Rodney Swenson

A Nine—Word dementia version of the california verbal learning test

Abstract The validity of an experimental 9-word version of the California Verbal Learning Test (CVLT) was investigated. The construct validity of the 9-word CVLT was assessed with a principal component analysis (PCA) on a sample of nondemented subjects. A three—factor solution, related to immediate free recall, delayed recall and recognition, and intrusion errors was produced. Construct validity was also assessed by comparing subjects with probable Alzheimers disease (AD), probable ischemic vascular dementia (IVD), and a normal control (NC) group. AD subjects evidenced little learning on immediate free recall test conditions, made no improvement on cued recall or recognition test conditions, and produced copious amounts of intrusion errors. IVD subjects performed similarly to AD subjects on immediate free recall test conditions, but improved on all cued recall and recognition test conditions, and made significantly fewer intrusion errors. The NC group was vastly superior to both groups of demented subjec...

LEUKOARAIOSIS SEVERITY AND LIST-LEARNING IN DEMENTIA

In patients with dementia, leukoaraiosis (LA) was hypothesized to result in differential patterns of impairment on a verbal serial list-learning test. Using a visual rating scale, 144 dementia patients with ischemic scores <4 were re-categorized as having mild (n = 73), moderate (n = 44), or severe LA (n = 27). Mild LA was predicted to be associated with an amnestic list-learning profile, while severe LA was predicted to be associated with a dysexecutive profile. List-learning performances were standardized to a group of healthy older adults (n = 24). Analyses were conducted on a set of four factors derived from the list-learning paradigm, as well as error scores. Data indicate that LA severity is an important marker for understanding list learning in dementia.

Linking MRI Hyperintensities With Patterns of Neuropsychological Impairment: Evidence for a Threshold Effect

Background and Purpose— Leukoaraiosis (LA) might interrupt intra- and interhemispheric communication and thus induce cognitive impairments and dementia. It remains unclear, however, if there is a volume threshold of LA that is needed before either the signs of dementia and/or a specific pattern of neuropsychological impairment become manifest. Roman et al has suggested that 25% of white matter may need to be involved before white matter alterations influence the clinical signs associated with dementia. The purpose of this study is to ascertain the threshold of MRI-LA as measured with a visual rating scale needed to induce specific patterns of neuropsychological impairment associated with dementia. Methods— One hundred fifteen patients with dementia received a comprehensive neuropsychological examination and the severity of MRI-LA was measured using a 40-point LA scale. Results— Patients were categorized into low (mean LA=4.21±2.92; 3.22%–17.82%), moderate (mean LA=12.58±2.54; 25.01%–37.80%), and severe (mean LA=22.36±4.04; 45.80%–66.00%) LA groups. Patients in the mild LA group obtained markedly lower scores on tests of episodic memory compared with working memory, a neuropsychological profile often associated with Alzheimer disease. Patients with moderate LA displayed equal impairment on neuropsychological tests. Patients in the severe LA group obtained significantly lower scores on tests of working memory as compared with episodic memory. Conclusions— These data provide evidence that a threshold of moderate MRI-LA as measured with a visual rating scale is associated with greater and/or equal impairment on tests of working memory versus episodic memory and provides a benchmark to assess the effect of MRI-LA on the clinical presentation of dementia.

Lateralized Cognitive Style and Self-Description

A scale of hemispheric preference in cognitive style was related to self-report measures of emotional functioning, with the hypothesis that persons who rely on cognition characteristic of one hemisphere may also manifest emotional characteristics of that hemisphere. In two studies, university students characterizing themselves as preferring a cognitive style representative of right hemisphere processes endorsed more positive emotional orientations. This finding may suggest a more optimistic attitude, but may also reflect a tendency to deny negative traits; a right hemispheric cognitive style was associated with a positive self-report bias. These observations in normals have interesting parallels to the changes in emotional orientation and self-description bias that follow lateralized brain lesions or temporal lobe epilepsy.

Binswanger's Disease: Some Neuropsychological Considerations

The literature regarding Binswangers disease is reviewed. Emphasis is placed on reviewing the neuropsychological literature related to Binswangers disease. In addition, a retrospective analysis was carried out among four groups of subjects (N = 61) who were divided according to the presence or absence of dementia and deep white-matter alterations. A main effect for deep white-matter alterations was found for almost all measures of diastolic and systolic blood pressure. Among the two nondemented groups there was an effect of deep white matter alteration on neuropsychological functioning. Subjects with deep white matter changes performed worse on tests of immediate and delayed recall of a prose passage. Among the two demented groups there were no differences on any of the neuropsychological measures, although subjects with deep white matter alterations exhibited a higher incidence of focal neurologic signs and stroke. We conclude that Binswangers disease is probably more prevalent than currently appreciated. Also, among clinically nondemented individuals periventricular white-matter alterations may be associated with subtle but definable neuropsychological deficits, and these individuals may be at risk for developing a dementing illness. (J Geriatr Psychiatry Neurol 1990;3:31-40).

Digital Clock Drawing: differentiating "thinking" versus "doing" in younger and older adults with depression.

Psychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)-younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=-.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=-.47; p=.03) and older euthymic groups (r=-.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics.

Edith Kaplan and the Boston Process Approach

The history including some of the intellectual origins of the Boston Process Approach and some misconceptions about the Boston Process Approach are reviewed. The influence of Gestalt psychology and Edith Kaplan’s principal collaborators regarding the development of the Boston Process Approach is discussed.

Periventricular white matter alterations, dementia, and binswanger's disease

Although periventricular white matter alterations (PWMA) are commonly reported on magnetic resonance imaging (MRI) scans of elderly individuals, a consistent pattern of neuropsychological deficits has yet to be found. However, there are some findings suggesting that executive functions (Luria, 1980) are more impaired than other areas of neuropsychological functioning. We undertook a prospective study of two groups of elderly, demented patients with and without PWMA as measured by MRI. The results demonstrated that subjects with greater white matter alterations performed worse on some executive function tests (e.g., Trail Making Test‐Part B and competing programs/go‐no‐go), whereas there were no differences in other areas of neuropsychological functioning. There were no between‐group differences on the Modified Ischemic Scale (Rosen, Terry, Fuld, Katzman, & Peck, 1980) or on measures of depression. Other pertinent clinical and methodological issues related to the clinical presentation of PWMA, as well as B...

Visuoconstructional Impairment in Subtypes of Mild Cognitive Impairment

Clock Drawing Test performance was examined alongside other neuropsychological tests in mild cognitive impairment (MCI). We tested the hypothesis that clock-drawing errors are related to executive impairment. The current research examined 86 patients with MCI for whom, in prior research, cluster analysis was used to sort patients into dysexecutive (dMCI, n = 22), amnestic (aMCI, n = 13), and multidomain (mMCI, n = 51) subtypes. First, principal components analysis (PCA) and linear regression examined relations between clock-drawing errors and neuropsychological test performance independent of MCI subtype. Second, between-group differences were assessed with analysis of variance (ANOVA) where MCI subgroups were compared to normal controls (NC). PCA yielded a 3-group solution. Contrary to expectations, clock-drawing errors loaded with lower performance on naming/lexical retrieval, rather than with executive tests. Regression analyses found increasing clock-drawing errors to command were associated with worse performance only on naming/lexical retrieval tests. ANOVAs revealed no differences in clock-drawing errors between dMCI versus mMCI or aMCI versus NCs. Both the dMCI and mMCI groups generated more clock-drawing errors than the aMCI and NC groups in the command condition. In MCI, language-related skills contribute to clock-drawing impairment.

DETECTING PRE-MILD COGNITIVE IMPAIRMENT: COMBINING MRI AND MEMORY TEST PERFORMANCE

Background: Accurate and timely diagnosis of dementia is important to allow individuals to access support, plan for the future and commence psychopharmacological treatments. However, there is great regional variability in the number of people diagnosed in a timely manner. In the UK, primary care acts as gatekeeper to the dementia diagnosis pathway, conducting basic initial assessment and deciding which patients should be referred for further investigation. We evaluated the cost-effectiveness of introducing CANTAB to the standard diagnostic pathways for patients presenting with subjective memory complaints (SMC) in the UK. Methods: We calculated the propensity of different groups to present to primary care with subjective memory complaints (SMC), including dementia, mild cognitive impairment, depression and the worried well. The cost of the diagnostic pathway was calculated from published literature (including NHS Reference Costs 2012-13, PSSRU, 2012), and was assumed to follow current UK NHS Clinical Guidelines (NICE, 2006). One-way sensitivity analysis was carried out on key model parameters. The disutility associated with untreated depression was also calculated in the model. Results: The model estimated that 47% of people presenting to primary care with SMC are likely to be ’worried well’ and an additional 15% to have depression and not dementia. Therefore, less than half of patients presenting to primary care with SMC should be appropriately referred to dementia diagnostic services. The average diagnostic cost per patient presenting to primary care was £371.43. However, systematic use of a suitable cognitive test and depression screen in patients with SMC resulted in a reduction in diagnostic cost of 40% in comparison to no systematic assessment. Additional quality of life benefits were associated with earlier depression detection, including an associated reduction in disutility of 0.002 quality-adjusted life-years QALY’s (per patient). Conclusions: This model illustrates the health economic benefits of accurate and appropriate primary care triage of possible dementia cases in the UK. Because primary care plays a key role in supporting and meeting the demands of an aging population, these findings have important implications for future service planning and healthcare providers.