Validation of alternative dot counting test E-score cutoffs based on degree of cognitive impairment in veteran and civilian clinical samples.

Objective: This study examined Dot Counting Test (DCT) performance among patient populations with no/minimal impairment and mild impairment in an attempt to cross-validate a more parsimonious interpretative strategy and to derive optimal E-Score cutoffs.

Method: Participants included clinically-referred patients from VA ( = 101) and academic medical center (AMC,  = 183) settings. Patients were separated by validity status (valid/invalid), and subsequently two comparison groups were formed from each sample's valid group.

Comparing the Independent and Aggregated Accuracy of Trial 1 and the First 10 TOMM Items for Detecting Invalid Neuropsychological Test Performance Across Civilian and Veteran Clinical Samples.

Previous studies support using two abbreviated tests of the Test of Memory Malingering (TOMM), including (a) Trial 1 (T1) and (b) the number of errors on the first 10 items of T1 (T1e10), as performance validity tests (PVTs). In this study, we examined the independent and aggregated predictive utility of TOMM T1 and T1e10 for identifying invalid neuropsychological test performance across two clinical samples. We employed cross-sectional research to examine two independent and demographically diverse mixed samples of military veterans and civilians (VA = 108; academic medical center = 234) of patients who underwent neuropsychological evaluations.

Cross-validation of a forced-choice validity indicator to enhance the clinical utility of the Rey Auditory Verbal Learning Test.

A forced-choice (FC) recognition trial was recently developed as an embedded validity indicator for the Rey Auditory Verbal Learning Test (RAVLT), although it has not been replicated outside of the initial validation study. This study cross-validated the RAVLT FC trial for detecting invalid neuropsychological test performance and assessed the degree to which material-specific verbal memory impairment severity impacts its classification accuracy as a performance validity test (PVT). This cross-sectional study included 172 neuropsychiatric patients who completed the RAVLT and 4 independent criterion PVTs, which were used to classify validity groups (134 valid/38 invalid).

"I Couldn't Be Better": Assessing Self-Awareness With the Mayo-Portland Adaptability Inventory-4 Following TBI.

Introduction/objective: To describe level of awareness, as assessed by the Mayo-Portland Adaptability Inventory-4 (MPAI-4), across physical, cognitive, functional, and emotional domains in individuals with mild, moderate, and severe traumatic brain injury (TBI) participating in a residential rehabilitation program. In addition, this study aimed to examine the relationship between time since injury and awareness. A novel way the MPAI-4 can be used to measure self-awareness is also presented.

Assessment of differential neurocognitive performance based on the number of performance validity tests failures: A cross-validation study across multiple mixed clinical samples.

This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample ( = 76) and academic medical sample (AMC;  = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs.

Minimizing evaluation time while maintaining accuracy: Cross-validation of the Test of Memory Malingering (TOMM) Trial 1 and first 10-item errors as briefer performance validity tests.

Current standards of practice in neuropsychology advocate for including validity tests (PVTs). Abbreviating PVTs, such as the Test of Memory Malingering (TOMM), may help reduce overall evaluation time while maintaining diagnostic accuracy. TOMM Trial 1 performance (T1), as well as the number of errors within the first 10 items of Trial 1 (TOMMe10), have shown initial promise as abbreviated PVTs but require additional external cross-validation.

Relative impacts of mild and major neurocognitive disorder on rate of verbal learning acquisition.

Objective: The California Verbal Learning Test-second edition (CVLT-II) learning slope index may signal the presence of cognitive impairment, though the relative impacts of mild (MiND) and major (MaND) neurocognitive disorders on the rate of verbal learning acquisition remain unknown.

Methods: Latent intercept-only, linear, quadratic, and exponential models were fit to raw scores for the five CVLT-II learning trials of 197 veterans. Dummy-coded variables reflecting MiND and MaND predicted the growth factors.

Cognitive impairment does not cause invalid performance: analyzing performance patterns among cognitively unimpaired, impaired, and noncredible participants across six performance validity tests.

: Performance validity tests (PVTs) are essential in neuropsychological evaluations; however, it has been questioned how PVTs function in the context of cognitive impairment, and whether cognitive impairment alone is sufficient to cause PVT failure. Further, there is concern that some clinicians will disregard failed PVTs due to their perception that failures represent false-positive errors secondary to cognitive impairment. This study examined patterns associated with cognitively impaired versus noncredible performance across a battery of PVTs and neuropsychological tests.

A Model of Care for Community Reintegration: The Polytrauma Transitional Rehabilitation Program.

The Department of Veterans Affairs Polytrauma Transitional Rehabilitation Program was established to extend the rehabilitation of veterans and active duty service members past the acute phase and reintegrate them into the community. Effective community reintegration is best achieved with a diverse interdisciplinary team that treats patients' physical, cognitive, and psychological deficits in a collaborative approach. Barriers, such as lack of accurate awareness of functional limitations and premorbid psychosocial stressors, can limit the recovery process.

Convergent, Discriminant, and Concurrent Validity of Nonmemory-Based Performance Validity Tests.

To supplement memory-based Performance Validity Tests (PVTs) in identifying noncredible performance, we examined the validity of the two most commonly used nonmemory-based PVTs-Dot Counting Test (DCT) and Wechsler Adult Intelligence Scale-Fourth edition (WAIS-IV) Reliable Digit Span (RDS)-as well as two alternative WAIS-IV Digit Span (DS) subtest PVTs. Examinees completed DCT, WAIS-IV DS, and the following criterion PVTs: Test of Memory Malingering, Word Memory Test, and Word Choice Test. Validity groups were determined by passing 3 (valid; = 69) or failing ⩾2 (noncredible; = 30) criterion PVTs.

The Utility of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in US Military Veterans With a History of Mild Traumatic Brain Injury.

Objective: To examine the utility of the Mayo-Portland Adaptability Inventory-4th Edition Participation Index (M2PI) as a self-report measure of functional outcome following mild traumatic brain injury (mTBI) in US Military veterans.

Setting: Department of Veterans Affairs Polytrauma Rehabilitation Center specialty hospital.

Participants: On hundred thirty-nine veterans with a history of self-reported mTBI.

Relax while you rehabilitate: A pilot study integrating a novel, yoga-based mindfulness group intervention into a residential military brain injury rehabilitation program.

Objective: This preliminary, pilot study assessed the effectiveness of a group-based, mindfulness intervention in a residential, rehabilitation setting with specific focus on assessing participants' self-report of perceived benefit of the intervention on overall health, pain, sleep, mood/anxiety, attention, and self-awareness, as well as implementing modifications needed for successful intervention application among a diverse, clinical military population.

Method/design: Participants were 19 veterans and active duty service members with a history of traumatic brain injury (TBI; 63% severe) who completed a mindfulness-based group intervention during inpatient admission at a Veterans Affairs Polytrauma Transitional Rehabilitation Program (PTRP). Mindfulness and yoga skills were taught in a required, weekly group incorporated into participants' rehabilitation schedule.

Evaluating the accuracy of the Wechsler Memory Scale-Fourth Edition (WMS-IV) logical memory embedded validity index for detecting invalid test performance.

Embedded performance validity tests (PVTs) allow for continuous assessment of invalid performance throughout neuropsychological test batteries. This study evaluated the utility of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LM) Recognition score as an embedded PVT using the Advanced Clinical Solutions (ACS) for WAIS-IV/WMS-IV Effort System. This mixed clinical sample was comprised of 97 total participants, 71 of whom were classified as valid and 26 as invalid based on three well-validated, freestanding criterion PVTs.

The Dot Counting Test adds up: Validation and response pattern analysis in a mixed clinical veteran sample.

Objective: This study cross-validated the Dot Counting Test (DCT) as a performance validity test (PVT) among a mixed clinical veteran sample. Completion time and error patterns also were examined by validity group and cognitive impairment status.

Method: This cross-sectional study included 77 veterans who completed the DCT during clinical evaluation.

Neuropsychological Evaluation in Traumatic Brain Injury.

Clinical neuropsychology is a subspecialty of professional psychology that is concerned with the scientific study and clinical application of brain-behavior relationships. Broadly defined, a neuropsychological evaluation is a flexible clinical tool that involves integration of objective, psychometric test data along with various other sources of clinical information to comprehensively elucidate the cognitive, behavioral, and emotional sequelae after traumatic brain injury (TBI). In addition to characterizing TBI sequelae, evidenced-based neuropsychological assessment can contribute to TBI patient care by aiding with prognostic assessment, measuring interval change/recovery over time (eg, resolution of posttraumatic amnesia), informing and implementing rehabilitation strategies, and evaluating the effectiveness of interventions.

The effect of perceptual reasoning abilities on confrontation naming performance: An examination of three naming tests.

Introduction: Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual-perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy.

Method: A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation.

The relationship of childhood abuse and early separation from the military among Army advanced individual trainees.

Objective: To identify the prevalence rates and gender differences of childhood physical, sexual, and emotional abuse among advanced individual trainees and to determine if soldiers with a history of abuse increasingly separated from the Army before completing the training.

Methods: Archival medical records of trainees presented to a military outpatient mental health clinic were analyzed for a history of abuse and separation from the Army.

Results: A significant number of soldiers with a history of abuse were discharged from the Army without completing training.

Association between combat stress and post-concussive symptom reporting in OEF/OIF service members with mild traumatic brain injuries.

Objective: The relationship between combat stress and post-concussive symptoms in service members with mild traumatic brain injuries (mTBI) is poorly understood. It was hypothesized that the co-occurrence of combat stress would have a significant effect on the severity of post-concussive complaints, specifically on emotional and cognitive symptoms.

Methods: Four hundred and seventy-two combat-deployed service members with mTBI completed self-report inventories of post-traumatic stress and post-concussive symptoms.

Factors influencing cognitive functioning following mild traumatic brain injury in OIF/OEF burn patients.

Objective: To examine the relationship between mild traumatic brain injury (mTBI), psychiatric conditions, pain medications, and injury severity on cognitive functioning in service members admitted to a burn unit. We hypothesize that psychiatric co-morbidity and pain medications will have a stronger relationship with cognitive dysfunction than mTBI diagnosis in this population.

Method: Retrospective review of clinical evaluations (n=194) completed between September 2005 - October 2007 on service members with burn injuries secondary to explosive munitions.