Douglas L. Shore

Cognitive Complaints, Depression, Medical Symptoms, and Their Association With Neuropsychological Functioning in HIV Infection: A Structural Equation Model Analysis

The main objective of this study was to use structural equation modeling (SEM) to clarify the relationship between subjective cognitive complaints and neuropsychological functioning in 160 adults with HIV infection. Participants completed questionnaires assessing cognitive complaints, symptoms of depression, and HIV-related medical symptoms. Neuropsychological tests included measures of attention, verbal fluency, psychomotor skills, learning, memory, and executive skills. SEM was used to test models of the relationships among cognitive complaints, mood, and medical symptoms with neuropsychological functioning. The model indicated that although depressed mood (beta = 0.32, p < .01) and medical symptoms (beta = 0.31, p < .01) influenced cognitive complaints, cognitive complaints were independently associated with poorer neuropsychological performance (beta = 0.39, p < .01). Mood and medical symptoms were significantly correlated but were not significantly associated with neuropsychological skills.

African American acculturation and neuropsychological test performance following traumatic brain injury

The present study examined the influence of African American acculturation on the performance of neuropsychological tests following traumatic brain injury (TBI). Seventy one participants already enrolled in a larger-scale study assessing the impact of TBI (i.e., the South Eastern Michigan Traumatic Brain Injury Model Systems project) completed a self-report measure of African American acculturation (African American Acculturation Scale-Short Form; Landrine & Klonoff, 1995) in addition to a standardized battery of neuropsychological tests. Hierarchical regression analyses were conducted to evaluate the relationship between level of acculturation and test performance after controlling for injury-related (initial Glasgow Coma Scale score, time since injury) and demographic variables (age, sex, years of education, and socioeconomic status). Lower levels of acculturation were associated with significantly poorer performances on the Galveston Orientation & Amnesia Test, MAE Tokens test, WAIS-R Block Design, Rey Auditory Verbal Learning Test, and Symbol Digit Modalities Test. Decreased levels of acculturation were also significantly related to lower scores on a composite indicator of overall neuropsychological test performance. In addition, the examiners ethnicity (Black or White) was related with scores on a few of the tests (i.e., Block Design, Trail Making Test), but was not significantly associated with the overall neuropsychological test performance. Overall, these findings suggest that differences in cultural experience may be an important factor in the neuropsychological assessment of African Americans following TBI, and provide additional support for the hypothesis that cultural factors may partially account for the differences among ethnic/cultural groups on neuropsychological tests.

Perception of Nonverbal Emotion Cues by Children with Nonverbal Learning Disabilities

The purpose of this study was to document deficits in the perception of nonverbal emotion cues that have been implicated as a cause of social maladjustment in children with nonverbal learning disabilities (NLD). Thirty-three children between the ages of 9 and 14 identified as having NLD, verbal learning disabilities (VLD), or as nonlearning disabled psychiatric controls were administered the Diagnostic Analysis of Nonverbal Accuracy and Personality Inventory for Children – Revised (PIC-R) to measure social perception and social adjustment, respectively. The NLD group was significantly less accurate than were the VLD and control groups in interpreting adult facial expressions and gestures, and significantly less accurate than was control group in interpreting subtle (i.e., low intensity) adult facial expressions. There was a nonsignificant trend toward more social skill deficits demonstrated on the PIC-R by the NLD group than the other study groups. Children with NLD were twice as likely as children with VLD to be diagnosed with an internalizing disorder. There were also consistent and compelling trends in the predicted direction with the NLD group showing the most impairment on measures of nonverbal perception.

Theoretically derived CVLT subtypes in HIV-1 infection: Internal and external validation

The present study sought to delineate empirically derived memory subtypes using the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of adults with HIV-1 infection (N = 154). Confirmatory factor analysis was used to evaluate eight models of the CVLT structure suggested by Wiegner and Donders (1999). A four-factor model, consisting of Attention Span, Learning Efficiency, Delayed Recall, and Inaccurate Recall appeared to be the best fitting model. Variables with the highest factor loadings from the model were entered in a two-stage cluster analysis. Four reliable CVLT clusters or subtypes were identified: Normal, Atypical, Subsyndromal, and Frontal-striatal. Internal and external validation of subtypes demonstrated that clusters were stable and clinically interpretable. Subtypes were meaningfully related to neuropsychological functioning, and to some extent, depressive symptomatology. Subtypes did not differ significantly with respect to subjective neurocognitive complaints and markers of HIV-1 disease. The present findings highlight the heterogeneity of memory profiles in HIV-1 infection and support a frontal-striatal conceptualization of verbal memory performance. The identification of robust HIV-1 memory subtypes may have important implications for the clinical management of adults infected with HIV-1 infection.

Recovery of memory after severe closed head injury: Dissociations in recovery of memory parameters and predictors of outcome

This study examined selective reminding and recognition memory performance of 21 severe closed-head injured patients tested within 6 months of regaining consciousness and then again after at least 1 year. Performances on selective reminding parameters were highly correlated and patients performed significantly worse at both testings than did hospitalized controls matched for age, education, and sex. Patients improved from testing 1 to testing 2 on only four of six memory variables. Average Impairment Rating at testing 1 was a marginally better predictor of memory performance at testing 2 than was length of coma. Results are discussed in terms of (a) utility of selective reminding parameters and predictors of outcome and (b) dissociations in recovery of memory parameters.

Discrepancies in Parent and Teacher Ratings of Adaptive Behavior of Children with Multiple Disabilities.

Parent and teacher ratings of adaptive skills of 59 children with multiple disabilities (mean age 6 years) in a rehabilitation day treatment setting were compared. The Vineland Adaptive Behavior Scales Classroom and Survey Editions were administered to each childs teacher and mother or other primary caretaker, respectively. Correlational analyses indicated a robust relation between Vineland forms; however, mean score comparisons indicated that teachers systematically rated the children as more skilled in both the global and the specific domains of adaptive behavior than did caretakers. Sources of interrater disagreement and implications for assessment of children with multiple disabilities were discussed.

The Role of Depression in Verbal Memory Following Traumatic Brain Injury

The purpose of this study was to characterize the relationship between verbal memory and depression scores on the Personality Assessment Inventory following traumatic brain injury. Depression was associated with diminished delayed recall and recognition on the California Verbal Learning Test-II (CVLT-II), even after controlling for a neuropsychological composite score and/or a measure of motivation (i.e., the TOMM). There was no relationship between depression and recall on Verbal Paired Associates or Logical Memory when controlling for the same covariates. The findings were most consistent with depressed subjects failing to utilize the semantic organization of the CVLT-II list to enhance their learning.

Congruence in Parent and Teacher Ratings of Adaptive Behavior of Low-Functioning Children

We examined discrepancies in parent and teacher ratings of adaptive skills of 90 low-functioning children (mean age, 6 years) in a rehabilitation day treatment facility. Comparison of full Vineland Survey and Classroom Edition protocols suggested that teachers systematically rated the children as having more adaptive skills (p < .0001) than did caretakers. However, examination of a subset of identical items that overlaps the Classroom and Survey Editions indicated at least fair interrater agreement (φ > .40, p < .01) on 92% of the items. Item analysis also indicated that when disagreement between pairs of raters occurred, caretakers were more likely to rate skills as more advanced. Caretakers tended to rate skills using extreme categories (i.e., present versus absent), whereas teachers rated skills as emergent. Discrepant standard scores for low-functioning children reflect a Classroom Edition floor effect. Implications for research and practice are discussed.

A review of: “The rush to fill the void”

Abstract Lance E. Trexler (Ed.) Cognitive Rehabilitation: Conceptualization and Intervention. New York: Plenum Press, 280 pp. 1982.

K-ABC sequential-simultaneous processing and language-impaired preschoolers

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