The impact of race and other demographic factors on the false positive rates of five embedded Performance Validity Tests (PVTs) in a Veteran sample.

Introduction: It is common to use normative adjustments based on race to maintain accuracy when interpreting cognitive test results during neuropsychological assessment. However, embedded performance validity tests (PVTs) do not adjust for these racial differences and may result in elevated rates of false positives in African American/Black (AA) samples compared to European American/White (EA) samples.

Methods: Veterans without Major Neurocognitive Disorder completed an outpatient neuropsychological assessment and were deemed to be performing in a valid manner (e.

The minimal effect of depression on cognitive functioning when accounting for TOMM performance in a sample of U.S. veterans.

While many studies have demonstrated a relationship between depression and cognitive deficits, most have neglected to include measurements of performance validity. This study examined the relationship between depression and cognition after accounting for noncredible performance. Participants were veterans referred for outpatient clinical evaluation.

Self-reported disability-seeking predicts PVT failure in veterans undergoing clinical neuropsychological evaluation.

This study examined disability-related factors as predictors of PVT performance in Veterans who underwent neuropsychological evaluation for clinical purposes, not for determination of disability benefits. Participants were 1,438 Veterans who were seen for clinical evaluation in a VA Medical Center's Neuropsychology Clinic. All were administered the TOMM, MSVT, or both.

Comparison of conventional and actuarial neuropsychological criteria for mild cognitive impairment in a clinical setting.

Introduction: Evidence-based practice in neuropsychology involves the use of validated tests, cutoff scores, and interpretive algorithms to identify clinically significant cognitive deficits. Recently, actuarial neuropsychological criteria (ANP) for identifying mild cognitive impairment were developed, demonstrating improved criterion validity and temporal stability compared to conventional criteria (CNP). However, benefits of the ANP criteria have not been investigated in non-research, clinical settings with varied etiologies, severities, and comorbidities.

Demographic differences in performance validity test failure.

Objective: The present study investigated demographic differences in performance validity test (PVT) failure in a Veteran sample.

Method: Data were extracted from clinical neuropsychological evaluations. Only veterans who identified as men, as either European American/White (EA) or African American/Black (AA) were included ( = 1261).

Rivastigmine Transdermal Patch Treatment for Moderate to Severe Cognitive Impairment in Veterans with Traumatic Brain Injury (RiVET Study): A Randomized Clinical Trial.

Cognitive impairment is common in veterans with histories of traumatic brain injury (TBI). Cholinergic deficits have been hypothesized as contributors to this impairment. We report the effects of cholinesterase inhibitor rivastigmine transdermal patch treatment in veterans with TBI and post-traumatic memory impairment.

Five-factor structure of the RBANS is supported in an Alzheimer's disease sample: Implications for validation of neuropsychological assessment instruments.

Development of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was theoretically driven, with the goal of providing an assessment of abilities across five cognitive domains. Since its development, numerous factor analytic studies have failed to provide empirical support for the proposed five-factor structure and, furthermore, have lacked consensus on the internal structure of this instrument. A key limitation of these prior studies is the use of normal or mixed clinical samples, a practice that can obscure distinctions that may be evident in specific homogeneous clinical samples.

The influence of traumatic brain injury on treatment outcomes of Concurrent Treatment for PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) in veterans.

Background: The co-occurrence of posttraumatic stress disorder (PTSD), substance use disorders (SUD), and traumatic brain injury (TBI) in veterans of Operations Enduring/Iraqi Freedom and New Dawn has received much attention in the literature. Although hypotheses have been presented and disseminated that TBI history will negatively influence treatment response, little data exist to support these claims. The present study investigates the influence of TBI history on response to COPE (Concurrent Treatment of PTSD and SUD Using Prolonged Exposure), a 12-session, integrated psychotherapy designed to address co-occurring PTSD and SUD.

An Intervention to Decrease the Occurrence of Invalid Data on Neuropsychological Evaluation.

Objective: This study tested whether patients who were given a handout based on deterrence theory, immediately prior to evaluation, would provide invalid data less frequently than patients who were simply given an informational handout.

Method: All outpatients seen for clinical evaluation in a VA Neuropsychology Clinic were randomly given one of the two handouts immediately prior to evaluation. The "Intervention" handout emphasized the importance of trying one's hardest, explicitly listed consequences of valid and invalid responding and asked patients to sign and initial it.

A comparison of four embedded validity indices for the RBANS in a memory disorders clinic.

This examination of four embedded validity indices for the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) explores the potential utility of integrating cognitive and self-reported depressive measures. Examined indices include the proposed RBANS Performance Validity Index (RBANS PVI) and the Charleston Revised Index of Effort for the RBANS (CRIER). The CRIER represented the novel integration of cognitive test performance and depression self-report information.

Psychological characteristics of individuals who put forth inadequate cognitive effort in a secondary gain context.

The current study sought to characterize the psychological architecture of individuals who put forth inadequate effort. The Minnesota Multiphasic Personality Inventory, 2nd Edition-Restructured Form was used to identify dimensions of psychological functioning in a mixed outpatient sample of U.S.

[Formula: see text]inadequate effort on neuropsychological evaluation is associated with increased healthcare utilization.

Patients who exert inadequate effort on neuropsychological examination might not receive accurate diagnoses and recommendations, and might not cooperate fully with other aspects of healthcare. This study examined whether inadequate effort is associated with increased healthcare utilization. Of 355 patients seen for routine, clinical neuropsychological examination at a VA Medical Center, 283 (79.

CE hospital service utilization is reduced following neuropsychological evaluation in a sample of U.S. veterans.

The aim of this study was to evaluate the objective value of neuropsychological evaluation (NPE) through reduction in Emergency Room (ER) visits and hospitalizations. Retrospective analysis examined trends in ER visits and hospitalizations in 440 U.S.

Performance on Standard Indexes of Effort Among Patients with Dementia.

Assessment of response validity is an integral part of neuropsychological practice. Although many studies have demonstrated the efficacy of stand alone and embedded effort measures in a variety of medical and compensation-seeking contexts, much less is known about the robustness of these measures in elderly populations, particularly in patients with dementia. Although older adults may be viewed as less likely to intentionally feign symptoms for an external gain, there are a variety of other factors that could result in suboptimal effort, including fatigue, lack of interest or cooperation in the testing process, or failure to fully appreciate the implications of the assessment on treatment care and outcome.

Attentional functioning in patients with posttraumatic stress disorder: a preliminary study.

Objective: To compare patients with posttraumatic stress disorder (PTSD) to patients without psychiatric or cognitive disorders on neuropsychological measures of attention.

Methods: The sample included 19 patients with PTSD and 22 participants with no cognitive or psychiatric diagnosis. All had been referred for clinical neuropsychological evaluation at a VA Medical Center.

A pilot trial of neuropsychological evaluations conducted via telemedicine in the Veterans Health Administration.

Introduction: Many veterans live in rural areas distant from Veterans Affairs Medical Centers (VAMCs) and receive primary medical care from community-based outpatient clinics (CBOCs). These veterans often must travel great distances to the nearest VAMC for neuropsychological evaluations, resulting in poor access to care, travel reimbursement costs, fee-basis evaluations of uncontrolled quality, and driving safety concerns. Return trips for feedback compound complications.

Intact cognition in depressed elderly veterans providing adequate effort.

Geriatric depression has been associated with cognitive impairments, but whether suboptimal effort contributes to these deficits is unknown. This study investigated differences in cognitive functioning between depressed and nondepressed elderly veterans, before and after excluding patients who provided suboptimal effort on testing at a memory disorders clinic. Patients diagnosed with a depressive disorder performed more poorly than nondepressed patients on almost all Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) indices, but these differences became nonstatistically significant after excluding patients who provided suboptimal effort.

Embedded indices of effort in the repeatable battery for the assessment of neuropsychological status (RBANS) in a geriatric sample.

The clinical utility of embedded indices of effort in the RBANS was examined in a geriatric sample. Patients were classified as providing suspect effort (n = 45) or probable good effort (n = 258) using the TOMM and clinical consensus. Following the methodology of Silverberg and colleagues (2007), selected individual subtests and a summary Effort Index were evaluated.

A population-based study of repetitive traumatic brain injury among persons with traumatic brain injury.

Primary Objective: The objective was to estimate and compare the hazards of repetitive traumatic brain injury (RTBI) events as a function of the index TBI severity, in a cohort of TBI hospital discharges include in the South Carolina Traumatic Brain Injury Follow-up Registry.

Research Design: Retrospective cohort.

Methods And Procedures: There were 4357 persons with TBI who were followed from the index hospital discharge through 31 December 2005 for RTBI events through the statewide hospital discharge (HD) and emergency department (ED) records.

Pre-existing health conditions and repeat traumatic brain injury.

Objective: To assess and compare the effect of Pre-existing epilepsy/seizure disorder and drug/alcohol problem on the hazard of repeat traumatic brain injury (TBI) in persons with TBI who participated in a follow-up study.

Design: Retrospective cohort.

Setting: Acute care hospitals in South Carolina.

A preliminary controlled trial of divalproex in posttraumatic stress disorder.

Background: Case reports and open trials have reported beneficial effects of divalproex in the treatment of posttraumatic stress disorder (PTSD). The objective of this study was to conduct a placebo-controlled study of the efficacy and tolerability of divalproex in chronic PTSD patients.

Methods: Patients were randomized to receive placebo or divalproex.

Measures of cognitive functioning as predictors of treatment outcome for cocaine dependence.

Amlodipine is a calcium-channel antagonist with neuropharmacological properties believed to be protective against cerebral hypoperfusion, microinfarcts, and excitoxic cell death. Based on its pharmacological properties, we hypothesized that amlodipine would be associated with improved attention, processing speed, memory, and executive functioning at treatment follow-up in 84 cocaine-dependent individuals enrolled in a 12-week, placebo-controlled, double-blind clinical trial of amlodipine. We also hypothesized that better cognitive functioning at baseline would be associated with reduced cocaine use (negative urine drug screens) and longer treatment retention (last session attended).

Factor analysis of the Repeatable Battery for the Assessment of Neuropsychological Status.

A sample of 175 veterans' scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998) was examined to investigate the factor structure of this scale. First, we attempted to replicate a five-factor model to reflect the five Index Scores of the RBANS (immediate memory, visuospatial/constructional, language, attention, and delayed memory) from the 12 individual subtests, using confirmatory factor analysis (CFA). We were unable to identify a five-factor structure of the RBANS.

Predictors of psychological symptoms 1 year after traumatic brain injury: a population-based, epidemiological study.

Objective: To examine self-reported psychological symptoms 1 year after traumatic brain injury (TBI) in a population-based sample.

Participants: There were 1560 adults who had sustained TBI.

Design: A telephone survey with questions about recent mood and anxiety symptoms, and diagnoses since TBI.

Neurocognitive deficits and prefrontal cortical atrophy in patients with schizophrenia.

Rationale: Cognitive deficits are of particular importance in schizophrenia since they are strongly associated with poor prognosis. We investigated the relationship between prefrontal cortical atrophy as measured by MRI and the neuropsychological performance of participants diagnosed with DSM-IV-TR schizophrenia.

Methods: Fourteen unmedicated adult patients and thirteen matched controls were studied.