Christopher A. Abeare

Pain, Executive Functioning, and Affect in Patients with Rheumatoid Arthritis

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. MethodsA sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the Wechsler Adult Intelligence Scale—Third Edition and the Stroop Color Word Test tests, respectively. ResultsConsistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. DiscussionThese findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning and functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.

Semantic activation within and across the cerebral hemispheres: What's left isn't right

This study examined differences in the spread of semantic activation within and between the cerebral hemispheres. A lateralised lexical decision task using indirect priming was presented to 58 undergraduates with primes and targets separated by 215 or 750 milliseconds (ms). Prime and target words were presented to the same or opposite visual fields and were either directly related (book–read), indirectly related (lion–[tiger]–stripes), or unrelated (cup–street). At 215 ms participants exhibited significant priming effects to directly related words in all conditions except when primes and targets were both presented to the right hemisphere (RH). In contrast, priming to indirectly related words was effective only when primes and targets were presented to opposite hemispheres. At 750 ms, significant priming occurred for directly related words in all conditions, and for indirectly related words when primes were presented to the RH. Results suggest that priming for directly and indirectly related concepts occurs unilaterally in each hemisphere before 215 ms. Both prime types activate semantic networks in the RH within 750 ms, whereas the LH processes information in a more focused manner. This suggests that activation spreads contralaterally from each hemisphere first to directly and then to indirectly related concepts, indicating the importance of incorporating contralateral priming contrasts in lexical decision tasks.

Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Processing Speed Scores as Measures of Noncredible Responding: The Third Generation of Embedded Performance Validity Indicators.

Research suggests that select processing speed measures can also serve as embedded validity indicators (EVIs). The present study examined the diagnostic utility of Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests as EVIs in a mixed clinical sample of 205 patients medically referred for neuropsychological assessment (53.3% female, mean age = 45.1). Classification accuracy was calculated against 3 composite measures of performance validity as criterion variables. A PSI ⩽79 produced a good combination of sensitivity (.23–.56) and specificity (.92–.98). A Coding scaled score ⩽5 resulted in good specificity (.94–1.00), but low and variable sensitivity (.04–.28). A Symbol Search scaled score ⩽6 achieved a good balance between sensitivity (.38–.64) and specificity (.88–.93). A Coding—Symbol Search scaled score difference ≥5 produced adequate specificity (.89–.91) but consistently low sensitivity (.08–.12). A 2-tailed cutoff on the Coding/Symbol Search raw score ratio (⩽1.41 or ≥3.57) produced acceptable specificity (.87–.93), but low sensitivity (.15–.24). Failing ≥2 of these EVIs produced variable specificity (.81–.93) and sensitivity (.31–.59). Failing ≥3 of these EVIs stabilized specificity (.89–.94) at a small cost to sensitivity (.23–.53). Results suggest that processing speed based EVIs have the potential to provide a cost-effective and expedient method for evaluating the validity of cognitive data. Given their generally low and variable sensitivity, however, they should not be used in isolation to determine the credibility of a given response set. They also produced unacceptably high rates of false positive errors in patients with moderate-to-severe head injury. Combining evidence from multiple EVIs has the potential to improve overall classification accuracy.

Clinical Utility of Demographically Corrected WAIS-III Subtest Scores After Traumatic Brain Injury

The present study explored the diagnostic accuracy of demographically corrected norms for the Wechsler Adult Intelligence Scale–Third Edition (WAIS-III) in a diverse sample of 57 patients with traumatic brain injury (TBI) and a matched group of 61 pseudoneurologic controls. The use of demographic corrections did not significantly improve the sensitivity or specificity of WAIS-III subtest scores to TBI relative to traditional age-corrected norms. Overall classification rates were quite good for both normative systems. Although the demographic corrections attenuate ethnicity differences on the subtest scores of TBI patients, the updated norms are no more or less beneficial than traditional age-corrected norms for neurodiagnostic purposes.

The power of timing: Adding a time-to-completion cutoff to the Word Choice Test and Recognition Memory Test improves classification accuracy

ABSTRACT Introduction: The Recognition Memory Test (RMT) and Word Choice Test (WCT) are structurally similar, but psychometrically different. Previous research demonstrated that adding a time-to-completion cutoff improved the classification accuracy of the RMT. However, the contribution of WCT time-cutoffs to improve the detection of invalid responding has not been investigated. The present study was designed to evaluate the classification accuracy of time-to-completion on the WCT compared to the accuracy score and the RMT. Method: Both tests were administered to 202 adults (Mage = 45.3 years, SD = 16.8; 54.5% female) clinically referred for neuropsychological assessment in counterbalanced order as part of a larger battery of cognitive tests. Results: Participants obtained lower and more variable scores on the RMT (M = 44.1, SD = 7.6) than on the WCT (M = 46.9, SD = 5.7). Similarly, they took longer to complete the recognition trial on the RMT (M = 157.2 s,SD = 71.8) than the WCT (M = 137.2 s, SD = 75.7). The optimal cutoff on the RMT (≤43) produced .60 sensitivity at .87 specificity. The optimal cutoff on the WCT (≤47) produced .57 sensitivity at .87 specificity. Time-cutoffs produced comparable classification accuracies for both RMT (≥192 s; .48 sensitivity at .88 specificity) and WCT (≥171 s; .49 sensitivity at .91 specificity). They also identified an additional 6–10% of the invalid profiles missed by accuracy score cutoffs, while maintaining good specificity (.93–.95). Functional equivalence was reached at accuracy scores ≤43 (RMT) and ≤47 (WCT) or time-to-completion ≥192 s (RMT) and ≥171 s (WCT). Conclusions: Time-to-completion cutoffs are valuable additions to both tests. They can function as independent validity indicators or enhance the sensitivity of accuracy scores without requiring additional measures or extending standard administration time.

Performance validity in undergraduate research participants: a comparison of failure rates across tests and cutoffs

Abstract Objective: This study compared failure rates on performance validity tests (PVTs) across liberal and conservative cutoffs in a sample of undergraduate students participating in academic research.Method: Participants (n = 120) were administered four free-standing PVTs (Test of Memory Malingering, Word Memory Test, Rey 15-Item Test, Hiscock Forced-Choice Procedure) and three embedded PVTs (Digit Span, letter and category fluency). Participants also reported their perceived level of effort during testing.Results: At liberal cutoffs, 36.7% of the sample failed ≥1 PVTs, 6.7% failed ≥2, and .8% failed 3. At conservative cutoffs, 18.3% of the sample failed ≥1 PVTs, 2.5% failed ≥2, and .8% failed 3. Participants were 3 to 5 times more likely to fail embedded (15.8–30.8%) compared to free-standing PVTs (3.3–10.0%). There was no significant difference in failure rates between native and non-native English speaking participants at either liberal or conservative cutoffs. Additionally, there was no relation between self-reported effort and PVT failure rates.Conclusions: Although PVT failure rates varied as a function of PVTs and cutoffs, between a third and a fifth of the sample failed ≥1 PVTs, consistent with high initial estimates of invalid performance in this population. Embedded PVTs had notably higher failure rates than free-standing PVTs. Assuming optimal effort in research using students as participants without a formal assessment of performance validity introduces a potentially significant confound in the study design.

Inconsistent vs consistent right-handers' performance on an episodic memory task: evidence from the California Verbal Learning Test.

Inconsistent handedness is associated with better memory performance on episodic memory tasks than consistent handedness. The present study further explored this difference in memory related to handedness by administering a measure that is used in clinical settings to assess different aspects of long-term memory. The results indicated that inconsistent right-handed individuals recalled and recognised more words on the California Verbal Learning Test–II than consistent right-handed individuals. Inconsistent right-handers also showed better performance than consistent right-handers on measures of source recognition. The results of this study further extend the effects of handedness on memory to the clinical setting because the CVLT–II is a measure used extensively in clinical neuropsychology.

Affective and cognitive correlates of gambling behavior in university students.

The purpose of the following study was to explore certain affective and cognitive components and their relationships to gambling behavior in an undergraduate population. Specifically, the aim was to predict gambling severity using depression scores on the BDI-II, the dependency and self-criticism subscales on the DEQ, emotional awareness scores on the LEAS, cognitive flexibility scores from the STROOP, and a creativity subtests from the TTCT. Participants were 200 undergraduate students and 3.5–7.5% of individuals reported some level of problematic gambling behavior. Multiple regression analysis indicated that self-criticism and creative originality were significant predictors of gambling behavior, explaining 7.6% of the variance. Further analyses reveal a non-linear trend in the creative originality of those who gamble; only the at-risk gamblers were high in creativity whereas abstainers and problematic gamblers display similarly lower levels of creativity. Results are discussed in regards to Blaszczynski and Nower’s Addiction 97:487–499 (2002) subtypes of gambling vulnerability.

Degree versus direction: A comparison of four handedness classification schemes through the investigation of lateralised semantic priming

Four classification systems were examined using lateralised semantic priming in order to investigate whether degree or direction of handedness better captures the pattern of lateralised semantic priming. A total of 85 participants completed a lateralised semantic priming task and three handedness questionnaires. The classification systems tested were: (1) the traditional right- vs left-handed (RHs vs LHs); (2) a four-factor model of strong and weak right- and left-handers (SRHs, WRHs, SLHs, WLHs); (3) strong- vs mixed-handed (SHs vs MHs); and (4) a three-factor model of consistent left- (CLHs), inconsistent left- (ILHs), and consistent right-handers (CRHs). Mixed-factorial ANOVAs demonstrated significant visual field (VF) by handedness interactions for all but the third model. Results show that LHs, SLHs, CLHs, and ILHs responded faster to LVF targets, whereas RHs, SRHs, and CRHs responded faster to RVF targets; no significant VF by handedness interaction was found between SHs and MHs. The three-factor model better captures handedness group divergence on lateralised semantic priming by incorporating the direction of handedness as well as the degree. These findings help explain some of the variance in language lateralisation, demonstrating that direction of handedness is as important as degree. The need for greater consideration of handedness subgroups in laterality research is highlighted.

Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator

Importance Estimated base rates of invalid performance on baseline testing (base rates of failure) for the management of sport-related concussion range from 6.1% to 40.0%, depending on the validity indicator used. The instability of this key measure represents a challenge in the clinical interpretation of test results that could undermine the utility of baseline testing. Objectives To determine the prevalence of invalid performance on baseline testing and to assess whether the prevalence varies as a function of age and validity indicator. Design, Setting, and Participants This retrospective, cross-sectional study included data collected between January 1, 2012, and December 31, 2016, from a clinical referral center in the Midwestern United States. Participants included 7897 consecutively tested, equivalently proportioned male and female athletes aged 10 to 21 years, who completed baseline neurocognitive testing for the purpose of concussion management. Interventions Baseline assessment was conducted with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT), a computerized neurocognitive test designed for assessment of concussion. Main Outcomes and Measures Base rates of failure on published ImPACT validity indicators were compared within and across age groups. Hypotheses were developed after data collection but prior to analyses. Results Of the 7897 study participants, 4086 (51.7%) were male, mean (SD) age was 14.71 (1.78) years, 7820 (99.0%) were primarily English speaking, and the mean (SD) educational level was 8.79 (1.68) years. The base rate of failure ranged from 6.4% to 47.6% across individual indicators. Most of the sample (55.7%) failed at least 1 of 4 validity indicators. The base rate of failure varied considerably across age groups (117 of 140 [83.6%] for those aged 10 years to 14 of 48 [29.2%] for those aged 21 years), representing a risk ratio of 2.86 (95% CI, 2.60-3.16; P < .001). Conclusions and Relevance The results for base rate of failure were surprisingly high overall and varied widely depending on the specific validity indicator and the age of the examinee. The strong age association, with 3 of 4 participants aged 10 to 12 years failing validity indicators, suggests that the clinical interpretation and utility of baseline testing in this age group is questionable. These findings underscore the need for close scrutiny of performance validity indicators on baseline testing across age groups.