions: There

is minimal evidence that the field is moving toward promotion of cognitive health as gleaned from Archive publication trends

over the past 10 years. Future directions to promote a shift from a focus on characterization of pathological brain–behavior

relationships toward a PNP focus are discussed.

C-67Part-Whole Stability of Performance on a Controlled Oral Word Association Task

Suffiield J, Crockett D, Spreen O

This study examined the relationship of productivity during 15-s intervals on a controlled oral word association task in a sample

of 126 participants referred for neuropsychological assessment. The correlations among the productivity during the first

through fourth 15-s interval and overall productivity (range ¼ .794 to .885) and correlations among intervals (range ¼ .620

to .852) were consistently high. The productivity during the second (R ¼ .787, SEE ¼ 2.116) and third (R ¼ .752, SEE ¼

1.956) intervals were significantly related to the productivity during the other intervals, even when the effects of demographic

variables were controlled. Although the productivity during the first interval was significantly related to productivity during the

other intervals (R ¼ .739, SEE ¼ 2.659), productivity on the fourth interval did not make a significant contribution. Similarly,

productivity during the fourth interval was significantly related to productivity during the second and third intervals (R ¼ .703,

SEE ¼ 2.185) but the contribution of productivity during the first interval was not significant. This suggested that performance

on the first and final trials was determined in a different manner than productivity during the second and third intervals. The

effects of the demographic variables included in this study were similar to those reported by other researchers. That is, age and

education had a significant impact on overall productivity, whereas gender had only a modest association with productivity.

Overall, these analyses indicated that part-scores share a similar basis and that differences among them might be clinically

significant.

C-68Factor Structure of the Maternal Perinatal Scale

Trammell B, Mazur-Mosiewicz A, Holcomb M, Dean R

Objective: Although the rate of infant mortality has dropped over the past century, the most recent figure has not changed sig-

nificantly in the last 10 years, maintaining a steady rate of approximately 6.71 deaths per 1,000 live births (MacDorman &

Mathews, 2008). The lack of success that decreases infant death warrants additional research in the area of prenatal assessment

to positively influence the trend in infant mortality. The Maternal Perinatal Scale (MPS; Dean & Gray, 1985) is a 28-item self-

report measure that was developed to ascertain the risk that perinatal complications carry on poor developmental outcomes.

Previous factor analyses on the MPS yielded 10 factors, not improving the ease of interpretation as the original scale has

only 28 items. The purpose of this paper was to create a more interpretable factor structure to allow for future studies to

implement scoring criteria to increase interpretability of the scale. Method: Archival data from 714 participants were used.

The mean age of mother was 34.50 years (SD ¼ 9.72; median ¼ 33). The age of the child in question was no more than 5

years old at the time of evaluation. Results: The seven-factor solution accounted for some 43.98% of the total variability, a

slightly simpler solution than the aforementioned. Implications: This structure allows for more strategic scoring criteria to

increase the utilization of the MPS in clinical practice. By adding scoring criteria to each item, validated by factor cutoff

scores, this measure has a potential to be even more useful in clinical practice.

C-69

Factor Analysis of the Personality Assessment Inventory in a Neuropsychological PopulationBusse M, Wald D, Whiteside D, Breisch A

Objective: Research has investigated the use of the Personality Assessment Inventory (PAI) within specific clinical popu-

lations, such as eating disorders and alcohol dependence. The studies have replicated the normative four-factor structure of

the PAI (Boyle & Lennon, 1994; Schinka, 1995). However, no research has examined the factor structure of the PAI in neu-

ropsychological populations, which the current study was designed to do. Method: Participants included consecutive referrals

for comprehensive neuropsychological evaluations in either an outpatient multispecialty practice or a university training clinic

who completed the PAI. Participants were 45% males and 55% females, with a mean age of 43.8 years (SD ¼ 15.1) and mean

education of 13.4 years (SD ¼ 2.3). The sample was 88% Caucasian, 3% African American, and 9% from other racial back-

grounds, with 75% clinical referrals and 25% forensic referrals. Results: Exploratory factor analytic results indicate a five-


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factor solution when all PAI scales were analyzed, with factors labeled distress, egocentricity, social detachment, substance

abuse, and profile validity. When the validity scales were removed, validity factor was not found. Using only clinical

scales, results indicated a two-factor solution. All analyses were consistent with a general distress factor, which accounted

for approximately 40%–50% of the variance. Conclusions: Results essentially replicated the normative factor structure

with slight differences. Specifically, differences in the five-factor solution included separate social detachment and substance

abuse factors. The two-factor solution found only the distress factor and a combined egocentricity/substance abuse factor,

whereas the four- and five-factor solutions were similar except for the lack of a validity factor in the four-factor solution.

C-70

Clinical Use of the Geriatric Depression Scale (GDS-15) in Young and Middle-aged Adults with Bipolar Disorder

Fieldstone S, Vannorsda T, Lassen-Greene C, Gordon B, Schretlen D

Objective: The 15-item Geriatric Depression Scale (GDS-15) yields self-ratings of depression severity. It is brief, easy to read,

and well-validated for use with older individuals as well as young and middle-aged adults. The aim of this study was to deter-

mine whether the GDS-15 is also suitable for clinical use with young and middle-aged adults with bipolar disorder. Method:

We administered the GDS-15 to a community sample of adults and to participants in a study of work disability in bipolar dis-

order. Each participant completed either a structured psychiatric interview or a combined protocol including the Mini

International Neuropsychiatric Interview Short-Version, Montgomery-Asberg Depression Rating Scale and Young Mania

Scale. We then compared 96 young or middle-aged, healthy, non-depressed participants (controls) from the community

sample with 72 individuals who met DSM-IV diagnostic criteria for bipolar disorder. Mean ages were 45 and 44, respectively.

Results: With a cut-off score of 5 or more on the GDS-15, we used discriminant and receiver operating characteristic (ROC)

analyses to distinguish between bipolar and non-depressed participants. This cut-off correctly classified 100% of individuals

with bipolar disorder who were experiencing a depressed/mixed state at the time of assessment, while also correctly classifying

95% of controls as non-depressed. Of those with bipolar disorder, 81% in partial remission and 41% in full remission were

correctly classified, as were 99% of controls in both instances. Conclusions: In addition to being appropriate for use in

young and middle-aged adults with depression, the GDS-15 shows very good diagnostic sensitivity and specificity for individ-

uals with active symptoms of bipolar disorder.

C-71

Measurement Invariance of the Geriatric Depression Scale-15 (GDS-15): Does Gender, Age, or Education Bias One’sScores?

Launeanu M, Hubley A

Objective: The 15-item Geriatric Depression Scale (GDS-15) is commonly used to screen for depression across a wide age

range in clinical and community settings. The purpose of this study was to examine the measurement invariance of the

15-item Geriatric Depression Scale (GDS-15) across gender, age, and educational levels. Method: The sample consisted of

896 community dwelling adults (418 men, 478 women), ages 16 to 94 with 2 to 21 years of education, who completed the

GDS-15. A series of multi-group confirmatory factor analyses (MG-CFA) using Robust Maximum Likelihood estimation

were conducted on these data to test for measurement invariance. Results: The GDS-15 showed measurement invariance

across gender. This means that, all other things being equal, men and women with the same latent (true) level of depression

obtained the same observed score on the GDS-15. This was not the case for age and education, however. That is, all other things

being equal, individuals with the same latent (true) level of depression scored differently on the GDS-15 only because of (a)

their age or (b) their educational status. Conclusions: The presence of measurement invariance for gender means that men and

women can be meaningfully compared using the GDS-15 and that gender alone does not bias one’s scores. The lack of

measurement invariance across age and education in the GDS-15, however, may lead to reported differences in depressive

status that do not represent true differences in depression but rather individuals’ membership in an age or educational group.

C-72

The Relationship between the NEO Personality Inventory-Revised (NEO PI-R), Beck Depression Inventory Fast Screenfor Medical Patients (BDI-FS), and the Beck Anxiety Inventory (BAI): An Instrument Validity Study in an Acute

Rehabilitation Hospital

Maruyama R, Cuesta G

Objective: To find the correlation between the facet scale scores of depression and anxiety in the personality inventory, Revised

NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992) with the Beck Depression Inventory Fast Screen for Medical

Patients (BDI-FS; Beck et al., 2000) and the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988). Method:


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The BDI-FS, the BAI, and the NEO-PI-R were administered to 52 individuals on the Spinal Cord Injury unit of an acute reha-

bilitation hospital. The patients invited to the study included those with traumatic spinal cord injuries, neurological disorders,

and spinal stenosis and/or back procedures. The participants were a cross-sectional random selection of patients admitted to the

SCI unit. They were recruited by the researchers upon admission. Results: The Anxiety subscale of the NEO-PI-R had a mod-

erate correlation with the BAI (r (n¼52)¼.31, p¼.024), with a 95% confidence interval of 0.045 to 0.54. The Depression sub-

scale of the NEO-PI-R also had a moderate correlation with the BDI-FS (r(n¼52)¼.557, p,.000), with a 95% confidence

interval of 0.336 to 0.72. Conclusions: The results of our analysis show support for the instrument validity of the BDI-FS

and the BAI in an acute rehabilitation hospital setting. Further research with a larger sample size is required to find stronger

support for the instrument validity of the BDI-FS and the BAI by using their correlation with the facet scale scores of the

NEO-PI-R.


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Poster Session D


D-1Cross-Cultural Comparison of Attention, Mood, and Behavior Problems: Japanese and U.S. College Students

Davis J, Takahashi T, Shinoda H, Gregg N

Objective: The purposes of this study were to compare levels of Attention-deficit/Hyperactivity Disorder (ADHD) symptoms

of Japanese college students to U.S. peers, to estimate prevalence rates in both populations, and to examine the relationship

between ADHD symptoms and other behavioral and mood problems. There is little cross-national research in this area, and

these results are among the first to identify such problems in Japanese college students. Method: Participants included 271

U.S. and 712 Japanese college students who completed a rating scale assessing the 18 Diagnostic and Statistical Manual of

Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) symptoms of ADHD as well as a measure of other behavior

and mood problems (Achenbach Adult Self-Report or Youth Self-Report). Results: Japanese students reported higher levels

of childhood (F(1, 957) ¼ 30.64, p , .001) and current (F(1, 959) ¼ 37.11, p , .001) problems with inattention resulting

in higher levels of overall ADHD symptoms (childhood F(1, 949) ¼ 6.17, p ¼ .01); current F(1, 948) ¼ 17.15, p , .001).

Using DSM-IV-TR symptom thresholds, 5.70% of U.S. students and 6.26% of Japanese students reported enough symptoms

to meet the cutoff for inattentive, hyperactive/impulsive, or combined type during childhood; 2.66% of U.S. students and

4.52% of Japanese students reported enough symptoms to meet the cutoff for one of the three subtypes currently. ADHD symp-

toms were significantly correlated with mood and other behavioral problems in both groups of students. Conclusions: These

rates are consistent with expectations based on previous research and indicate that it is possible to assess and identify

ADHD symptoms in Japanese college students. Higher self-report of problems by Japanese students was unexpected.

D-2

Cross-Cultural Invariance of Attention-deficit/Hyperactivity Disorder Factors

Davis J, Cheung S, Takahashi T, Shinoda H, Gregg N

Objectives: Prior research with children generally supports the two-dimensional structure of Attention-deficit/Hyperactivity

Disorder (ADHD) symptoms (I and H/I factors) in the Diagnostic and Statistical Manual of Mental Disorders-Fourth

Edition-Text Revision (DSM-IV-TR) and that this structure is invariant across cultures. Research with adults supports

either a two-factor or three-factor structure depending on reporting source. However, research with adults is limited and

there are few studies addressing cross-cultural invariance in adults. The purposes of this study were to (1) assess relative fit

of two- versus three-factor solutions for self-report of recent ADHD symptoms in adults and (2) further establish cross-cultural

invariance of factors. Method: Participants included 271 U.S. and 712 Japanese college students who completed a rating scale

assessing the 18 DSM-IV-TR ADHD symptoms. Confirmatory factor analysis using Mplus (Version 6) and the mean and

variance-adjusted weighted least-squares (WLSMV) procedure were used to test invariance of two- and three-factor models

across U.S. and Japanese samples. Results: The two- and three-factor models showed similar fit indices (two-factor CFI ¼

.929, TLI ¼ .936, RMSEA ¼ .079, WRMR ¼ 3.976; three-factor CFI ¼ .929, TLI ¼ .936, RMSEA ¼ .079, WRMR ¼

4.002). The same model seems to hold for U.S. and Japanese participants. Conclusions: Neither a two-factor nor a three-factor

model was clearly superior. The two-factor model is more parsimonious and consistent with current theory. The study supports

cross-cultural invariance of factors and is consistent with prior research with Australian, Brazilian, German, Malaysian, Puerto

Rican, Spanish, and Taiwanese children as well as Chinese and New Zealand adults. Collectively, this research supports the use

of current ADHD diagnostic criteria internationally.

D-3

Differential Cognitive Performance in Children with a Primary Diagnosis of Attention-deficit/Hyperactivity Disorder

(ADHD) or Traumatic Brain Injury (TBI)Holcomb M, Mazur A, Trammell B, Dean R

Introduction: Attention-deficit/hyperactivity disorder (ADHD) and traumatic brain injury (TBI) are two of the most common

childhood disorders and can be difficult to distinguish one from another due to similar clinical and behavioral manifestations.

The purpose of the current study was to investigate and differentiate cognitive processing differences in children with ADHD

and TBIs according to the Cattell–Horn–Carroll (CHC, i.e., Carroll, 1993) cognitive processing theory. Methodology: The


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current study examined 129 children; 59 ADHD and 70 TBI (mean age ¼ 11.26, SD ¼ 3.36) who had been referred for a neu-

ropsychological assessment and were given a primary diagnosis of ADHD or TBI. Each participant completed, as part of a

comprehensive battery, 14 cognitive subtests that were selected from the Woodcock–Johnson Psycho-Educational

Battery-Third Edition (WJ-III; Woodcock, McGrew, & Mather, 2001). Results and summary: The results of a multivariate

analysis of variance (MANOVA) indicated that cognitive differences on subtests did indeed exist between the two groups

(Wilks’ Lambda ¼ .761, F(13, 128) ¼ 2.780, p ¼ .002). Overall, the group with ADHD performed at a higher level than

did the group with TBI in cognitive tasks. The group with ADHD performed significantly better on 5 of the 13 subtests admi-

nistered including: sound blending, visual matching, numbers reversed, memory for words, and pair cancellation. Findings

suggest differences in the areas of processing speed (Gs), auditory processing (Ga), and short-term memory (Gsm).

D-4Risk Factors for Neurodevelopmental Disorders

Perna R, Jackson A, Villar R

Objective: Pediatric neuropsychological evaluations often involve children who have many early life risk factors for

Attention-deficit/Hyperactivity Disorder (ADHD), learning disorders (LD), or intellectual disabilities. Some early risk

factors may negatively affect brain development and subsequent cognitive functioning and behavioral regulation. Low birth

weight, early life abuse/neglect, and preschool developmental disorders are associated with later occurring academic and be-

havioral problems. Our research hypothesis is that abuse/neglect, birth weight, birth hypoxia, and preschool developmental

disorders (in speech and motor function) are significantly associated with later occurring ADHD, LDs, and diagnosed behav-

ioral and emotional problems. Method: This study involved 22 (15 boys, 7 girls) consecutive neuropsychological evaluations

with mean age ¼ 11.6 years, mean birth weight ¼ 7.9 pounds, and mean Full Scale IQ (Wechsler Intelligence Scale for

Children-Fourth Edition; WISC-IV) ¼ 88. Variables measured include: birth weight, apgar scores, birth hypoxia, preschool

developmental delay (Devdelay: speech or motor function), history of abuse or neglect, current diagnoses involving

ADHD, LD, behavioral or emotional disorder (affective disorder, oppositional defiant disorder, conduct disorder, disruptive

behavior disorder). Results: The strongest correlations included: abuse/neglect and later behavioral disorder (r ¼ .52), birth

hypoxia and devdelay (r ¼ .39), Devdelay and ADHD (r ¼ .33), and Devdelay and FSIQ (r ¼ 2.31). Birth weight had a

weak correlation with other variables. Fifty-five percent of those who had developmental delays developed ADHD, but

only 10% developed LDs. Using analysis of variance (ANOVA), those who suffered abuse/neglect were more likely to be diag-

nosed with behavioral/emotional disorders (F(1, 21) ¼ 7.3, p , .05). Early life abuse is associated with a high incidence of

behavioral problems, but has less of an effect on FSIQ, ADHD, or LD. Developmental delays appear to be a very strong risk

factor for ADHD, but not for LD.


D-5Sequelae of Viral Meningitis: A Pediatric Case Study

Ager D, Ellicon B

Objective: This poster presentation will highlight a case study in which a child who contracted viral meningitis experienced

debilitating sequelae, including ataxia and expressive aphasia. Prevalent neuropsychological research focuses on bacterial

meningitis, given the greater cognitive and functional consequences of this form, including death in some cases. While

viral meningitis is more common, significant sequelae are unusual, and literature on its neuropsychological impact is

sparse. Method: This previously healthy, typically functioning 3-year-old initially presented to the Emergency Department

with vague symptoms of the common cold, which rapidly progressed to an altered mental status. An initial MRI revealed

increased signal in the cerebellar white matter, and viral meningitis was eventually diagnosed. Upon her transfer to an inpatient

rehabilitation hospital, she received intensive physical, occupational, and speech therapies, as well as a neuropsychological

evaluation. Results: During her 2-month inpatient stay, this patient made remarkable progress. At discharge, she was ambulat-

ing with supervision and her aphasia was improving. Neuropsychological evaluation conducted prior to discharge revealed

largely intact cognitive skills in concept development and expressive and receptive vocabulary. Consistent with known neu-

ropsychological sequelae of bacterial meningitis, this child revealed relative weaknesses in visual-motor integration and con-

struction skills, reasoning, and fine motor coordination. Conclusions: This case study reflects an important and unique

contribution to the literature on meningitis, as it documents the existence, albeit transient, of debilitating effects subsequent

to viral meningitis. In addition, this neuropsychological evaluation highlights consistencies with cognitive deficits implicated

in bacterial meningitis, suggesting that viral meningitis can also have significant neuropsychological effects.


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D-6

Neuropsychological Outcome Following Admission to Pediatric Intensive Care

Als L, Nadel S, Cooper M, Pierce C, Hau S, Vezir S, Picouto M, Sahakian B, Garralda E

Objectives: The study aimed to explore neuropsychological function in children 3–6 months following hospital discharge from

pediatric intensive care (PICU). Methods: A prospective study of children aged 5–16 years admitted to PICUs in the London

area and healthy controls recruited from the general community. Children with previous conditions likely to have an impact on

neuropsychological function were excluded. Recruitment of participants is ongoing. Currently, 65 children (41 boys and 24

girls) admitted to PICU (mean age: 9.97 years; SEM .43) and 61 matched controls have been recruited. The PICU group con-

sists of 16 patients admitted with meningo-encephalitis, 15 with septicaemia, and 33 with other critical illnesses. Children’s

neuropsychological function was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB)

and the Children’s Memory Scale (CMS), focusing on the domains of visual and verbal memory and attention. Results:

Preliminary analysis revealed the PICU group underperformed the controls. Specifically, the PICU group performed worse

on measures of pattern recognition memory (p ¼ .07; p ¼ .05), spatial working memory (p ¼ .03; p , .01), spatial span

(p ¼ .07), visual sustained attention (p ¼ .02), verbal recall memory (p ¼ .05; p ¼ .01), and verbal recognition memory (p

, .01). Exploratory analysis indicated that these main effects were driven by poor performance in the children admitted to

PICU with meningo-encephalitis and septicemia. Conclusion: Our results suggest impaired neuropsychological function in

children following severe pediatric illness, with particular incidence in children with meningo-encephalitis and septicemia.

D-7

Neuropsychological Deficits Following Lesion in the Left Dorsomedial Thalamic Region: A Pediatric Case Study

Mucci G, Barber B

Objective: Thalamic tumors are commonly associated with several neurocognitive deficits, including sensory loss, muscle

weakness, decreased intellect, vision problems, and emotional dysregulation, as most sensory input is first relayed through

the thalamus. The age of diagnosis, gender, histology, and type of treatment affect prognosis (Pathy, 2002). Thalamic

tumors are rare and account for 2%–5% of pediatric brain tumors with no clear direction on optimal treatment (Crimmins,

2007). Method: Neuropsychological testing was administered on a 16-year-old Caucasian male, diagnosed with a left, dor-

somedial thalamic tumor 1 year prior. He presented with academic, emotional, and motor difficulties. Due to the deep,

central placement of the tumor, resection has not been undertaken; instead, close monitoring has been instituted. Results:

Neuropsychological testing revealed average verbal intelligence and below-average non-verbal intelligence, with low-average

working memory and below-average processing speed. Average reading and written language skills were found with

below-average math skills. Contrasting intelligence test results, neuropsychological testing displayed stronger non-verbal

than verbal learning and memory, with strengths in visuospatial, visuomotor, and motor domains. Weaknesses were found

in attention, executive functioning, verbal fluency, phonological and auditory processing, expressive language, and emotional

regulation. The individual endorsed many symptoms associated with depression and anxiety. Conclusion: Neuropsychological

deficits consistent with processes mediated by left dorsomedial thalamus, including deficits in attention, organization, abstract

thinking, memory, and mood. Language deficits are consistent with lesion in the dominant hemisphere. The importance of

close monitoring and regular neuropsychological evaluation is discussed.

D-8

Asperger’s Disorder Versus Non-Verbal Learning Disabilities: A Diagnostic Conundrum

Semrud-Clikeman M, Goldenring J, Bledsoe J, Vroman L, Crow S

Objective: The purpose of this study was to evaluate consistency of diagnosis for children with Asperger’s Disorder (AS) or

Non-verbal learning disabilities (NLD) in a group of children referred for a neuropsychological study of social competence.

Method: Thirty-six children previously diagnosed with NLD and 27 children diagnosed with AS prior to entry in the study

were evaluated using the Autism Diagnostic Interview-Revised (ADI-R) structured parent interview, IQ screening, and selected

neuropsychological measures. The criteria for NLD were adapted from existing research protocols. To meet criteria for AS,

each child needed to meet Diagnostic and Statistical Manual-Fourth Edition-Text Revision (DSM-IV-TR) criteria as well

as to be below the cutoff for autism on the ADI-R parent interview but within the logarithm for AS on this interview and

to show stereotyped interests but not language delay. Criteria for NLD varied across clinicians but in no child previously diag-

nosed with NLD had the ADI-R been completed. For children with AS, the ADI-R had been completed in less than 20% of the

sample. Results: Of the 36 children in this study previously diagnosed with NLD, 18 were diagnosed with AS or another dis-

order. In the AS group, all diagnoses were confirmed. Review of the record found that the children previously classified as NLD

had been diagnosed based on a verbal-performance IQ split of 15 or more standard score points (14) or based on parent report


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of a social skills deficit (2). Conclusion: This paper presents evidence in support of the use of a structured parent interview to

rule out autistic spectrum disorders in children being evaluated for a possible non-verbal learning disability.

D-9

Analysis of Motor Functioning in Children with Pervasive Developmental DisordersZimmerman A, Mazur-Mosiewicz A, Roberds E, Dean R

Objective: The present study examined neuropsychological differences in motor performance between children with a Pervasive

Developmental Disorder (PDD) diagnosis and their normal counterparts. Methods: Participants in the PDD group were 49 children

(mean age ¼ 9.90, SD¼ 3.31) who had a primary diagnosis of pervasive developmental disorder NOS, autistic disorder, or

Asperger’s disorder (N ¼ 49). All of the diagnoses were classified according to the Diagnostic and Statistical Manual of Mental

Disorders-Fourth Edition (DSM-IV, 1994) and the International Classification of Diseases, Ninth Revision (ICD-9, 1998).

Participants in the normal group were 52 children (mean age ¼ 10.78, SD ¼ 4.00) who had no history of neurologic or psychiatric

diagnosis. All of the children were administered the subtests of the Dean–Woodcock Sensory Motor Battery (DWSMB). The

examiners were graduate-level students, who underwent training and supervision in the areas of neuropsychological, cognitive,

and psychological assessment. Results: The results of a nominal regression analysis indicated significant differences in motor func-

tioning between normal children and children with a PDD. Specifically, the two differed on expressive speech and grip strength.

There was no statistical difference in the other motor areas (i.e., construction, coordination, gait and station, Romberg, mime move-

ments, left–right movements, finger tapping). Conclusions: In this study, children with PDD presented with impaired expressive

speech and grip strength. While expressive speech difficulties were expected, the grip strength impairment is a novel finding.

Moreover, the results suggest that motor functioning should be included in standard pediatric neuropsychological examination.

D-10

Neuropsychological Findings in a Girl with Encephalitis LethargicaSokol D, Hole M, Teat R, Paquett B

Objective: Encephalitis lethargica (EL) describes an encephalitis with psychiatric, sleep, and movement disorders. The absence

of viral antigens, the benefit of immunotherapies, and the presence of anti-neuronal antibodies and Cerebral Spinal Fluid (CSF)

oligoclonal bands suggests it is an autoimmune disease. EL often remains undiagnosed and therefore untreated. We report

initial neuropsychological findings of a girl who remained encephalopathic for two years until immunotherapy was begun.

Method: A 12-yr-old previously healthy girl presented at age nine with headache and dyskinesias. Within one week she experi-

enced visual hallucinations, then lost speech and ambulation. On the 12th day she was resuscitated for respiratory cardiac

arrest, later requiring tracheostomy. CSF was inflammatory but demonstrated no viral antigens. EEG showed slowing but

no electrographic seizures. Serial brain MRIs were negative. She showed no response to one course of immunoglobulin and

steroids. Two years later the patient had not regained speech or ambulation. Re-examination of CSF showed oligoclonal

bands and antiphospholipid antibodies. She underwent monthly immunoglobulin and pulse steroid treatments for six

months. During treatment, the patient began speaking, walking, and performing daily living skills. Results: Preliminary neu-

ropsychological testing performed six months after beginning treatment showed: Peabody Picture Vocabulary Test (PPVT)

Receptive Speech SS of 67 (90% CI: 61–74) at the 1%tile with age equivalent of 7 yr-1mo. Weschler Abbreviated Scale

of Intelligence (WASI) Full Scale IQ was 55 (90% CI: 52–62) at the 0.1 %tile with Verbal IQ at 55 (90% CI: 52–64) at

the 0.1 %tile and Performance IQ of 61 (90% CI: 58–69) at the 0.5 %tile. She slowly completed Trails A &

B. Conclusions: Significant neuropsychological sequelae follow dramatic improvement in autoimmune EL.

NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER

D-11Case Report: Neurocognitive Findings in an Adult with Hypothalamic Hamartoma and History of Helastic Seizures

Undergoing Presurgical Neuropsychological Evaluation

Albano J, Broshek D, Elias J

Objective: Hypothalamic hamartoma (HH) is a rare developmental malformation which commonly presents in young children

with gelastic seizures and is highly pharmacoresistant, usually requiring resection. Our aim is to report the neurocognitive find-

ings of an adult with epilepsy with a previously undiagnosed HH. Given that initial diagnosis in adulthood is less common, this

study will contribute to our knowledge of the neuropsychological profile of patients with HH. Method: Neuropsychological test

results were obtained from a 37-year-old, right-handed male as part of a presurgical evaluation. The patient’s premorbid intelli-

gence was estimated to be in the high-average range. He had just been terminated from his employment as a senior librarian due


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to anger outbursts. Results: Assessed verbal intelligence was average (Wechsler Adult Intelligence Scale-Fourth Edition

[WAIS-IV] VCI ¼ 100) and non-verbal intelligence was borderline (WAIS-IV PRI ¼ 75). Working memory was borderline

(6th percentile) and processing speed was low average (5th percentile). Verbal and visual memory, visual scanning, and

motor speed were average (WMS-IV, California Verbal Learning Test-Second Edition [CVLT-II], Rey Complex

Figure Test [RCFT], and Delis-Kaplan Executive Function System [D-KEFS Trails]). Impairments were noted in non-verbal

problem-solving and mental flexibility (category test at 6th percentile), rapid semantic and phonemic retrieval (animal fluency

at 1st percentile; Controlled Oral Word Association Test; COWA at 14th percentile) and confrontation naming (Boston Naming

Test [BNT] at ,1st percentile). Sequencing and switching on the D-KEFS Trails were low average. A relative weakness in

non-dominant (left hand) motor performance and relatively greater right peripheral sensory deficits were observed.

Conclusions: In contrast to published reports of memory deficits in patients with HH, this patient demonstrated intact

memory in the context of executive deficits, suppressed IQ (VCI.PRI), and sensorimotor deficits.

D-12

Quality of Life and Driving Behaviors in Multiple SclerosisBrennan L, Chakravarti P, Schultheis L, Kibby M, Weisser V, Hynd G, Ang J

Objective: This study examined the relationship between quality of life (QOL) and driving behaviors in multiple sclerosis (MS).

Driving behaviors were hypothesized to have moderate effects in the relationships between QOL and fatigue and QOL and

depression, two well-established predictors of QOL in the MS literature. Methods: The current study is a subcomponent of a

larger prospective study. All data were collected in an outpatient research setting and an outpatient driver rehabilitation

program. Participants were 64 community-dwelling, licensed individuals with clinically defined MS between the ages of 23 and

56. Self-report questionnaires assessing driving frequency in days per week, change in driving status, fatigue, depression, and

quality of life were administered. Results: Multiple regressions revealed fatigue and depression to be strong independent predictors

of quality of life in MS (p , .001), consistent with the literature. Driving frequency (days per week) had significant independent

predictive value in the fatigue (p ¼ .05) and depression (p ¼ .01) models, and change in driving status demonstrated significant

independent effects in the depression model (p , .01). The driving behaviors measured did not have moderate effects on the

relationships between QOL and fatigue and QOL and depression. Conclusions: Driving behaviors are valuable predictors of

QOL in MS; however, the behaviors measured in this study did not serve as moderators in the relationships between QOL and

fatigue and QOL and depression in our sample. The results suggest that fatigue and depression are primary predictors of QOL

in MS, even when an important independent activity such as driving is accounted for.

D-13

Impact Types of Multiple Sclerosis (MS) on the Oral Symbol Digit Modalities TestCrockett D, Puente A, Weiss E, Longman R, Antoniello D, Axelrod B, McGinley J, Gomes W, Masur D

Objectives: This study examined the impact of different proportions of types of patients with multiple sclerosis (MS) using

discrepancies from predicted performance on the oral version of the Symbol Digit Modalities Test (OSDMT). Method: The

proportion of patients with Secondary-Progressive (SP), Progressive-Remitting and Progressive-Relapsing (PR&PR),

Primary-Progressive and Chronic-Progressive (PP&CP), and Relapsing-Remitting (RR) types of MS was recorded for 61

sample means (n ¼ 3,116 patients with MS). Data from healthy control participants (n of groups ¼ 234, n of participants ¼

32,397) were used to develop predictive equations based on selected demographic variables. Scores on the OSDMT could

be predicted using age, education, square and cubed transformations of discrepancies of age from the aggregated mean of

age, prior assessment using the written SDMT, and proportion of male participants (R ¼ .773, p , .001). Results: Overall,

the means of OSDMT for patients with MS fell below their predicted levels (observed/expected ¼ .785, range ¼ .461 to

1.007). As the proportion of patients with RR increased, so did means of OSDMT and correspondingly the discrepancy

between the observed and expected score decreased (Rxy ¼ 2.438, df ¼ 49, p , .01). In contrast, as the proportion of patients

with PR&PR increased, the discrepancy between the observed and expected score increased (Rxy ¼ .611, df ¼ 48, p , .01).

Conclusion: Although many studies failed to report complete data, these results indicate that impact of the differing proportion

of types of MS can affect the neuropsychological tests results.

D-14

Does Duration of Diagnosis Predict Cognitive Impairment in Multiple Sclerosis?Davis A, Lutz J, Roberds E, Williams R, Gupta A

Objective: Multiple sclerosis (MS) is a debilitating neurological condition that has been thought to primarily result in white

matter dysfunction. However, recent research has suggested that the disease pathology is also associated with cortical


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impairment, which accounts for the depth and breadth of cognitive impairment seen in patients with MS. The purpose of this

study was to investigate the relationship between duration of diagnosis of MS and cognitive processing. Method: Participants

were 33 patients with MS (mean age of 45.61 years, SD ¼ 8.71 years). The mean duration of diagnosis was 7.15 years with an

SD of 7.89 years. Most of the participants (75.8%) had relapsing-remitting MS. All participants completed the Wechsler

Abbreviated Scale of Intelligence and the Repeatable Battery for the Assessment of Neuropsychological Status as part of a

clinical battery. Results: Although group deficits in attention, immediate memory, and delayed memory were observed, the

sample’s mean FSIQ, VIQ, and PIQ scores were in the average range. Duration of diagnosis was not a significant predictor

of verbal intelligence (R2 ¼ .000; p ¼ .95), but was a significant predictor of fluid intelligence (R2 ¼ .138; p ¼ .034).

Conclusions: Duration of diagnosis has been shown to be a mixed predictor of cognitive impairment for patients with MS.

The results of this study suggest that crystallized intelligence is more sensitive to disease progression. The implications will

be discussed for practitioners and researchers.

D-15

Misophonia and Attention Disturbance Following Right Orbital Brain InjuryEstes B, Dennison A, Schiff W, Hertza J

Objective: The objective of this study is to explore the relationship between misophonia (i.e., pathological aversion to

sounds) and orbital-frontal lesion, as well as the impact on attention. Misophonia is an aversion or decreased tolerance

to sounds that is thought to be the result of heightened autonomic/limbic responses triggered by the auditory system.

However, little is known about the neuroanatomical and pathological causes of misphonia. Method: A 41-year-old, right-

handed male who fell 10 feet from a ladder striking his head on some railing, resulting in a right orbital-frontal fracture.

The individual presented with a diagnosis of misophonia, as confirmed by an audiology specialty clinic. Medical history

otherwise includes a right parietal brain abscess that was removed 16 years earlier without apparent complication or cog-

nitive sequelae. He had been high functioning until the fall, and subsequently has been unable to function in environ-

ments where he cannot control the sounds. Evaluation procedures included administration, scoring, and interpretation

of comprehensive quantitative and qualitative measures. Results: Neuropsychological testing revealed average to above-

average cognitive functioning with exception to poor attentional vigilance and organization of information. Emotional

indices showed a relatively well-adjusted individual without significant depression, despite an otherwise clear pattern

of panic attacks triggered by sounds. Results were used to guide psychotherapeutic interventions, including compensatory

strategies and biofeedback aimed at desensitization. Conclusion: Misophonia may be the result of orbital-frontal lesion

affecting anterior limbic structure, and neuropsychological testing is beneficial in ruling out processing and emotional

disturbances that may contribute to an aversion to sounds.

D-16

Borderline Intellectual Functioning in Adults with Physical and Psychiatric Disorders

Ferrari M

Objective: This study examined differential relationships between demographic and empirical variables in two clinical

groups of adults with and without borderline intellectual functioning. Method: In an outpatient service principally

designed for providing vocational rehabilitation, records from 1,014 adults who had undergone assessment were exam-

ined. Four hundred and fifteen were used in this study. Two hundred and twenty-six (54.5%) had exclusive referral diag-

noses of physical impairment, whereas 189 (45.5%) had affective psychiatric disorders as their principal diagnosis

making them eligible for the service. Results: Twenty-four and 8/10th percent of the sample had Full Scale IQ (FSIQ)

scores between 71 and 84, potentially reflective of borderline intellectual functioning. Mean education level for the

full sample was 11.66 years (SD ¼ 1.98). Regardless of area of disability (physical or psychiatric) those with borderline

intellectual functioning had the least years of education (mean 10.82) and lowest performance on cognitive measures.

Based on multivariate analysis of variance (MANOVA), neurocognitive performance and academic achievement were

explained significantly more fully by borderline intellectual functioning than referral diagnoses or any other subject vari-

able (F(1, 411) ¼ 27.97, p , .0001). Discussion: Despite the fact that it is only a potential V-code in Diagnostic and

Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnosis and usually does not drive any form of

funding or service eligibility, borderline intellectual functioning is often reflective of significant disability characterized

by elevated risk and potentially poor functional outcomes. This study revealed that borderline intellectual functioning was

a more salient risk factor than affective psychiatric disorder in predicting educational and vocational outcomes in adults.

Neuropsychologists are in a key position to recognize and evaluate this potential area of disability and provide meaning-

ful assistance. Implications of the results for clinical practice are discussed.


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D-17

Differential Effects of Treatment on Cognitive Functioning in Primary Central Nervous System Lymphoma

Fitzgerald K, Elbin R, Patwardhan S, Covassin T, Kiewel N, Kontos A, Meyers C, Hakun J, Ravizza S, Berger K

Objective: In the cancer literature, quality of life has recently increased in salience in treatment planning, as an important aspect

of functional outcome. In a primary brain cancer population, such as primary central nervous system lymphoma (PCNSL), both

disease- and treatment-related changes in neurocognitive function (NCF) commonly render significant adverse effects on

quality of life. Because of its low incidence and sparse research, little is known about treatment-related changes in NCF in

PCNSL. The present study investigated the differential effects of chemotherapy with and without concurrent radiation on

NCF in the treatment of PCNSL. Method: Cognition was assessed using specific subtests (Block Design, Similarities, Digit

Span, Digit Symbol) from the Wechsler Adult Intelligence Scale-Third Edition, Controlled Oral Word Association task,

and the Hopkin’s Verbal Learning Test. Twelve PCNSL patients participated (mean age ¼ 50 years, male ¼ 50%,

right-handed ¼ 91.6%, mean years of education ¼ 13). There were no significant differences between groups in sex, age, hand-

edness, or years of education. Six independent sample t-test analyses were performed. Results: Performance on tasks of audi-

tory attention and working memory, visuospatial construction skill, immediate verbal memory, and learning efficiency was

significantly better in patients treated with chemotherapy alone than in those undergoing chemoradiation. Conclusions:

Although both chemotherapy and radiation are known to have some effects on cognition, chemotherapy alone appears to be

associated with better cognitive performance than chemoradiation. Further investigation on common neuropsychological

effects of both of these treatments may help to further inform treatment plans for patients with PCNSL.

D-18

Multiple System Atrophy: A Case StudyHertza J, Phillips F, Estes B, Schiff W, Bell C, Anderson J

Objective: The objective of this single case study is to explore multiple system atrophy (MSA). MSA is a progressive neuro-

degenerative disorder characterized by symptoms of autonomic nervous system failure combined with tremor, rigidity, brady-

kinesia, and ataxia; three types are recognized based on symptom presentation: a Parkinson’s, autonomic, and cerebellar type.

MSA is associated with the degeneration of nerve cells in specific areas of the brain causing problems with movement, balance,

and automatic functions of the body. Although cognitive dysfunction may appear minimal in the early stages, most patients

experience frontal system impairment and many develop dementia later in the course of the disease. This case will discuss

a patient diagnosed with MSA by his neurologist. Method: A 67-year-old African American male was assessed in a hospital

setting. Patient has a 4-year history of progressive changes in gait, bilateral tremor, incomplete bladder emptying progressed to

urinary incontinence, erectile disorder, peripheral neuropathy, orthrostatic hypotension, and a new onset of sleep apnea and

restless leg syndrome. The patient has noted slowed processing speed and mild word-finding difficulties with intact

memory. Archival neuropsychological data, de-identified history, physician report, and neuroimaging will be organized and

presented in a single study case summary. Evaluation procedures included administration, scoring, and interpretation of com-

prehensive quantitative and qualitative measures. Results: Assessment revealed several areas of impairment, including tremor,

rigidity, bradykinesia, and ataxia. Deficits were noted in verbal fluency, inhibition, cognitive flexibility, and problem-solving.

Memory was intact. Conclusion: The patient presented with deficits consistent with MSA.

D-19

Neuropsychological Assessment of Frontal Temporal Dementia: A Case Study

Horton A, Reynolds C

Objective: Recent research has identified a frontal temporal dementia (FTD) syndrome that impairs executive functioning in middle

age and progresses rapidly. There have been few clinical reports of neuropsychological assessment with such FTD patients. This

poster describes the neuropsychological assessment of an FTD female in order to demonstrate the value of neuropsychological assess-

ment in diagnosing FTD patients. Method: The patient was a 50-year-old, divorced, African American right-handed female, who had

a 2-year history of problems with short-term memory and poor judgment that were becoming worse. The patient had difficulty ful-

filling her job duties in a security agency to the point she was retired, had been swindled out of thousands of dollars by various scams,

and gained 50 pounds in the last 2 years due to overeating. In addition, there were concerns about the patient driving at high speeds in

the patient’s car. A comprehensive battery of neuropsychological tests was administered that included measures of intelligence, aca-

demic skills, perceptual and motor functioning, visual spatial abilities, attention and memory, executive functioning, effort, and

emotional status. Results: The neuropsychological profile was not lateralized but rather appears to be associated with frontal

temporal impairment with severe impairment of executive functioning, verbal fluency, and short-term memory abilities. On the

Test of Verbal Conceptualization and Fluency (TVCF), subtest scores of Category Fluency (32T), and Perseverative Errors


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(32T) clearly documented FTD symptoms. Conclusion: Neuropsychological assessment is important in the diagnosis of FTD

patients. Future research on identifying neuropsychological correlations of FTD is warranted.

D-20

Relationship Between Dysregulation of the Plasma Cytokine Network and Neuropsychiatric Impairment in Adults withChronic Hepatitis C Infection

Huckans M, Vandenbark A, Loftis J

Objective: To evaluate the role of plasma cytokine dysregulation in the development of neuropsychiatric impairments in adults

with chronic hepatitis C virus (HCV) infection. Methods: HCV-infected adults with no history of interferon-a therapy

(HCV-positive, n ¼ 24) and non-infected controls (HCV-negative, n ¼ 28) completed clinical interviews, the Beck

Depression Inventory (BDI-II), a comprehensive neuropsychological testing battery, and blood sample collection for determi-

nation of plasma cytokine levels (interleukin [IL]-1b, soluble IL-2 receptor alpha [sIL-2Ra], tumor necrosis factor [TNF]-a,

and IL-10). Results: Groups did not differ in terms of age, gender, race, or rates of most psychiatric or medical conditions. All

four plasma cytokine levels were 3–25-fold higher in the HCV-positive group compared with the HCV-negative control group,

but these differences were non-significant (Mann–Whitney U-tests, p . .050). As hypothesized, within the HCV-positive

group, but not within the HCV-negative control group, elevations in cytokine levels significantly correlated with both

depression and cognitive impairment (Spearman’s rho correlations, p , .050). Specifically, within the HCV-positive group,

there were significant correlations between depression and number of elevated cytokines as well as TNF-a levels. There

were also significant correlations between global cognitive impairment and sIL-2Ra, motor speed and TNF-a, language

fluency and sIL-2Ra, and verbal memory and sIL-2Ra. Additional correlations between neuropsychiatric impairment and

cytokine levels trended (p , .100) in the same direction, including the correlation between global cognitive impairment

and number of elevated cytokines. Conclusions: Overall, these results indicate that dysregulated expression of peripheral cyto-

kines likely contributes to HCV-associated neuropsychiatric impairments, including depression and cognitive dysfunction.

D-21

Screening for Cognitive Impairment with the Montreal Cognitive Assessment in Parkinson’s Disease PatientsLangill M, Roberts R, Iverson G, Appel-Cresswell S, Stoessl A

Objective: The purpose of the study was to characterize demographic and clinical factors associated with low Montreal

Cognitive Assessment (MoCA) scores in patients with Parkinson’s disease (PD). Methods: Participants were 32 outpatients

with probable or definite PD. The sample was 66% males, their average age was 64.4 (SD ¼ 10.4) years, and their average

education was 16.2 (SD ¼ 3.8) years. They had been diagnosed with PD 7.2 (SD ¼ 5.8, range ¼ 1–26) years prior. Unified

Parkinson’s Disease Rating Scale (UPDRS) motor scores (part III; on-medication) and Modified Hoehn and Yahr Scale

(MHYS) scores were 14.5 (SD ¼ 6.7) and 2.1 (SD ¼ .5), respectively. Participants were administered the MoCA, Finger

Tapping Test, Test of Premorbid Functioning, Beck Depression Inventory-Second Edition, Beck Anxiety Inventory, Ruff

Neurobehavioral Inventory Cognitive Scale, and Behavior Rating Inventory of Executive Function (BRIEF) Working

Memory subscale (self and informant versions). Results: Approximately half (47%) of the sample screened positive for cog-

nitive impairment on the MoCA (total score , 26). Those with cognitive impairment were older (p , .001; Cohen’s d ¼ 1.39),

had more advanced disease as measured by the UPDRS (p , .020, d ¼ .98) and MHYS (p , .002, d ¼ 1.34), and had slower

right-hand finger tapping speed (p , .03, d ¼ .79). There was a trend toward those who were cognitively impaired having

symptoms of PD for longer (p , .06, d ¼ .72). The groups did not differ on estimated premorbid intelligence or self-reported

depression, anxiety, or ratings of perceived cognitive functioning (self or informant). Conclusions: The MoCA was well-

tolerated, identified half the sample as cognitively impaired, and performance was associated with disease severity. The

groups did not differ on self or informant ratings of cognition.

D-22

The Montreal Cognitive Assessment as a Screening Tool for Cognitive Dysfunction in Fragile X Tremor/Ataxia

Syndrome (FXTAS)Lazarus J, Olcese R, Juncos J, McCaskell D, Allen E, Shubeck L, Hamilton D, Novack G, Sherman S

Cognitive dysfunction in fragile X tremor/ataxia syndrome (FXTAS) is characterized by executive dysfunction and non-

specific deficits of memory and intelligence. Objective: To determine if the Montreal Cognitive Assessment (MoCA) (1) is

sensitive to the pattern of cognitive impairment seen in FXTAS, (2) correlates with standard neuropsychological measures,

and (3) correlates with the neuropsychiatric symptomatology seen in this disorder. Methods: We conducted a retrospective

review of 45 male FMR1 premutation carriers at Emory University School of Medicine. Participants completed a standardized


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battery of cognitive tests, a MoCA test, and validated questionnaires for depression and anxiety. For statistical analysis, we

used Pearson correlations (p , .05) to determine the convergent validity of the MoCA and simple regression analyses to deter-

mine which MoCA subtests were the strongest contributors to its overall psychometric properties in FXTAS patients. Results:

MoCA scores correlated significantly with general cognition (r ¼ .51, p , .001), executive function (r ¼ .32, p ¼ .02), intelli-

gence (r ¼ .42, p , .01), and memory (r ¼ .35, p ¼ .02). Regression analysis identified the attention, delayed recall, and

language portions of the MoCA as the key predictors of global cognitive impairment. MoCA scores also correlated with

depression (r ¼ 2.32, p ¼ .02), but not with anxiety. Preliminary data showed 88% sensitivity and 60% specificity for cog-

nitive impairment as defined by the neuropsychological battery. Conclusions: The MoCA appears to be a valid and sensitive

screening tool for cognitive impairment in FXTAS. A longitudinal study comparing the psychometric properties of the MoCA

to alternate screening tests is anticipated.

D-23

Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) Scale Elevations in a Group of Patients

Diagnosed with Parkinson’s DiseaseLivingson R, Schmitt A, Stewart R, Doyle K, Smernoff E, Galusha J, Hua S

Objective: Individuals with Parkinson’s disease are known to experience significant motor symptoms, often accompanied by

cognitive symptoms. A high percentage of patients also experience significant changes in mood and personality. The objective

of this study was to explore scale elevations on the Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) in

a group of patients diagnosed with Parkinson’s disease. Method: The study sample consisted of 60 participants (38 men and 22

women) with a mean age of 64.7 (SD ¼ 9.7). The sample was comprised of individuals living in the community with advanced

Parkinson’s disease involving motor fluctuations (wearing off and dyskinesia). The MMPI-2 scales that were explored included

the 10 clinical scales and 3 validity scales (L, F, and K). Results: Patients in this sample showed significant MMPI-2 mean

elevations on Scale 3 (T ¼ 67.6), followed by Scale 1 (T ¼ 67.1) and Scale 2 (T ¼ 65.0). The mean T-score on Scale 8

approached significance (T ¼ 64.7). Mean scores on the other MMPI-2 scales analyzed were within normal limits.

Conclusions: The mean elevations observed on Scale 1 (hypochondriasis) and Scale 3 (hysteria) are consistent with the impair-

ment in physical function in Parkinson’s disease. These elevations are 1–2 SD above the mean of the normal population. The

elevation on Scale 2 (depression) is also consistent with previous literature, indicating that a relatively high percentage of

patients with Parkinson’s disease have a comorbid diagnosis of a mood disorder. The high mean scores on Scale 8 may

include a combination of symptoms reflecting impaired cognition and unusual somatic symptoms.

D-24

Pre-surgical Verbal Fluency Performance of Selected Right and Left Temporal Lobe Epilepsy PatientsMattingly M, Rinehardt E, Benbadis S, Borzog A, Rogers-Neame N, Vale F, Frontera A, Schoenberg M

Objective: Epilepsy is a relatively frequent neurological disorder with a prevalence of approximately 1%. Temporal lobe

epilepsy (TLE) is a common epilepsy syndrome having negative neuropsychological effects. Decline in language has been

reported in patients with medically refractory epilepsy. This study evaluated the extent to which verbal fluency measures

distinguish between left and right surgical patients. Method: The study included review of temporal lobe epilepsy patients

completing a neuropsychological evaluation. Participants: Thirty patients were identified that met study inclusion and

exclusion criteria. There were 44 left TLE and 60 right TLE patients. Variables/measure(s): All participants completed

comprehensive neuropsychological evaluations, including the Controlled Oral Word Associations Test (COWAT),

Semantic Fluency (Animals), and Boston Naming Test (BNT). Results: Neuropsychological data are presented.

Intelligence, age, and education were not significantly different between these groups. Analysis of covariance

(ANCOVA) revealed significant differences in pre-surgical COWAT (p ¼ .002) and BNT (p ¼ .001) performance,

between left and right TLE patients. Left TLE patients scored significantly lower on these measures. In contrast,

animal fluency revealed no significant difference (p ¼ .157). Conclusion: In this sample of patients diagnosed with

either left temporal lobe epilepsy (LTLE) or right temporal lobe epilepsy (RTLE), LTLE patients performed significantly

worse than RTLE patients on the COWAT and BNT, but not animal fluency.

D-25

Individual Profiles of Word List Learning and Memory in Multiple Sclerosis: Evidence of a Retrieval Deficit?Norman M, Woods S, Houshyarnejad A, Filoteo W, Corey-Bloom J

Objective: Episodic memory disturbance is a common feature of multiple sclerosis (MS), but there is controversy about

whether this predominately reflects a deficit in encoding or retrieval. Therefore, the aim of this study was to examine the


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prevalence of encoding and retrieval profiles in MS using the California Verbal Learning Test (CVLT-II). Method: Participants

included 56 individuals with clinically definite MS and 40 demographically comparable healthy adults (HA). All participants’

CVLT-II profiles were classified as either “normal,” “encoding/storage,” or “retrieval” using the methodology of Filoteo and

Colleagues (1997). Results: Relative to the HA group, the MS sample had a significantly lower rate of normal (41% vs. 80%)

profiles, but a higher prevalence of retrieval profiles (52% vs. 13%; p , .001). However, the two groups showed similar rates of

encoding/storage profiles (7% vs. 8%). Within the MS group, individuals with retrieval profiles performed significantly worse

on standard clinical measures of processing speed, verbal fluency, and sequencing when compared with persons with normal

and encoding profiles (p , .05). Conclusions: Findings suggest that the memory profile of MS is heterogeneous, but may be

best characterized as a retrieval deficit, which in this study was approximately four times more prevalent than in HA and was

associated with greater severity of cognitive impairment.

D-26

Clinical Utility of the Montreal Cognitive Assessment When Assessing Decision-Making Capacity

Pachet A, Larco C

Objective: To determine if cognitive deficits, as measured by the Montreal Cognitive Assessment (MoCA), can accurately

predict decision-making capacity. An additional question addressed in this study was to determine if the sensitivity and speci-

ficity of the MoCA varied based upon the patient population. Methods: A sample size of 131 was obtained, with patients having

completed the MoCA within 1 week of the capacity evaluation. Diagnostic groups were dementia, acquired brain injury, and

psychiatric. Additional data points collected were MoCA scores and determinations of capacity made after completion of a

functional inquiry. The MoCA is a brief cognitive screen and the functional inquiry is a semi-structured interview often

viewed as the gold standard when making a capacity determination. Results: ROC analysis revealed that the MoCA distin-

guished between groups classified according to the functional interview. When a MoCA cutoff of 20 was employed, strong

sensitivity and specificity were identified. However, as the MoCA cutoff score was increased, higher rates of Type 1 errors

and poor specificity resulted. Additionally, sensitivity and specificity across the three major diagnostic groups was quite

strong, with the exception of the psychiatric illness group. Conclusions: Although the use of the MoCA as a standalone

tool to assess decision-making capacity is not recommended, it is a useful adjunct when completing capacity evaluations.

False-positive rates are acceptably low, and hit rates are acceptably high for scores below 20. However, limitations exist

based on the patient population being assessed.

D-27

Neuropsychological Consequences of Autosomal Dominant Spinal Cerebellar Atrophy: A Clinical Case Study

Raymond M

Objective: This case study describes the neuropsychological consequences of a 61-year-old, Caucasian married, right-handed

male with a high school education who was diagnosed with spinal cerebellar atrophy in 2002. Method: Autosomal dominant

spinal cerebellar atrophy is primarily related to inherited genetic mutations that interfere with the normal production of necess-

ary proteins for neuronal survival. L.L. developed a gradual progressive ataxia and mild dysarthria in 2002. He underwent a

cerebral MRI which identified cerebellar atrophy. A diagnosis of autosomal dominant spinal cerebellar atrophy was made

based on the aformentioned neuroimaging findings and familial diagnoses of his father and both sisters. Based on the persistent

nature of his subjective neurocognitive and behavioral complaints, he was referred for baseline neuropsychological consul-

tation at approximately 5 years after diagnosis. Results: Results of L.L.’s neuropsychological evaluation (July 27, 2007)

suggested moderate-to-severe adaptive impairments as indicated by scores on standardized neuropsychological indices

(Halstead Impairment Index 1.0, GNDS 45). Aside from expected sensorimotor alterations and dysarthria, primary deficits

were in areas of delayed memory, infomation processing speed, sustained attention/concentration, and executive functions.

Conclusion: This case underscores the importance of obtaining baseline neuropsychological data in individuals diagnosed

with cerebellar atrophy/degeneration.

D-28Performance of Selected Right and Left Temporal Lobe Epilepsy Patients on the Wechsler Memory Scale-Fourth

Edition and Common Verbal and Visual Memory Tests

Rinehardt E, Mattingly M, Benbadis S, Borzog A, Rogers-Neame N, Vale F, Frontera A, Schoenberg M

Objective: Neuropsychological evaluations of temporal lobe epilepsy (TLE) patients are important for pre-surgical

decision-making because left temporal resections increase the risk of memory and language impairment. The updated

Wechsler Memory Scale-Fourth Edition (WMS-IV) may be used to assess pre-surgical lateralization of function, but


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its utility has not been extensively investigated. We analyzed the WMS-IV, Rey Auditory Verbal Learning Test

(RAVLT), and the Rey Complex Figure Test (RCFT) in this setting. Method: Neuropsychological evaluations were con-

ducted on patients with TLE. Participants: A total of 19 participants met criteria for this study. There were 9 left TLE

(LTLE) and 10 right TLE (RTLE) patients. Variables/measures: Participants completed neuropsychological evaluations

including the WMS-IV, RAVLT and RCFT. Results: Intelligence, education, and age did not differ between groups.

Analysis of variance (ANOVA) did not identify significant differences between LTLE and RTLE groups on the

WMS-IV primary indices (auditory, visual, immediate, or delayed memory). Subtest analyses found that LTLE patients

scored significantly worse than RTLE patients on the WMS-IV Logical Memory I (p ¼ .040) and Logical Memory II

(p ¼ .009) subtests. LTLE patients scored significantly worse than RTLE patients on the RAVLT Trial 5 (p ¼ .048)

and 30-min delayed recall (p ¼ .031). No significant differences were found for the RCFT. Conclusions: These data

raise questions about the clinical utility of the WMS-IV or RCFT to assess known neurological dysfunction. As found

in previous research, the RAVLT demonstrated clear clinical utility to lateralize neurological dysfunction. The primary

WMS-IV memory indices failed to differentiate between lateralized neurological dysfunction, and further study is

needed with larger samples.

D-29

Correlation between Parkinson’s Disease Rating Scales and the Repeatable Battery for the Assessment ofNeuropsychological Status in Patients Diagnosed with Parkinson’s Disease

Schmitt A, Stewart R, Livingston R, Doyle K, Smernoff E, Werry A, Claunch J, Galusha J

Objective: The relationship between performance on the United Parkinson’s Disease Rating Scale (UPDRS), the Hoehn

and Yahr scale, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was examined in

a group of patients diagnosed with Parkinson’s disease. Method: The study sample consisted of 60 participants (38 men

and 22 women) with a mean age of 64.7 (SD ¼ 9.7). The sample was comprised of individuals living in the community

with advanced Parkinson’s disease involving motor fluctuations (wearing off and dyskinesia). Spearman coefficients

were calculated between the UPDRS, Hoehn and Yahr, and RBANS Total Scale and index scores. Results: The

RBANS Total Scale score showed moderate correlations with the UPDRS III (r ¼ 2.50) and the Hoehn and Yahr

scale (r ¼ 2.48). The RBANS Total Scale score showed minimal correlations with the UPDRS II and the UPDRS

I. Comparing the UPDRS with the RBANS index scores, moderate correlations were found with the Visuospatial/

Constructional Index (r ¼ 2.50), the Delayed Memory Index (r ¼ 2.43), and the Attention Index (r ¼ 2.35).

Conclusion: The RBANS correlated with the sub-section of the UPDRS that evaluates motor performance in this popu-

lation. Although there were only moderate correlations between the RBANS and the Parkinson’s rating scales, these

preliminary analyses suggest a relationship between the cognitive performance (as measured by the RBANS) and

motor function in this population.

D-30Internet-based Assessment of Post-Operative Neurocognitive Function in Cardiac and Thoracic Aortic Surgery Patients

Uysal S, Mazzeffi M, Lin H, Reich D

Objective: The aim of this study was to examine long-term neurocognitive function in patients who underwent cardiac or

thoracic aortic surgery with varying periods of cardiopulmonary bypass (CPB), hypothermic circulatory arrest (HCA),

and selective cerebral perfusion (SCP) in the past 6 years. Method: Patients who had undergone procedures with CPB

(n ¼ 207), CPB with HCA (n ¼ 67), or CPB with HCA and SCP (n ¼ 26) were administered the Cognitive Stability

Index HeadMinderw battery to assess response speed, processing speed, memory, and attention factor scores. Multiple

linear regression modeled associations among CPB, HCA, and SCP times and factor scores, controlling for standard cov-

ariates: age, gender, educational status, and time since surgery. Non-linear relationships were tested by quadratic poly-

nomial terms. Results: CPB and SCP durations were unrelated to any of the factor scores. HCA duration was

negatively associated with processing speed scores and memory scores; for any 10-min increase in exposure to HCA,

the processing speed and memory z-scores were reduced by .64 and .70, respectively. Attention scores demonstrated a

similar non-significant trend; for any 10-min increase in exposure to HCA, the z-score was reduced by .36 (p ¼ .09).

There was a non-significant trend for a non-linear association between HCA duration and response speed (p ¼ .07);

beyond 24 min, for any 10-min increase in HCA time, the response speed z-score was reduced by .81. Conclusion:

Despite the limitation of not assessing baseline function, these preliminary data support the hypothesis that HCA

.24 min is associated with poorer neurocognitive outcomes and demonstrate the efficacy of remote Internet-based post-

operative cognitive assessment.


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NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: TRAUMATIC BRAIN INJURY

D-31Expectations for Recovery by Patients and Their Families based on Functional Changes Following Traumatic Brain

Injury

August-Fedio A, Sexton Ja, Keller J, Thomas T, Fedio P

Objective: The study was designed to codify the impact of physical, cognitive, and emotional changes on patients following

traumatic brain injury (TBI) and their families regarding their current and future satisfaction with recovery. Method: Twelve

mild-to-moderate TBI patients recruited from a community treatment program (7 males, 5 females, averaging 36 years of age

and 4 years post-injury) and a family member (spouse/parent) completed the Neurobehavioral Functioning Inventory (NFI-R).

Each rated the patient’s changes in somatization, motor skills, attention/memory, communication, depression, and aggression.

Each dyad also rated the level of satisfaction regarding functional recovery. Results: The NFI-R ratings by patients and their

families were closely aligned within the average range, with strong correlations on measures of depression (p ¼ .005),

memory/attention (p ¼ .002), and motor problems (p ¼ .08). Patients’ level of satisfaction with recovery was inversely

related to their level of impairment, especially for depression (p ¼ .02) and memory/attention (p ¼ .01). Motor (p ¼ .001)

and somatic (p ¼ .01) problems were highly related to patients’ dissatisfaction with recovery from depression and aggression,

respectively. Patients’ NFI-R ratings of depression, somatization, and motor problems correlated highly (p , .05) with their

future satisfaction across areas of functioning. Dyads’ ratings of satisfaction regarding recovery were consistent except that

families overestimated how much improvement the patients anticipated in the future. Conclusions: Somatic/motor problems

and depression were readily identified by TBI patients and their families as critical sources of dissatisfaction with recovery.

These problem areas influenced patients’ ratings of their progress and prognosis. Joint treatment of patients and their families

should focus on adjusting the expectations of both parties regarding recovery.

D-32Neuropsychologic Outcomes after a Pole Vaulting Traumatic Brain Injury

Austin A, Millikin C, Baade L, Shelton P, Yamout K, Marotta J, Boatwright B, Heinrichs R

Objective: We present the case of a 20-year-old pole vaulter who landed on his head and incurred a severe brain injury but

recovered and returned to pole vaulting. Method: While pole vaulting, the patient missed the mat and struck his head.

Emergency Medical Services (EMS) noted “decorticate posturing,” loss of consciousness, and Glasgow Coma Score of

5. CT indicated subdural blood collection in the right frontal lobe, right and left temporal and parietal lobes, and diffuse

white matter edema. Treatment included intracranial pressure monitoring, frontotemporal parietal decompression craniotomy,

evacuation of intracerebral and subdural hematoma, and placement of right frontal ventriculostomy. After hospitalization and

inpatient rehabilitation, the patient was referred for neuropsychological evaluation. Results: The patient was tested twice. Initial

testing revealed average IQ, poor processing speed, mild visual memory deficits, variable executive functioning scores (i.e.,

poor rule monitoring and impulsivity), bilateral motor weakness, and variable academic performance. Six months later,

testing revealed improved scores, including high average to superior IQ scores, improvement in processing speed and

memory, average executive functioning skills, and only residual left side fine motor deficits. Interestingly, this patient reported

and demonstrated improvements in casual artistic abilities, despite piecemeal assessment performance with clear misalign-

ments on geometric figures. Conclusion: Despite significant diffuse injury throughout the brain, this patient demonstrated

remarkable cognitive resilience and recovery. Implications of the present case will be explored.

D-33

Fatigue, Sleep Disturbance, and Neuropsychological Functioning Following Acquired Brain Injury

Blake T, Silverberg N, Anton H

Objective: Fatigue and sleep disturbance are both common in patients with acquired brain injury (ABI). Their relationship is

uncertain, as is their independent and cumulative impact on neuropsychological test performance. We aimed to explore these

relationships in the same sample of ABI patients. Method: Participants were 38 adult ABI rehabilitation outpatients (53% trau-

matic brain injury, 26% stroke, and 21% other) who were referred for comprehensive neuropsychological evaluation.

Neuropsychological test scores were aggregated into indices of attention/working memory, processing speed, verbal recall,

executive functioning, and global cognition. Fatigue was measured with the Fatigue Severity Scale (FSS). We categorized

item 16 of the Beck Depression Inventory-II as normal sleep pattern, insomnia, and hypersomnia. Results: Approximately

half of participants reported problematic fatigue over the past week (FSS . 4) and 61% reported recent sleep disturbance.

Subjective fatigue ratings did not differ among participants reporting insomnia, hypersomia, or normal sleep pattern.


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Multivariate regression demonstrated that fatigue was weakly related to higher global cognition (b ¼ .42, p ¼ .022), whereas

the effects for insomnia and hypersomnia were non-significant. These patterns were similar across the neuropsychological

domain index scores. There were no fatigue and sleep disturbance interaction effects on the index scores. Conclusions:

Fatigue was independent of changes in sleep pattern in our ABI sample. Contrary to expectation, complaints of fatigue and

sleep disturbance were not associated with lower performance on common neuropsychological tests. Based on prior research,

adverse fatigue and insomnia/hypersomnia effects may be more detectable on sustained attention tasks, which were not

included in our battery.

D-34

Neuropsychological Performance in Veterans Following Concussion due to Blast Versus Non-Blast Injuries

Bradley E, Lockwood C, Hull A, Poole J

Objective: To examine neuropsychological performance of veterans with suspected concussions resulting from blasts

versus other mechanisms of injury. Method: Participants: Eighty-seven outpatients in a Veterans Affairs Medical

Center (median age ¼ 28, median education ¼ 13), who screened positive for possible concussion completed the

Neuropsychological Assessment Battery-Screening Module (NAB-S) and the Posttraumatic Stress Disorder (PTSD)

Checklist (PCL) as a part of a standard neuropsychological assessment. Spearman correlations were calculated

between NAB-S scores and number of blast exposures, and concussions from other mechanism of injury. We excluded

individuals whose test performance suggested inadequate effort. Results: Number of blast exposures was correlated with

lower scores on the NAB total screening index, and the attention, spatial, and executive indices (p , .05). History of

concussions from non-blast mechanisms was unrelated to current performance on the NAB-S. Severity of PTSD symp-

toms was correlated with lower memory and spatial scores (p , .05), but not with attention or executive scores.

Conclusions: As veterans return from combat with multiple blast exposures, there are questions regarding the physical

and emotional effects of these experiences. The present findings indicate that blast exposures are related to both cognitive

and emotional difficulties. In addition, this study suggests that the physical and emotional impact of blasts may influence

different aspects of cognitive functioning. Clinical application with this population will be discussed. Future studies

should expand this analysis to a broad range of neuropsychological measures.

D-35

Comparison of Subjective Cognitive Complaints and Objective Cognitive Performance in Blast-Exposed OperationEnduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans Diagnosed with Posttraumatic Stress Disorder

and/or Depression

Demadura T, Storzbach D, Tun S

Objective: The objective of the present analyses was to compare subjective cognitive complaints and objective cognitive per-

formance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without diagnoses of

depression and Posttraumatic Stress Disorder (PTSD). Method: Thirty-five participants were drawn from an ongoing study

of neuropsychological functioning in blast-exposed OEF/OIF veterans. Data analyzed using analysis of covariance

(ANCOVA)s with age as a covariate consisted of major depression and PTSD diagnosis status as determined by a structured

diagnostic interview, subjective cognitive complaints as measured by the Ruff Neurobehavioral Inventory (RNBI), and objec-

tive cognitive performance as measured by the memory, attention, spatial, and executive functioning measures of the

Neuropsychological Assessment Battery (NAB). Results: Veterans with (N ¼ 22) and without (N ¼ 13) diagnosis of PTSD

showed significant (p , .05) differences for RNBI measures of subjective cognitive complaints related to attention, executive

functioning, and memory. However, veterans with (N ¼ 15) and without (N ¼ 20) diagnosis of depression showed no signifi-

cant differences on any RNBI measures. No significant differences was found between any of the groups on NAB measures.

Conclusions: Findings suggest that although PTSD was associated with increased subjective reporting of cognitive problems in

blast-exposed OIF/OEF veterans, depression was not, and neither diagnosis was associated with differences in objective cog-

nitive performance.

D-36

Comparison of the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Neuropsychological

Assessment Battery Screening Module (S-NAB) in Veterans Screened Positive for History of Traumatic Brain InjuryHull A, Greenberg L, Lockwood C, Hutson L, Belsher B, Sullivan C, Poole J

Objective: This study compares the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and

Neuropsychological Assessment Battery Screening Module (S-NAB) in the initial assessment of VA patients who screened


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positive for possible traumatic brain injury (TBI). Methods: Participants were 41 outpatient veterans, aged 20–58, who

screened positive for possible TBI on a standard VA screen, and whose histories suggested possible mild-to-moderate TBI.

Participants were given the S-NAB and RBANS as part of a standard assessment battery. Analyses compared S-NAB and

RBANS standard scores for attention, memory, language, and visuospatial skills. Results: S-NAB and RBANS attention

and memory indices were significantly correlated (r ¼ .8 and .7), whereas their language and spatial indices were not (r ,

.3). RBANS scores were significantly lower than S-NAB scores for memory (2.9 SD) and language (21.2 SD). Beck

Anxiety and Depression indices correlated significantly with S-NAB and RBANS aAttention, S-NAB memory, and S-NAB

spatial indices (r ¼ 2.4 to 2.5). Conclusion: This study indicates that the RBANS and S-NAB are not equivalent. Their atten-

tion and memory tests tap similar functions, but their language and spatial tests do not. The S-NAB includes an executive

index, but the RBANS does not. Furthermore, patients in our TBI clinic obtained lower memory and language scores on

the RBANS than the S-NAB. Possible reasons include differences in the RBANS and NAB normative samples, floor/

ceiling effects, and the sensitivity/specificity of items, which will be discussed in this presentation. Understanding the contents,

constructs, and relative difficulty of these two popular screening batteries can help clinicians select appropriate tests for specific

patient populations.

D-37

Successfully Surviving a Brain InjuryLa Point S, Harrison A, Suhr J, Heilbronner R

Successfully surviving a brain injury is rarely achieved in isolation. Usually, it takes the herculean efforts of many. For Garry

Prowe, whose wife sustained a traumatic brain injury (TBI) in a 1997 automobile accident, it took a panel of 300 survivors,

caregivers, and professionals to go from uninformed to educated. In “Successfully Surviving a Brain Injury: A Family

Guidebook,” Garry shares his personal story of heartache and resiliency. And along the way, he ends up telling the story of

everyone who has sustained a brain injury. Numbers regarding prevalence and incidence indicate the scope of the issue,

but they do not tell the whole story. Garry does. TBI is not a respecter of gender, race, religion, age, abilities, culture,

class, ethnicity, or sexual orientation. It is an equal opportunity destroyer. But it does not have to be that way. This presentation

will communicate what everyone should know about The Silent Epidemic. The uneducated can learn from those who have been

there, done that. Included will be the personal insights of those who, together with Garry Prowe, have learned to live success-

fully with adversity after TBI and as a result make the road to recovery easier to travel.

D-38

Clinical Utility of the Protein S100B to Evaluate Traumatic Brain Injury in the Context of Alcohol Intoxication

Lange R, Iverson G, Brubacher J

Objective: Alcohol intoxication at the time of traumatic brain injury (TBI) is common and can affect the reliability and accu-

racy of behaviorally based measures designed to evaluate brain injury severity (e.g., Glasgow Coma Scale). The purpose of this

study was to examine the role of the protein S100B as a biomarker for TBI in the context of alcohol intoxication. Method:

Participants were 159 patients who presented to a large urban Level 1 Trauma Center in Vancouver, Canada. Patients were

classified into four clinical groups (Medical Controls [MC], Trauma Controls [TC], Uncomplicated Mild TBI [MTBI], and

Definite TBI [DTBI]) and two day-of-injury alcohol intoxication groups (i.e., sober and intoxicated). Blood samples were col-

lected within 8 hr of injury (M ¼ 1:36, SD ¼ 1:14) and analyzed using a commercially available assay kit (Sangtec 100 Elisa).

Results: Higher S100B levels were found in patients who sustained an MTBI or DTBI compared with patients in the MC and

TC group (p , .03, d ¼ .42 to 2.71). There was a positive linear relationship between S100B levels and brain injury severity

for those patients who were sober (DTBI . MTBI; d ¼ 1.47), but not in those patients who were intoxicated (DTBI ¼MTBI,

d ¼ .19). Overall, alcohol consumption at the time of injury did not effect S100B levels (sober ¼ intoxicated: p . .304).

S100B levels had modest diagnostic accuracy for identifying patients with brain injury in this clinical setting (Sens ¼ .69,

Spec ¼ .84, PPP ¼ .81, NPP ¼ .73). Conclusion: Increased S100B levels were significantly associated with mild and definite

TBI. However, this biomarker had modest diagnostic accuracy in the presence and absence of acute intoxication.

D-39

Complicated Versus Uncomplicated Mild Traumatic Brain Injury: Neurocognitive and Symptom Outcomes

Lange R, Waljas M, Iverson G, Hakulinen U, Dastidar P, Hartikainen K, Soimakallio S, Ohman J

Objective: The purpose of this study was to compare acute outcomes following complicated versus uncomplicated mild trau-

matic brain injury (MTBI) using neurocognitive and self-report measures. Method: Participants were 13 patients with compli-

cated MTBI and 34 patients with uncomplicated MTBI who presented to the Emergency Department of Tampere University


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Hospital, Finland (age: M ¼ 30.3 years, SD ¼ 9.4; education: M ¼ 13.0 years, SD ¼ 2.3). All patients completed self-report

measures and neurocognitive testing at 3–4 weeks post-injury (M ¼ 25.8, SD ¼ 2.9, range 21–34 days), as well as MRI scan-

ning using a Siemens 3T scanner (Magnetum Trio). Participants were classified into the complicated MTBI or uncomplicated

MTBI group based on the presence/absence of intracranial abnormality on day-of-injury CT scan or 3–4 weeks of MRI scan.

Patients were excluded if non-trauma-related abnormalities were identified. Results: There were no significant differences

between groups for any of the neurocognitive or self-report measures (all p . .05). However, medium effect sizes were

found for many comparisons. The complicated MTBI group reported fewer depression (d ¼ .52) and post-concussion symp-

toms (d ¼ .43). Paradoxically, the complicated MTBI group performed better on tasks on learning and memory (Rey Auditory

Verbal Learning Test [RAVLT] total [d ¼ .39] and delay [d ¼ .47]) and executive functioning (Stroop, d ¼ .47), but worse on

tasks of verbal fluency (animal naming, d ¼ .43). Nonetheless, there were no differences in the proportion of patients who (a)

met criteria for depression or International Classification of Diseases-Tenth Edition/Diagnostic and Statistical Manual of

Mental Disorders-Fourth Edition (ICD-10/DSM-IV) post-concussional disorder or (b) had multiple low scores on the neuro-

cognitive measures. Conclusion: Overall, patients with complicated MTBIs did not perform more poorly on neurocognitive

measures, or report more symptoms, at 3–4 weeks after injury compared with uncomplicated MTBIs.

D-40

The Utility of Early Computerized Neuropsychological Assessment in Predicting Post-Concussive Symptoms (PCS) 1Year Post-Mild Traumatic Brain Injury

Lee-Wilk T, Ryan P, Kurtz S, Dux M, Dischinger P, Auman K, Murdock K, Kane R

Objective: The Automated Neuropsychological Assessment Metrics (ANAMTM) is a computerized battery of neuropsycholo-

gical tests designed for repeated evaluations. This study assessed if early cognitive symptoms predict persistent post-

concussive symptoms (PCS) at 1 year post-mild traumatic brain injury (mTBI). Participants and methods: Participants (N ¼

52), aged 18–64, and 63% males, were recruited from an urban hospital trauma center following mTBI. Participants were

administered the ANAMTM at 7–10 days and 3, 6, and 12 months after injury. They also completed self-report questionnaires

regarding potential PCS (cognitive, emotional, and physical symptoms). Logistic regressions examined the association

between specific ANAMTM tests at 7–10 days (simple reaction time [SRT], procedural reaction time [PRT], Code

Substitution-Learning [CDS], and Code Substitution-Delayed [CDD]) and post-concussive symptoms at 1 year, controlling

for age, gender, and education. Persistent PCS was defined as having greater than or equal to 4/9 cognitive, emotional, and/

or physical symptoms. Results: Three ANAMTM tests administered within 10 days of injury were significantly predictive

of later PCS: A choice reaction time test (PRT; p , .03), a symbol-digit learning test (CDS; p , .04), and a delayed

memory test (CDD; p , .04). There was no significant relationship between SRT and PCS. Conclusions: Findings suggest

that poorer performance on tests of choice reaction time, learning, and delayed memory in the 2 weeks after injury were pre-

dictive of greater endorsement of PCS at 1 year. This suggests that early neurocognitive difficulties may predict persistent PCS.

This has implications for preventive and treatment interventions.

D-41

Processing Speed and Executive Abilities in Veterans with Concussion, Posttraumatic Stress Disorder (PTSD), or

Comorbid Concussion/PTSDLockwood C, Hull A, Poole J

Objective: This study compared processing speed and executive abilities in veterans with history of concussion, Posttraumatic

Stress Disorder (PTSD), or both. Method: Participants: 67 veterans, aged 21–64, mean education 13 years, with positive stan-

dard VA screen for possible mild traumatic brain injury (TBI). Measures: PTSD Checklist (PCL), Trails, Grooved Pegboard,

Wisconsin Card Sort-64 (WCST-64), Wechsler Adult Intellligence Scale (WAIS) Coding & Symbol Search, Delis-Kaplan

Executive Function System (D-KEFS) Verbal Fluency & Interference, and effort measures, within a standard battery.

Based on history (LOC, PTA) and current symptoms, patients were classified into three groups: Concussion only, PTSD

only, comorbid concussion/PTSD. Due to suspect effort, 18 participants were excluded (final N ¼ 49). Results: The PTSD/con-

cussion group did worse than the PTSD group on Trails B (z ¼ 22.1, p ¼ .04), with a similar trend on the WCST-64

(z ¼ 21.8, p ¼ .07). The PTSD/concussion group did significantly worse than the concussion group on Trails A

(z ¼ 22.9, p ¼ .002). There were no significant test differences between the groups with concussion or PTSD alone.

Conclusions: Patients with a comorbid history of concussion and PTSD did more poorly than those with PTSD alone on

two measures of mental flexibility, but not other executive tasks. Likewise, veterans with comorbid concussion and PTSD

were slower than those with concussion during visual-motor search, but not other processing speed measures. This suggests

that interaction of concussion and PTSD may be related to subtle problems in mental flexibility and visual-motor scanning.


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Future studies should examine whether such cognitive findings reflect consequences of these disorders, or pre-exiting risk

factors for persistent post-concussive and post-traumatic syndromes.

D-42

Trends in Symptom Reporting Following Blast-Related Mild Traumatic Brain InjuryMacGregor A, Watt D, Puente A

Objective: Mild traumatic brain injury (MTBI) is an emerging health concern among U.S. military personnel. The objective of

this analysis was to describe the course of reported symptoms over time following blast-related MTBI. Method: U.S. military

personnel who sustained an MTBI during Operation Iraqi Freedom were identified from clinical records completed at the time

of injury (n ¼ 848). Results from Post Deployment Health Assessments (PDHAs) completed within 1 year after injury were

examined. Groups were divided into those answering a PDHA 1–30 days after MTBI, 31–60 days, 61–90 days, and greater

than 90 days. Neurological, somatic, and psychological self-reported symptoms and referral information were abstracted from

the PDHAs. Results: Headache and dizziness were more frequently reported in the initial 60 days following MTBI, and weak-

ness was reported more frequently in the initial 90 days. Although there were no significant associations with auditory com-

plaints, those completing a PDHA in the first 30 days were significantly more likely to receive an audiology referral.

Self-reported hyper-arousal, a hallmark symptom of post-traumatic stress disorder (PTSD), was significantly higher in the

initial 60 days, and remained significant after adjusting for combat exposure. Conclusions: This is the first study to examine

the course of symptom reporting following blast-related MTBI. These results have important clinical implications for manage-

ment of MTBI in combat situations and in distinguishing between MTBI and PTSD. Future studies are needed to identify

adverse neurological and psychological sequelae of blast-related MTBI and should incorporate repeated measurements to

assess symptoms longitudinally.

D-43Memory Impairment in TBI and Chemically Exposed Participants

Marceaux J, Dilks L, Carroll A, Ashworth B, Dilks S, Thrasher A, Carbonaro S, Blancett S

Objective: Memory and attentional impairments are common forms of dysfunction following mild traumatic brain injury (TBI)

and cause significant morbidity in patients (Niogi et al., 2008). In addition, chemical exposure is also suspected to affect many

areas of cognitive functioning in individuals (Heuser & Mena, 2008; Pastor, 2007). The purpose of this study was to explore the

differences in memory impairment between patients with TBI and patients who have been exposed to chemical toxins. Method:

The TBI group included 25 participants (20 males) who sustained head injuries in automobile crashes; ages ranged from 18 to

67 (mean age ¼ 44). The exposed group consisted of 17 males exposed to ethylene dichloride; ages ranged from 32 to 70

(mean age ¼ 44). After obtaining consent, participants were administered the Wechsler Memory Scale-Third Edition

(WMS-III). Results: multivariate analysis of variance (MANOVA) indicated a significant difference in memory functioning

between TBI and exposed participants (Wilks l ¼ .52, F(8, 33) ¼ 3.89; p ¼ .003; h2partial ¼ .49). Specifically, TBI partici-

pants had significantly lower memory scores (e.g., borderline range) than EDC exposed participants (e.g., low-average range).

Follow-up analysis of variance (ANOVA) revealed that TBI participants were significantly lower on all WMS-III scales, with

the exception of Auditory Recognition-Delayed. Conclusion: This study supports previous research findings that individuals

suffering from TBI and neurotoxic exposure demonstrate deficits in memory; however, those with a traumatic brain injury

may experience greater impairments. It is possible that chemical exposure results in more global, but less severe deficits.

Future research should examine this as there are few studies comparing these types of brain injuries and their effects on cog-

nitive functioning.

D-44

Classification of Brain Injury Severity in Pediatric Traumatic Brain InjuryRingdahl E, Finton M, Thaler N, Drane D, Umuhoza D, Schoenberg M, Umuhoza D, Allen D

Objective: Classification of brain injury severity following traumatic brain injury (TBI) is an area of continued interest, as

such classification may prove useful in predicting short- and long-term outcomes. A number of current methods rely pri-

marily on severity or duration of coma as an indicator of brain injury severity, with one commonly used method based on

the Glasgow Coma Scale (GCS). While the GCS has a number of potential strengths, limitations are also apparent. The

current study examined whether a neuropsychological measure with demonstrated sensitivity to brain injury would

provide a similar classification of brain damage severity compared with the GCS. Method: Participants included 92

youth who sustained a TBI. They were 57.8% males, between 8 and 19 years of age (mean ¼ 14.4, SD ¼ 2.6), and

were administered the Comprehensive Trail Making Test (CTMT). Hierarchical cluster analysis was used to specify


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three clusters using CTMT standard scores as attributes, and these clusters were compared with the standard GCS classi-

fication of mild, moderate, and severe injury. Results: Ward’s method extracted three CTMT clusters that were indicative

of mild, moderate, and severe impairment. They did not differ on age, gender, or ethnicity. Kappa between the CTMT

clusters and the GCS severity classifications indicated there was only slight agreement (k ¼ .13). Discussion: Findings

suggest substantial differences when neuropsychological tests and measures of coma severity are used to classify severity

of brain injury. These classification differences are expected to be associated with differential prediction of short- and

long-term outcomes following TBI.

D-45

Evidence of Added Value of Baseline Testing in Computerized Testing

Roebuck-Spencer T, Vincent A, Schlegel R, Gilliland K

Objective: Computerized testing is fast becoming a standard part of cognitive assessment for sports and military concussion

management programs. Protocols typically obtain a baseline of cognitive performance against which post-concussion perform-

ance is compared. It is presumed that baseline information is beneficial to determine the presence and severity of cognitive

insult. Without baseline information, clinicians must rely solely on examination of norm-based post-injury scores. Recently,

the incremental validity of having a baseline versus examination of norm-based post-injury scores has come into question.

The current study sought to evaluate the added value of baseline information in computerized neuropsychological assessment.

Method: Military service members (N . 10,000) were tested 6 days after return from deployment in support of Operation

Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Performance on the Automated Neuropsychological Assessment

Metrics (ANAM) was compared with pre-deployment baseline scores and with those of an age- and gender-matched military

normative sample (N . 107,000). Rates of “abnormal” post-deployment scores were determined using comparison to baseline

(based on Reliable Change Index scores) and comparison to norms only. Results: Two percent of controls (no injury) demon-

strated significantly lower performance relative to their own baseline. In contrast, 24% of the control group showed “abnormal”

performance when baseline performance was not considered. Using norms alone, 22% of controls were flagged as abnormal

scores when there was actually no change from baseline. Conclusions: Having a baseline assessment appeared to improve clini-

cal decision-making accuracy. Results illustrate the importance of having a baseline to avoid potential false-positive errors and

potential risks and stresses of misdiagnosis on the individual.

D-46Forensic Challenges of a Head Injury

Lazarus T

A 16-year-old patient who was involved in a motor vehicle accident whilst riding his motor cycle had his right, dominant hand

(above elbow) amputated. His Glasgow Coma Scale (GCS) was scored as 6/15 and a magnetic resonance angiography revealed

watershed ischemic area of injury 4 days after accident. His head injury was classified as severe in nature based on his admis-

sion GCS. Four years after accident, patient showed significant increase in his Wechsler Adult Intelligence Scale-Third Edition

(WAIS-III) scores and all cognitive tests. He commenced courses in draughtsmanship, retraining his left (non-dominant) hand

to use a computer mouse. Although the patient’s legal representatives argued for loss of income, the findings of improved intel-

lectual and cognitive scores required re-analysis of his brain scan and what injury mechanisms were involved. Was it a cer-

ebrovascular accident (CVA)-like injury or direct impact to the brain? Changes in personality were reported by patient’s

parents and his girlfriend. There was no evidence of impulsivity or disinhibition. The case is discussed in light of known pro-

files and outcomes of stroke and head-injured patients, illustrating the need for detailing more accurately the brain ischemic

changes after a head injury particularly with blood loss. The test findings obtained from this patient is contrasted with that

of a similarly aged stroke patient noting commonalities and differences.

NEUROPSYCHOLOGICAL DOMAINS: EXECUTIVE FUNCTIONS

D-47Young Adults with both Attention-deficit/Hyperactivity Disorder and Learning Disorders Have More Executive

Dysfunction than Those with ADHD Alone

Brown F, Katz L

Objective: To explore the hypothesis that young adults with both attention-deficit/hyperactivity disorder (ADHD) and learning

disorders (LD) will have more difficulties with executive functioning than those with only ADHD. Method: Two hundred and

twenty-one (192 males and 92 females) young adults (M ¼ 22.5, SD ¼ 7.8 years) were included from a larger group who


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sought out neuropsychological testing for either an updated evaluation or diagnostic clarification. Participants had some college

(M ¼ 14.2, SD ¼ 3.1 years of education) and had high average Full Scale IQs (M ¼ 114.1, SD ¼ 12.9). We only included those

who were diagnosed with ADHD and/or an LD without known neurological impairments. We used multivariate analysis of

covariance (MANCOVA)s with the fixed factor being diagnostic group (ADHD alone or ADHD and LD combined); dependent

variables were scores from Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Continuous Performance Test-Second

Edition (CPT-II), Trail Making A and B, Paced Auditory Serial Addition Test (PASAT), Wisconsin Card Sorting Test

(WCST), and Stroop; and the covariate was Full Scale IQ. Results: Individuals with both ADHD and LD had significantly

lower executive function (EF) scores than those with ADHD alone on WAIS-III subtests of coding (p , 001) and Symbol

Search (p ¼ .019), Trails B (p ¼ .011), Stroop Words (p ¼ .022), and Color Word Inhibition (p ¼ .011). There were no sig-

nificant differences on the other variables. Follow-up examination using Chi-square revealed those with ADHD and LD had

about twice the proportion of scaled scores , 7 on almost every EF measure. Conclusions: These results suggest that more

severe EF problems contribute to LD with appropriate medical treatments and EF strategies are particularly important for

this population.

D-48

Age, Gender, and Motor Performance: Differential Effects of Novelty and Complexity

Franchow E, Suchy Y, Kraybill M, Eastvold A

Objective: Motor programming (MP) represents a proxy of executive functioning (Suchy & Kraybill, 2007), and there is

evidence that the degree to which task novelty degrades motor planning latencies predicts future cognitive decline

(Kraybill, Suchy, & Adam, 2009). However, patterns of motor performance change in healthy adulthood remain unclear.

This study investigates the influence of task novelty and complexity on components of MP performance in younger and

older adult men and women. Method: Participants were 26 healthy younger adults (14 females) and 42 community-dwelling

older adults (27 females). Participants completed the Push-Turn-Taptap task from the Behavioral Dyscontrol

Scale-Electronic Version (BDS-EV) battery (Suchy, Derbidge, & Cope, 2005), which measures motor speed, initiation/plan-

ning time, and learning/accuracy across novel, intermediate, and complex performance blocks. Results: Repeated-measures

analyses of variance (ANOVAs) with novel versus complex blocks as a within-subjects factor and gender and age as

between-subjects factors showed (a) an interaction between age and gender for motor speed (F(1, 64) ¼ 4.096, p ¼

.047), with younger men being faster than younger women, but older men being slower than older women; (b) older

men having longer planning latencies than older women, but only on novel (t ¼ 3.62, df ¼ 40, p ¼ .001) and complex

(t ¼ 3.40, df ¼ 40, p ¼ .002) trials, and (c) older men making more errors than older women, but only on complex trials

(t ¼ 3.07, df ¼ 40, p ¼ .004). For all variables, there was a main effect of gender (all p , .001]. Conclusions: These find-

ings improve the clinical utility of MP, demonstrating that novelty and complexity have a differentially deleterious effect on

motor planning latencies and accuracy in older men.

D-49Relationship between Strategies and Errors of Learning and Executive Functions in College Students with Academic

Difficulties

Funes C, Stern S, Morris M

Objective: The California Verbal Learning Test (CVLT-II) is widely used to assess the process of learning. The current study

aims to examine the utility of learning strategy and error measures of the CVLT-II in providing clinicians with insight into

problems of executive functions (EF) in students with academic difficulties. We hypothesize that strategies, such as semantic

clustering and serial clustering, will be positively related to measures of EF, whereas error types such as intrusions, persevera-

tions, and false-positives will negatively relate to EF. Methods: Two hundred and twenty-one college students, evaluated for

academic difficulties at the Regents Center for Learning Disorders of Georgia, were included in this study. Students were admi-

nistered the CVLT-II. In addition, the Delis–Kaplan Executive Function System (D-KEFS) was administered to assess EF.

Results: Three measures of executive functions in the D-KEFS, category switching, letter–number switching, and color–

word inhibition, were correlated with two learning strategy measures (semantic clustering and serial clustering) and three

error measures (intrusions, perseverations, and false-positives) of the CVLT-II. As expected, false-positive errors were nega-

tively related to all EF scores. In addition, perseverative repetitions were negatively associated with the letter–number switch-

ing task. However, no other processes significantly correlated with EF scores. Conclusions: Contrary to predictions, strategy

measures of the CVLT-II are not good indicators of EF in students with learning difficulty. Thus clinicians should use caution

when interpreting these as measures of higher-order functioning. However, these results suggest that error measures might

yield important information in identifying EF difficulties and should further be probed.


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D-50

Reliability of the Oral Trail Making Test

Graham L, Parikh M, Hynan L, Grosch M, Weiner M, Cullum M

Objective: The Oral Trail Making Test (OTMT; Ricker & Axelrod, 1994) was developed as a non-motor, non-visual

analog of the standard Trail Making Test (TMT). Correlations between OTMT part B (OTMT-B) and TMT part B

(TMT-B) have ranged from .59 to .72 in various populations, suggesting convergent validity. Nevertheless, little is

known about the psychometric properties of the OTMT. This study explored test–retest reliability for OTMT-B com-

pletion time in a mixed sample of healthy controls and patients with dementia. Method: Participants were 91 older

adults, ages 50–90 years (M ¼ 67.4, SD ¼ 9.62), who completed the OTMT. The sample included 70 healthy controls

and 21 participants with dementia, 69.2% were females, with 8–20 years of education (M ¼ 14.2, SD ¼ 2.67), and

MMSE scores were 22–30 (M ¼ 28.6, SD ¼ 1.61). Participants were administered the OTMT in a traditional face-to-face

(FF) testing session, as well as in a videoconference (VC) testing session as part of a larger neuropsychological inves-

tigation, with approximately 1 hr between administrations. Test condition was counterbalanced across FF and VC con-

ditions, and scores did not differ across testing modality (t ¼ 2.54, p ¼ .59; F ¼ .56, p ¼ .57). Results: OTMT-B

scores showed significant agreement (intraclass correlation ¼ .62, p , .0001), a significant correlation (Pearson r ¼

.62, p , .0001), and similar mean scores (M ¼ 41.85, SD ¼ 32.55; M ¼ 43.40, SD ¼ 30.18) across administrations.

Conclusions: Results demonstrate moderate test–retest reliability of the OTMT-B. These findings are within the reliability

range for the standard TMT-B (.44 to .87 across various populations) and show promise for utilizing OTMT as a neu-

ropsychological tool. However, relatively wide variability in scores can be seen across individual participants, suggesting

clinicians use care when interpreting results.

D-51

Transition Planning for the Autism Spectrum Disorder (ASD) Student: Neuropsychological Implications

Hart J, Lavach J

Objective: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder defined by Diagnostic and Statistical Manual of

Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) and characterized by deficits in social interaction, perception,

problem-solving, learning, communication, memory, and reasoning. Expanded diagnostic criteria, referral patterns, service

availability, age at diagnosis, and increased awareness have resulted in 8 per 1,000 individuals identified in this broadened

spectrum. DSM-IV-TR is descriptive without including quantifiable neuropsychological indices, and psychologists argue

that the most common instruments used to evaluate individuals underestimate their intellectual potential, often leading to mis-

diagnosis. To comply with PL 94-142 and PL 99-457, and to better serve children, professionals require evidence-based brain-

behavior neuropsychological assessment grounded in pathophysiology and neuroanatomy. This answers not only “what” is

going on cognitively, but “why?” Method: Fifteen previously identified ASD public school students, aged 12–15, and

fifteen controls were participated in the study. Assessment included the NEPSY II: A Developmental Neuropsychology

Assessment, Quick Neurological Screening Test-R, the Bender Visual Motor Gestalt Test-II, House-Tree-Person, and

Rotter Incomplete Sentence Blank. Results: Data revealed statistically significant differences in mental flexibility, difficulty

with abstractions, emotional tone, and complex information processing. Although previous studies identified visuoconstructive

deficits, ASD participant’s performance on the Bender Visual Motor Gestalt Test was within normal limits along with drawings

of the house and tree. Human figures were treated unusually. Projective measures identified impaired social skills, communicat-

ing difficulty, and a strong external locus of control. Conclusion: Neuropsychological profiles differentiating ASD from con-

trols were identified resulting in a quantifiable, multidisciplinary education plan emphasizing future transition and

collaboration between the school, professionals, family, and ASD participants.

D-52Cognitive Set Shifting and Its Relationship to Fluid Intelligence

Holcomb M, Allen R

Objective: The present study examined performance on the Delis-Kaplan Executive Function System (D-KEFS) Trails Test

and its relationship to intellectual functioning. Method: Participants were 104 undergraduates from a medium-sized

Midwestern University. All participants completed the Wechsler Abbreviated Scale of Intelligence (WASI) and selected

tests from the D-KEFS. The mean age of the participants was 19.9 years (SD ¼ 3.62). A correlation matrix was conducted

examining the scaled scores from all WASI subtests, its two major composites (Verbal Intelligence Quotient VIQ and

Performance Intelligence Quotient PIQ), and the Full Scale IQ. Regression analysis was conducted for positive correlations

related to the PIQ. Results: Correlation results indicated a positive correlation between number–letter sequencing and Full


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Scale IQ (.238), PIQ (.294), Block Design (.286), and Matrix Reasoning (.199) with all correlations significant at the .05 level.

Regression conducted on Block Design and Matrix Reasoning showed that the number–letter condition of Trails from the

D-KEFS predicted almost 10% of the variance (R ¼ .286, r2 ¼ .082, p , .05) in Block Design score and 4% of the variance

(R ¼ .199, r2 ¼ .040, p , .05) in Matrix Reasoning. Conclusion: Results of the present study are consistent with previous

research, which links performance IQ (fluid intelligence) to executive functioning and suggests that there is an underlying con-

struct, which is shared among the abilities. Clinically, the results show the need for concomitant neuropsychological testing

along with traditional assessment and that possible functional implications exist for clinical populations that display executive

dysfunction such as ADHD.

D-53

Inhibition and Cognitive Flexibility as Predictors of General IntelligenceHolcomb M, Renee A

Objective: The present study examined the relationship between inhibition and cognitive flexibility and its relationship with

Full Scale IQ scores. Results showed that a surprising amount of variance in IQ scores can be explained by a person’s measured

ability to inhibit and shift cognitive patterns to meet task demands. Method: Participants were 104 undergraduates from a

medium-sized Midwestern University. All participants completed the Wechsler Abbreviated Scale of Intelligence (WASI)

and selected tests from the Delis-Kaplan Executive Function System (D-KEFS). The mean age of the participants was 19.9

years (SD ¼ 3.62). Forward regression was conducted using inhibition, inhibition switch, and letter–number sequencing as

predictors of FSIQ on the WASI. Results: Forward regression was used with FSIQ used as the stable dependent variable

and three tests from the D-KEFS (number–letter sequence, inhibition, and inhibition). Results indicated that inhibition and

cognitive flexibility account for approximately 20% of the variance in IQ scores as measured by the WASI (R ¼ .438, r2 ¼

.191, F ¼ 4.640, p , .05). Additionally a moderate positive correlation of approximately .44 was associated with IQ and inhi-

bition/cognitive set shifting. Conclusion: Inhibition and cognitive flexibility are two commonly measured constructs within

neuropsychology but their direct impact on intelligence is a phenomenon that is often overlooked and therefore paucity

exists in the literature. Clinically, such a relationship could have major implications with disorders such as ADHD which fea-

tures at its core difficulties with inhibition and mental flexibility, which may be negatively impacting, assessed IQ.

D-54

Lateralized Differences in Left Hemisphere Activation as a Function of Digestive Stress: Changes in Verbal FluencyPerformance and Regulation of Diastolic Blood Pressure Before and After Food Ingestion

Holland A, Erdodi L, Hellings J, Catoe A, Lajiness-O’Neill R, Whiteside D, Smith A, Brown J, Hardin J, Rutledge J, Carmona

J, Harrison D

The left frontal region plays a role in the regulation of parasympathetic tone (Wittling, 1995) and is associated with changes in

diastolic blood pressure (DBP). Diminished activation of the left hemisphere has been associated with decreased verbal fluency

performance (Haxby & Rappoport, 1985). In the present research, food digestion was investigated as a stressor lateralized to

left cerebral systems. Food consumption was predicted to influence changes in left frontal lobe activation as indicated through

decreased DBP measures and diminished performance on a verbal fluency task. Nine undergraduate right-handed women were

recruited for participation and fasted for 10 hr prior to participation. Each participant completed the Controlled Oral Word

Association Task (COWAT) before and after ingesting a sandwich containing 44–48 g of carbohydrates. The COWAT was

administered as a left frontal stressor. DBP was measured as each participant underwent pre-digestive, absorption, and diges-

tive phases. A main effect for DBP was found (F(4, 8) ¼ 5.02, p , .01), indicating a decrease in DBP upon the second admin-

istration of the COWAT during the digestive phase. Moreover, a Condition × Trial interaction was found (F(2, 16) ¼ 3.49, p ¼

.05), indicating an increase in perseverative errors across the three trials of the COWAT during the digestive phase. The pre-

diction that food consumption influences changes in left frontal activation was supported. The Condition × Trial interaction

indicates a diminished capacity to regulate the initiation of digestive stress concurrent with left-lateralized cognitive stress.

The present research may implicate the left frontal region in the regulation of digestive stress.

D-55

Cross-Validation of the Horton–Reynolds Executive Functioning Scale


Objective: There is a need for rapid assessment of cognitive functions in adults. This study attempted to replicate an earlier

study that correlated the new Horton–Reynolds Executive Functioning Scale (H-REFS) with an accepted measure of cognitive

functions in adults, the Montreal Cognitive Assessment Scale (MoCA), and found a correlation coefficient of .86. Method: A


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sample of 44 consecutive referrals for neuropsychological evaluation to an outpatient private practice office were administered

a battery of neuropsychological test which include the MoCA and subtests of the Test of Verbal Conceptualization and Fluency

(TVCF) and effort measures such as the Word Memory Test (WMT) and the Amsterdam Short-Term Memory Test (ASTMT).

All participants signed informed consent documents and had to pass effort tests. The sample was composed of 30 females and

14 males, with 40 Caucasians and 4 African Americans. Forty-one participants were right-handed and diagnoses included

stroke (28), head injury (5), brain tumor (3), epilepsy (2), hydrocephalis (1), Alzheimer’s diease (1), Parkinson’s disease

(1), multiple sclerosis (1), frontal-temporal dementia (1), and anoxia (1). The mean age of the sample was 57.9 (SD ¼

14.9) and the mean level of education was 14.5 (SD ¼ 2.3). The H-REFS was calculated by summing three subtests of the

TVCF (Categorical Fluency, Letter Fluency and Trails C) and dividing by 3. Results: The H-REFS was correlated with the

MoCA and a correlation coefficient of .40 was obtained. Conclusions: These results provide some support for the H-REFS

as a general screening indicator of cognitive functioning in adults. Future research with the H-REFS with other clinical

samples would appear warranted.

D-56Relationship between Intelligence and Executive Functioning


Objective: Intelligence is related to many neuropsychological tasks but the relationship varies by specific tasks. The

relationship of intelligence to executive functioning tasks is expected to be low to moderate. This poster examines the

relationships between two new measures of intelligence and executive functioning in order to clarify the relationship.

Method: Sixteen adult patients referred by neurologists for outpatient neuropsychological evaluation at a private practice

office were administered full neuropsychological batteries that included the Reynolds Intellectual Assessment Scale

(RIAS), a measure of intelligence, and the Test of Verbal Conceptualization and Fluency (TVCF), a measure of executive

functioning, and symptom validity measures, such as the Word Memory Test, Amsterdam Short-Term Memory Test and

Test of Malingered Memory. The RIAS is composed of four subtests that include verbal and non-verbal abstract reasoning

and long-term memory. The TVCF includes measures of verbal fluency, card sorting, and trail making. The patients

included 10 females, 15 Caucasians, and 1 African American, and all but one patient was right-handed. Diagnoses

include head trauma (6), stroke (4), brain tumor (2), anoxia (1), multiple sclerosis (MS) (1), epilepsy (1), and hydroce-

phalis (1). Ages ranged from 22 to 77 (mean ¼ 43, SD ¼ 14.0) and education ranged from 10 to 18 years (mean ¼ 14,

SD ¼ 2.2). All participants signed informed consent documents. Results: Correlations ranged from .65 (trail making/non-

verbal long-term memory and perseverative errors/verbal abstract reasoning) to .09 (phonemic verbal fluency/non-verbal

abstract reasoning). Conclusions: Correlations between intelligence and executive functioning subtests were moderate to

low as expected. Executive functioning subtest variances were not completely accounted for by intelligence subtests sup-

porting the construct of executive functioning.

D-57Aging and Executive Function: Behavioral and Cognitive Changes

Jurado M, Monroy M, Eddinger K, Serrano M, Rosselli M

Objective: The study aimed to determine whether age-related changes in psychometric tasks of executive functions (EF) are

accompanied by behavioral difficulties related to EF in healthy older adults. Method: Ninety healthy participants, classified

into four age groups (20s [n ¼ 30], 60s [n ¼ 18], 70s [n ¼ 27], 80s [n ¼ 15]), were tested on the Dysexecutive

Questionnaire (DEX) and three executive tasks of planning (Delis-Kaplan Executive Function System [D-KEFS] Tower

Test, TT), set shifting (Wisconsin Card Sorting Test [WCST]), and executive attention and inhibition (Continuous

Performance Test-Second Edition [CPT-II]). Four DEX factors (intention, inhibition, social regulation, and abstract

problem solving; Mooney, Walmsley, & McFarland, 2006) were compared to total achievement on the TT, omission and com-

mission errors on the CPT, and categories achieved on the WCST. Results: Significant correlations were found between omis-

sion errors and DEX factor “inhibition” (2.243), and commission errors with both DEX factors “intention” (.244) and “social

regulation” (.223). Analyses of variance revealed an age-related change in set shifting (F ¼ 6.597, p , .000), attentional

control (omission errors; F ¼ 3.369, p ¼ .022), and planning (F ¼ 2.756, p ¼ .047). Only behaviors related to the DEX

factor “intention” were found to change significantly with age (F ¼ 4.715, p ¼ .004) in an unexpected direction, with

younger adults reporting more problems in intention than older ones. Conclusion(s): Difficulty with goal-directed behavior

was associated with inhibition errors in young adults. Older adults showed significant decline in tasks of EF, but did not

report any associated difficulties in everyday executive skills. The results of this study suggest that age-related decline in psy-

chometric tasks of EF is not associated with behavioral difficulties related to EF.


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D-58

Use of Continuous Performance Test, Go/No-Go, and Stop Signal Tasks with High Functioning Autism/Asperger

SyndromeRiccio C, Banville F, Schretlen D, Wahlberg A, Vannorsdall T, Yoon H, Sung K, Simek A, Gordon B, Vaughn C

Objective: It is becoming more common for individuals diagnosed with high functioning autism (HFA) or Asperger Syndrome

(AS) to also be diagnosed with attention-deficit/hyperactivity disorder (ADHD). The purpose of this meta-analysis was to

provide a review of the extant HFA/AS literature with regard to paradigms frequently used in the assessment of ADHD-

Continuous Performance Test (CPT), go/no-go, and Stop Signal tasks. Data selection: Studies for inclusion were identified

through a search of PsychInfo and Medline, with variations of the task names in combination with the terms “high functioning

autism,” “Asperger,” and “pervasive developmental disorder.” This resulted in the generation of 20 articles. Additional refer-

ences were generated from the review of the cited articles. Only those articles that could be obtained in English and contained

data for more than one group were included in the analysis. Data synthesis: Cohen’s d was calculated for each reported variable

by task based on the information provided in each article. Results indicate that inattention attributes of individuals with HFA/

AS are not consistently evident on tasks (effects sizes are generally low) when compared with typical or mental age controls.

Differences are more evident (larger effect sizes) when compared with clinical controls with ADHD on some variables.

Conclusions: CPT, go/no-go, and Stop Signal Tasks are frequently used in the assessment of sustained attention and inhibition.

Based on the available studies, the use of this type of task as part of a comprehensive assessment of an individual with sus-

pected HFA/AS if there is a question of co-occurring ADHD.

PROFESSIONAL ISSUES: EFFORT AND MOTIVATION

D-59

Conscientiousness Moderates the Relationship between Performance Mean and Variability on a Single Task and

Performance Variability Across a Multiple-Measure Test BatteryBarwick F, Arnett P, Rabinowitz A, Vargas G

Objectives: This study was conducted to determine whether personality factors moderate the relationship between intraindivi-

dual performance variability (IPV) across a multiple-measure baseline concussion assessment battery and mean reaction time

(mRT) or variability in reaction time (vRT) on a continuous performance measure (Vigil). Methods: Four hundred and

eighty-one non-injured collegiate athletes (mean age 18.5 years; mean FSIQ 102.0; 74% M/26% F) were administered a con-

cussion assessment battery. The index of total-battery IPV was the standard deviation derived from z-scores for 16 measures.

Vigil mRT was the mean RT z-score and Vigil vRT was the standard deviation in RT across four consecutive blocks of the task.

Personality dimensions were assessed with the NEO Personality Inventory (NEO-PI). Vigil mRT and vRT were entered into

separate hierarchical regression analyses, along with correlated NEO personality dimensions and their interaction terms.

Total-battery IPV was a dependent measure. Results: The interaction term for Vigil mRT and NEO-Conscientiousness

accounted for a significant amount of the variance in total-battery IPV (t ¼ 23.06, p , .01), as did the interaction term for

Vigil vRT and NEO-Conscientiousness (t ¼ 22.80, p , .01). Examination of athlete groups scoring in the top and bottom

33% for mRT and NEO-Conscientiousness, and for vRT and NEO-Conscientiousness, showed that these groups differed sig-

nificantly on total-battery IPV. Conclusions: The relationship between mean RT and test-battery IPV, as well as between varia-

bility in RT and total-battery IPV, is moderated by the level of conscientiousness. Athletes who score low on conscientiousness

show greater changes in total-battery IPV at fast mRT versus slow mRT, or at low vRT versus high vRT, than athletes who

score high on conscientiousness.

D-60

Factors Associated with Intraindividual Performance Variability (IPV) at Baseline on a Sports Concussion AssessmentBattery

Barwick F, Arnett P, Rabinowitz A, Vargas G

Objectives: This study was conducted to determine whether intraindividual performance variability (IPV) on a single reaction

time (RT) task is related to IPV across a multiple-measure baseline concussion assessment battery. Methods: Five hundred and

forty-three non-injured collegiate athletes (mean age 18.5 years; mean FSIQ 102.0; 74% males/26% females) were adminis-

tered a multiple-measure baseline concussion assessment battery. As an index of IPV on a single task, the standard deviation

was derived from z-scores response times across four consecutive blocks of a reaction time (RT) task (Vigil Continuous

Performance Test). As an index of IPV across the test battery, the standard deviation was derived from z-scores for 16

additional measures. Vigil mean RT (mRT) and variability in RT (vRT) were then entered into a multiple regression correlation


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with total-battery IPV as the dependent measure. Groups differing on mRT and vRT were compared on total-battery IPV.

Results: Vigil mRT and vRT together accounted for 7% of the variance in total-battery IPV, even after controlling for baseline

estimated IQ, with each contributing unique variance (both p , .05). Only athletes who showed congruence in mRT and vRT

(low mRT/low vRT or high mRT/high vRT) differed significantly on total-battery IPV. Conclusions: A small but significant

percentage of IPV on a multiple-measure baseline concussion assessment battery is accounted for by mRT and vRT on a single

continuous performance task but only for collegiate athletes showing congruence on these factors, with athletes who had faster

mRT and less vRT showing lower total-battery IPV, and athletes who had slower mRT and more vRT showing higher total-

battery IPV.

D-61

Preliminary Examination of an Embedded Effort Measure Using Arithmetic Response TimeDavis J, Ramos C, Sherer C, Stone M, Wall J

Objective: This study examined classification accuracy of effort measures using the Wechsler Adult Intelligence Scale-Third

Edition (WAIS-III) Arithmetic subtest in a simulated malingering design. Method: Data were collected as part of a larger,

post-test-only experimental study conducted at a Midwestern university during 2007. Undergraduates without reported neuro-

logic history were randomized to control (n ¼ 31), naıve simulator (n ¼ 32), and coached simulator (n ¼ 34) groups. The

sample was 87% females, 86% Caucasian, and 92% right-handed; mean age was 20 years (SD ¼ 4) and mean education

was 13 years (SD ¼ 1). Outcome measures included WAIS-III Arithmetic and Word Memory Test (WMT). Accuracy of

Arithmetic effort measures based on raw score (A-R), scaled score (A-SS), and response time (A-RT) were compared with

the WMT. Results: Arithmetic scaled scores differed across groups (F(2, 94) ¼ 10.1, p , .001). Scheffe post hoc tests

showed that control participants scored higher than both simulator groups, which were not different. The WMT correctly classi-

fied 100% of control participants and 69%–71% of simulators. A-R correctly classified 100% of control participants and 9%–

16% of simulators. A-SS correctly classified 100% of control participants and 9%–24% of simulators. A-RT correctly classi-

fied 94% of control participants, 36% of naıve simulators, and 47% of coached simulators. Conclusions: Preliminary examin-

ation of embedded effort measures using WAIS-III Arithmetic showed stronger support for cutoff scores based on response

time compared with raw and scaled scores. Further examination of cutoff scores in a known group design or with a clinical

sample may be beneficial. Future research may also include other measures of reaction time and arithmetic (e.g., Wechsler

Adult Intelligence Scale-Fourth Edition [WAIS-IV]).

D-62

Utility of Embedded Effort Measures on the Trail Making Test

Davis J, Bagley A, McHugh T, Axelrod B, Hanks R

Objective: This study examined the utility of the Trail Making Test (TMT) as an embedded measure of effort in a sample

referred for independent medical examination at a private neuropsychology practice. Method: Inclusion criteria for the

study included mild traumatic brain injury; age 18–65, and administration of at least two effort measures. The sample

(N ¼ 102) was 43% females, 78% Caucasian, 90% right-handed, averaged 44 years of age and 13 years of education.

Performance on effort measures yielded groups that passed all (PASS; n ¼ 34), failed one (FAIL-1; n ¼ 32), and failed two

or more (FAIL-2; n ¼ 36) effort measures. These groups were not different in gender, age, ethnicity, or education. TMT

indices included raw scores on TMT-A, TMT-B, and the ratio of TMT-B/TMT-A (TMT-R). Results: FAIL-2 performed

worse on TMT-A than PASS and FAIL-1, which did not differ from each other. All groups differed from each other on

TMT-B, with FAIL-2 performing worst. The TMT-A cutoff score (≥63) correctly classified 97% of PASS and 36% of

FAIL-2 cases. The TMT-B cutoff score (≥200) correctly classified 100% of PASS and 42% of FAIL-2 cases. The TMT-R

cutoff score (≤1.45) correctly classified 97% of PASS but only 3% of FAIL-2 cases. Conclusions: All three TMT measures

showed good specificity, but sensitivity of TMT-R was too low to be useful in detecting poor effort. TMT-A and TMT-B cutoff

scores may be useful adjunctive effort measures.

D-63Efficiency and Accuracy in Predicting Non-Credible Cognitive Performance: Comparing Two Measures from Test of

Memory Malingering Trial 1 to a Compilation of Five Embedded Cognitive Measures

Denning J

Objective: There is a continuous need for empirically validated and highly efficient measures of test validity. We compared

the accuracy of three measures (two short forms of the Test of Memory Malingering [TOMM] vs. a compilation of five

embedded cognitive tests) in predicting non-credible test performance as measured by the Medical Symptom Validity


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Test (MSVT). Method: Participants/setting: Two hundred and forty consecutive referrals to a VA neuropsychology clinic

without a diagnosis of dementia or mild cognitive disorder (MCI)/cognitive disorder NOS (mean: age ¼ 43, education ¼

12.5; male ¼ 92%, Caucasian ¼ 92%). Variables/measures: TOMM trial 1 (total score; errors on first 10 items) and five

embedded cognitive measures were compared using regression/ROC to predict non-credible cognitive performance (pass/

fail MSVT). Cognitive measures included: Wechsler Adult Intelligence Scale-Third Edition (WAIS-III): WMI, PSI (stan-

dard scores), California Verbal Learning Test-Second Edition (CVLT-II) Forced Choice, Brief Visual Memory

Test-Revised (BVMT-R) (recognition: correct hits), and the Finger Tapping Test (FTT) (average of first five trials, dominant

hand). Results: TOMM trial 1 had the greatest accuracy in predicting non-credible MSVT performance (TOMM trial 1

,43: sensitivity ¼ 81%, specificity ¼ 95%, AUC ¼ 94%) followed by the five embedded measures (sensitivity ¼ 79%,

specificity ¼ 96%, overall accuracy ¼ 90%). Errors on the first 10 items of the TOMM were also an impressive predictor

(.1 error: sensitivity ¼ 73%, specificity ¼ 93%, AUC ¼ 89%). Conclusions: The three measures had comparable (and

impressive) accuracy in predicting non-credible cognitive performance with errors on the first 10 items of the TOMM

and TOMM trial 1 showing the greatest time efficiency. Results provide additional evidence of the usefulness of TOMM

trial 1 as a highly accurate standalone measure of test validity.

D-64

Efficiency of the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form and PersonalityAssessment Inventory Validity Indicators in Predicting Symptom Validity Test Performance

Gervais R, Sellbom M, Wygant D

Objective: To examine the effectiveness of the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured

Form (MMPI-2-RF) and Personality Assessment Inventory (PAI) validity scales in predicting Symptom Validity Test

(SVT) performance in a sample of forensic disability claimants. Method: Sample consisted of 390 consecutive disability clai-

mants (male ¼ 59%; age ¼ 42.2 [SD ¼ 11.1], Workers’ Compensation ¼ 77.4%) with corresponding valid MMPI-2-RF and

PAI protocols. Exclusion criteria: MMPI-2-RF CNS ≥ 18 or VRIN-r/TRIN-r ≥ 80T and PAI INC ≥ 73T or INF ≥ 75T.

We examined MMPI-2-RF and PAI over-reporting validity scale scores relative to SVT performance on: Word Memory

Test (WMT), Medical Symptom Validity Test (MSVT), Test of Memory Malingering (TOMM), Non-Verbal Medical

Symptom Validity Test (NV-MSVT), fail any single SVT, and fail any two SVTs conditions. Results: SVT failure was con-

sistently associated with higher scores (p , .05) on all MMPI-2-RF and PAI over-reporting validity scales and indices, with the

exception of PAI-RDF. The MMPI-2-RF Response Bias Scale (RBS) was associated with the largest effect sizes in all SVT

conditions, including the fail any single SVT group (d ¼ .91) and the fail any two SVTs group (d ¼ 1.08). RBS was associated

with the best overall classification accuracy of SVT failure (AUC ¼ .736 to .820). F–r was the next best predictor of SVT

failure in four of six comparisons. Conclusions: RBS was a consistently stronger predictor of SVT failure relative to the stan-

dard MMPI-2-RF and PAI validity scales. Further replication and extension of this study using different forensic disability

samples is warranted.

D-65

Therapist Experiential Model of Treatment

Klonoff P

Objective: To present a unique model (The Therapist Experiential Model of Treatment [TEMT]) depicting the phenom-

enological perspective of neurorehabilitation therapists, including their emotions, behaviors, experiences, and challenges

when treating patients with acquired brain injury and their support networks in outpatient multidisciplinary treatment set-

tings. The TEMT enhances therapeutic effectiveness and professional longevity through self-reflection and internal moni-

toring. Data selection: Informal procedures were used; the model is the third in a series. The first two, the Patient

Experiential Model of Recovery and the Family Experiential Model of Recovery (Klonoff, in press), capture the recovery

stages and various coping styles of patients and their support systems undergoing outpatient neurorehabilitation, with a

culmination in community reintegration. Data synthesis: The model was created based on the author’s conceptualization

and general feedback from approximately 20 multidisciplinary therapists. Typical treatment parameters are described in

four consecutive “placement phases.” A three-tier coping paradigm (Adaptive Coping Zone, Warning Zone, Danger Zone)

depicts the therapist’s fluctuating demeanor, adjustment, and overall outlook. Key variables which facilitate or impede

professional efficacy and growth are described, including the patients, their support networks, work-related factors,

and the therapist’s personal life. Model applications include helpful techniques to best cope with treatment and overall

work demands, so as to avoid burn out, countertransference problems, and fractionalized working alliances. The

TEMT is also a therapeutic tool to help patients recognize their impact on the working relationship with treating


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therapists. Conclusions: The TEMT is an effective mentalizing tool, catalyzing the therapist’s self-exploration so as to

maximize skills, professional investment, efficacy, and fulfillment.

D-66

Influence of Poor Effort on Self-Reported Symptoms and Neurocognitive Test Performance Following Mild TraumaticBrain Injury

Lange R, Iverson G, Carone D

Objective: To examine the influence of poor effort on self-reported symptoms and neurocognitive test performance following mild

head trauma. Method: Participants were 140 patients referred to an outpatient neuropsychology clinic: (a) 96 patients with long-

term symptoms after sustaining a mild head trauma (MHT), with or without evidence of mild brain injury, divided into two groups

based on effort test performance (21 MHT-Fail, 75 MHT-Pass), and (b) 44 patients who sustained a moderate-to-severe traumatic

brain injury (TBI) all of whom passed effort testing (TBI-Pass). Measures included the Postconcussion Symptom Checklist, Beck

Depression Inventory-II, Medical Symptom Validity Test, Word Memory Test, and eight common neurocognitive measures from

a larger battery. Results: Patients in the MHT-Pass group performed better on most of the cognitive tests compared with the

TBI-Pass (p , .05; range: d ¼ .44 to .86) and MHT-Fail group (p , .05; range: d ¼ .57 to 1.10). Using a criterion of three or

more low scores to define cognitive impairment, the MHT-Fail group had the greatest rate of impairment (52.4%), followed by

the TBI-Pass (34.1%) and MHT-Pass groups (9.3%). Both MHT groups reported significantly more symptoms than the

TBI-pass group (MHT-Pass & MHT-Fail . TBI-Pass). Patients in the MHT-Fail group endorsed greater symptoms than the

MHT-Pass group on some items (i.e., headache, memory, and sleep). Conclusions: Poor effort and high symptom reporting

were more common in chronically symptomatic MHT patients than in patients who had sustained moderate-to-severe TBIs.

High symptom reporting occurred in MHT patients regardless of effort test performance.

D-67Repeatable Battery for the Assessment of Neuropsychological Status Effort Index in Criminally and Civilly Committed

Psychiatric Inpatients

O’Connor Pennuto T, Kluck A, Ball J

Objective: The primary objective of this study was to evaluate the utility of the Repeatable Battery for the Assessment of

Neuropsychological Status Effort Index (RBANS EI; Silverberg, Wertheimer, & Fichtenberg, 2007) within a psychiatric

inpatient population. A secondary objective was to assess for significant differences in the RBANS EI based on the inpa-

tients’ commitment status. Method: Study design was a retrospective chart review. Setting was a large mid-Atlantic region

state psychiatric hospital. Participants included 387 psychiatric inpatients (81% civilly committed, 56% males, 48% African

American, 45% Caucasian, age M ¼ 49, education M ¼ 11 years) who had been referred for a neuropsychological evalu-

ation between August 1998 and December 2005 by their treatment team as part of standard care during inpatient treatment.

Measures included primarily the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph,

1998), which is a brief 12-subtest measure assessing functioning across multiple domains. The RBANS EI is derived from

summed weighted scores assigned to Digit Span and Word List Recognition subtest performances. Results were similar to

those of Hook et al. (2009) and Warren et al. (2010), with 34% of our sample obtaining scores higher than 3 on the EI,

indicating suspect effort. Interestingly, there was no significant difference in EI performance between criminally and

civilly committed inpatients (x2(1, N ¼ 383) ¼ .861, p ¼ .353). Conclusions: These results were consistent with recent

studies suggesting that the proposed RBANS EI may not be appropriate for use in certain populations; in this case,

those with severe psychopathology. Further study is warranted.

D-68

The Repeatable Battery for the Assessment of Neuropsychological Status Effort Index: Use of Multiple Cutscores andRelationship with Neuropsychological Test Performance

Pella R, Hietpas-Wilson T, McCoy K, VanBuren K, Hilsabeck R

Objective: Individuals with known cognitive disorders may perform poorly on effort measures secondary to their cognitive

dysfunction, resulting in false-positives. This project evaluated the relationship of the Repeatable Battery for the

Assessment of Neuropsychological Status (RBANS) Effort Index (REI) with neuropsychological variables and specificity

rates in those with cognitive dysfunction. Method: Data from non-litigating, largely elderly male patients (N ¼ 120) adminis-

tered a neuropsychological battery were examined. Correlation coefficients of the REI with neuropsychological tests were cal-

culated and specificity values of various cutscores of the REI were determined according to the presence of cognitive disorder.

Results: Weak (r ¼ 2.005) to strong correlations (r ¼ 2.607) were demonstrated between the REI and neuropsychological


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measures. Although premorbid and current intelligence, processing speed, mental-set shifting, response inhibition, language,

and word generation showed a significant relationship, visuospatial and problem-solving abilities did not. The REI showed a

strong relationship with measures of emotional functioning as well. Although the proportion of those with cognitive disorders

failing the original REI cutscore (.3) was high (25%), it was lower in those without cognitive dysfunction (3%) and decreased

with higher cutscores (e.g., .4, .5). Conclusion(s): The REI, in the context of cognitive disorders, is related to performance

on neurocognitive tests. Adjustment of the REI cutscore should be considered in this population. Further studies are needed to

assess suitability of the REI as a “well-validated” measure for use according to the Slick et al. (1999) criteria for malingered

neurocognitive dysfunction.

D-69

Correlations between Outcomes on the Word Memory Test and Repeatable Battery for the Assessment ofNeuropsychological Status Subtest Performance

Shahani L, Noggle C, Jain G, Sohi J, Thomspon J, Barisa M

Objective: The current study sought to outline the relationship between performance on the Word-Memory Test (WMT) and

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) subtests. Methods: An archival data set was

utilized for the present study. Participants included 72 individuals referred for neuropsychological evaluations who were admi-

nistered both the RBANS and the Word-Memory test as part of a more comprehensive battery. RBANS subtest scores and

WMT scores were recorded and analyzed. Results: Performance on the Immediate Recall condition of the WMT was signifi-

cantly related to performance on List Learning (r ¼ .343), Story memory (r ¼ .434), Figure copy (r ¼ .233), Line Orientation

(r ¼ .377), Semantic Fluency (r ¼ .283), Coding (r ¼ .347), List recognition (r ¼ .368), Story recall (r ¼ .460), and

Figure recall (r ¼ .245). Delayed recall on the WMT was significantly related to List Learning (r ¼ .373), Story memory

(r ¼ .470), Line Orientation (r ¼ .294), Semantic Fluency (r ¼ .302), Coding (r ¼ .354), List recall (r ¼ .268), List recog-

nition (r ¼ .478), and Story recall (r ¼ .335). Finally, the WMT-Consistency calculation was significantly correlated with per-

formance on List Learning (r ¼ .438), Story memory (r ¼ .499), Line Orientation (r ¼ .335), Semantic Fluency (r ¼ .335),

Coding (r ¼ .373), List Recall (r ¼ .332), List Recognition (r ¼ .523), Story Recall (r ¼ .565), and Figure Recall (r ¼

.258). Conclusions: Results carry clinical implications as they demonstrate the general relationship between performance on

the RBANS subtests and the WMT, thus offering some insights into the manner in which interpretations may be made on

the prior when there is questionable performance on the latter.

D-70

Clinical Validation of the Automated Neuropsychological Assessment Metrics Embedded Effort Measure

Vincent A, Roebuck-Spencer T, Cooper D, Bowles A, Gilliland K

Objective: Measurement of optimal effort is essential in neuropsychological testing and even more relevant for computerized

testing paradigms that require less direct supervision of the test-taker. A recent simulator study using a college sample evaluated

a promising embedded effort measure within the Automated Neuropsychological Assessment Metrics (ANAM). Results documen-

ted excellent sensitivity (.90%) to detection of simulated and coached poor effort and good concordance with validated symptom

validity measures. To provide clinical validation of this embedded ANAM effort measure, originally derived algorithms were eval-

uated using known clinical groups. Methods: The ANAM Effort Measure was calculated for three clinical samples who were admi-

nistered ANAM as part of ongoing research studies. Samples included acquired brain injury (ABI; n ¼ 17), mild traumatic brain

injury (mTBI; n ¼ 61), and complicated mild TBI (cmTBI; n ¼ 18). Results: Original cutoff points misclassified a large number of

patients in the clinical groups. New cutoff points were evaluated to achieve at least 90% specificity and 50% sensitivity in accord-

ance with literature on other embedded effort measures. New cutoff points resulted in 100% specificity of a control group and were

generally insensitive to detection of actual impairment, detecting only 10% of patients with mTBI, 17% with cmTBI, and 12% with

ABI. Applying these cutoff points to the original simulator study, sensitivity to detect simulated (47%) and coached (53%) poor

effort was decreased. Conclusions: While new cutoff points resulted in better specificity of control and known clinical groups, sen-

sitivity to poor effort was decreased. Decreased sensitivity is justifiable to reduce misclassification of true cognitive impairment and

is consistent with sensitivity of other single embedded effort measures.

D-71

A Known Group Analysis of the Test of Memory and Malingering: Validation of Diagnostic Decision RulesWomble M, Rohling M, Gervais R, Greiffenstein M

Objective: The study goal was to determine an appropriate cutoff score for Trial 1 of the Test of Memory Malingering (TOMM)

and utilize a known-groups design to determine the classification accuracy of the TOMM, using 10 other symptom validity


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measures (SVTs) as diagnostic criteria for the detection malingering in clinical practice. Method: Data were taken from the files

of individuals who underwent a neuropsychological evaluation in two separate clinical psychology practices. Participants were

3,042 individuals who had complete TOMM data, 1,451 had data from four or more SVTs, and 748 had data from six or more

SVTs. The data included the following SVTs: TOMM, Word Memory Test, Computerized Assessment of Response Bias,

Medical Symptom Validity Test, Non-Verbal Medical Symptom Validity Test, California Verbal Learning Test, Minnesota

Multiphasic Personality Inventory validity scales, Reliable Digit Span, Symbol Digits Modalities Test, Tapping Test,

Booklet Category Test, and the Story Recall Test. Participants were categorized using the MLR criteria for Feigned

Neurocognitive Dysfunction. Results: The TOMM scores for the known groups were submitted to a series of univariate ana-

lyses of variance (ANOVA) to examine group effects. The ANOVAs were significant for all TOMM trials. Post hoc compari-

sons revealed significant differences among group means for Trial 1. Based on these comparisons, a Trial 1 cutoff score of 39

was found to be appropriate. Conclusion: Data suggest that all TOMM trials, including Trial 1, can accurately detect malinger-

ing in clinical practice when using the a modified Slick et al. (1999) criteria. Results of all 11 additional SVTs will also be

presented.

D-72

The Need for Symptom Validity Testing in Post-secondary Student Populations: Selected Case Study Examples

Harrison A, Suhr J

Objective: Diagnosis of attention-deficit/hyperactivity disorder (ADHD) and learning disability (LD) in adulthood is difficult

and controversial. Because of the potential economic, academic, and/or recreational benefits of obtaining a LD or ADHD diag-

nosis, concerns have been raised regarding the ease with which unimpaired young adults can feign either of these disorders in

order to gain access to test accommodations, stimulant medications, or disability benefits. Much evidence has been presented

recently regarding the need for Symptom Validity Tests (SVT’s) in assessments of college-aged students seeking diagnoses of

LD and/or ADHD. This poster will demonstrate the effect of low effort/motivation to feign symptoms by presenting case data

on three students who failed multiple SVT’s, and who were subsequently retested. Method: Data from three students who failed

multiple SVT’s is presented, along with the scores they obtained upon retesting 6 months later. Results: As shown, all students

returned substantially improved scores in almost all areas of cognitive and self-reported functioning. The only intervening

event was that they had been told at the finish of their first assessment that their scores were invalid and that they were suspected

of exaggerating or magnifying symptoms. Conclusion: Evidence strongly suggests that the effects of effort and motivation have

a substantial impact on the test performance of students who fail multiple symptom validity tests, rendering the data obtained in

such assessments suspect. Given that scores on most tests improved significantly more than would be expected for test-retest,

these data add to the growing body of literature supporting the use of SVT’s in assessments.


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