Bernice A. Marcopulos

Are our Norms “Normal”? A 4-Year Follow-Up Study of a Biracial Sample of Rural Elders With Low Education

Conventional norms that test presumably normal elderly individuals at one point in time may include preclinical cases of dementia and therefore may be less sensitive to the presence of dementia (Sliwinski, Lipton, Buschke, & Stewart, 1996). A sample of presumably normal African American and White rural community older adults (first reported in Marcopulos, McLain, & Giuliano, 1997) were retested after approximately 4 years to develop “robust” norms for the Mini Mental State Examination, Mattis Dementia Rating Scale Fuld Object Memory Evaluation, WAIS-R Vocabulary and Block Design, Wechsler Memory Scale – Revised Logical Memory and Visual Reproduction, Raven’s Colored Progressive Matrices, and Clock Drawing Test. Ninety-four out of the original 133 participants were located and agreed to be retested. Twelve of the participants retested at Time 2 showed significant decline on testing relative to their own baseline and were dropped from the recalculated norms. Participants who declined on testing tended to be older, less educated, had lower WAIS-R scores on Vocabulary and Block Design combined, had poorer IADLs and were less socially active. There was no difference in physical health status or level of depression. Recalculated group means showed little change when the participants who declined had been removed, but this left very few participants at the extremes of age (>85 years) and education (<4 years). It appears that the incidence of cognitive decline in this sample is comparable to other community samples of cognitive decline and dementia. Results are discussed in light of the practical difficulties of identifying preclinical dementia for deriving robust norms, implications for the theory of cognitive reserve, risk of cognitive decline in persons with low education and/or low premorbid mental ability and the clinical utility of utilizing education-corrected norms.

California Older Adult Stroop Test (COAST): Development of a Stroop Test Adapted for Geriatric Populations

Abstract An adaptation of the traditional Stroop test, the California Older Adult Stroop Test (COAST) (Pachana, Marcopulos, Yoash-Gantz & Thompson, 1995), has been developed specifically for use with a geriatric population, utilizing larger typeface, fewer items (50) per task, and more easily distinguished colors (red, yellow and green). Test-retest reliability and validity data are reviewed for both control and clinical populations. Increased error rates on the Stroop test compared to the COAST were found for the color and color/word interference tasks. These results are discussed in terms of changes in the visual system with increasing age. The implications for better test sensitivity with the COAST for older adult populations are discussed.

A Forensic Case Report Involving Unequivocal Severe Brain Injury and Unequivocal Response Bias

ABSTRACT The following case report illustrates the value of neuropsychological expertise in disentangling the effects of brain injury and malingering when evaluating competency to stand trial (CST). A 58-year-old Caucasian male, charged with first-degree murder, sustained a self-inflicted gunshot wound to the head, with significant frontal lobe damage. He underwent multiple examinations of CST as well as competency restoration and cognitive remediation attempts. Initial neuropsychological evaluation revealed profound aphasia and neurocognitive dysfunction, with adequate performance validity; however, subsequent exams suggested nonneurological speech changes and symptom exaggeration, with no benefit from education efforts. The defendant was ultimately found competent to stand trial. This case study is a useful example for practicing forensic clinicians, as it involves both unequivocally severe brain injury and unequivocal response bias. It also raises technical and conceptual issues regarding malingering assessment in general and the revision of the Slick criteria for malingering specifically (e.g., the concept of “secondary malingering”).

Delirium Assessment in Older Adults

Publisher Summary This chapter provides contemporary information regarding the syndrome and its epidemiology, risk factors, diagnostic criteria, and psychosocial interventions. It includes a review of several of the most commonly employed clinical instruments designed to assess delirium and two case studies, to assist with assessing and understanding this complex syndrome. Clinical gerontologists consulting in hospitals and, to a lesser extent, outpatient settings, are likely to encounter delirious elderly patients. Delirium is a complex neuropsychiatric syndrome that is difficult to diagnose. This challenge is particularly concerning given prevalence rates ranging from 12 to 89%, and the many potential consequences of undiagnosed and untreated delirium (e.g., institutionalization, mortality). Although research regarding delirium has increased, measures used to screen for delirium continue to have limitations, including questionable reliability, validity, and clinical utility. Given the challenges with delirium measures, it appears that identification of delirium is a task best addressed from a multidisciplinary approach, perhaps involving physicians, nurses, and psychologists, as well as other medical staff. Assessment should include a thorough review of a patients medical history and current medical status, and the patients behavior should be observed over time. The combination of a brief cognitive screening measure and a longitudinally administered behavioral observation checklist is warranted. The clinical gerontologist should give careful consideration to the possibility of delirium before undertaking an extensive cognitive evaluation of an elderly hospital patient. In many cases, it might be best to briefly assess the patient with a carefully chosen delirium instrument, and then recommend that the patient have an extensive cognitive evaluation after stabilization and discharge from the hospital to avoid confounding the effects of dementia and delirium.