Retest reliability of the Halstead Impairment Index in a normal, a schizophrenic, and two samples of organic patients

Effects of Combined Physical Movement Activity and Multifaceted Cognitive Training in Older People with Mild Neurocognitive Disorder in a Rural Community: A Randomized Control Trial

INTRODUCTION

Cognitive deterioration in older people with mild neurocognitive disorders (mNCD) increases the risk of progress to major NCD. Health professionals worldwide are trying to find strategies for prevention. There is a limited number of studies that deal with cultural conditions in northern Thailand.

OBJECTIVES

This study aimed to investigate the effects of a combination of physical movement activity and multifaceted cognitive training on cognitive function in older people with mNCD.

METHODS

A randomized control trial involving 70 mNCD people, according to DSM-5 criteria, was conducted on an intervention group and a control group (n = 35 each). The program for the intervention group included 24 sessions (twice a week). The outcome measures on cognitive function were assessed before and after the intervention by means of composite cognitive measures for older people, i.e., the Trail-Making Test (TMT), Digit Span (DS), Verbal Fluency (VF), Word-List Learning (WLL), and Block Design (BD).

RESULTS

The combined intervention enhanced cognitive function. TMT-A was significantly improved in the intervention group. There were significant improvements in DS sequence scores, letter verbal fluency (LVF), and category verbal fluency (CVF). Comparing the groups, there were significant differences in LVF including immediate and delayed recall. BD improved significantly in the intervention group.

CONCLUSIONS

The combined intervention appeared to be effective in delaying/preventing cognitive deterioration and cognitive functional decline in people with mNCD. Further studies on a variation of treatments suited to cultural conditions and their effects are needed. Trials in other communities are also recommended.

Neuropsychologists diagnose traumatic brain injury

The case of John versus Im (2002) stands for the proposition that clinical neuropsychologists are not qualified to diagnose traumatic brain injury. This ruling by the Supreme Court of Virginia prohibits neuropsychologists from testifying about these professional conclusions in the courtroom. However, in clinical practice neuropsychologists are often asked to disentangle the relative contribution of brain dysfunction and psychological factors to presenting symptomology. In the proposed submission, the authors provide an analysis of the neuropsychological testimony at issue in John versus Im using the admissibility standards for expert testimony that were established and refined by a trilogy of cases from the Supreme Court of the United States. The paper provides support for the notion that neuropsychological method has an established scientific base of knowledge, standards for clinical competence, and evidence of peer-reviewed acceptance by medical related disciplines. No other scientific discipline has employed a more rigorous methodology for assessing cognitive function and disentangling the relative contributions of brain dysfunction and psychological factors to presenting symptomology. By limiting the testimony of neuropsychologists as to cause of an individual's cognitive impairment, courts will exclude opinions based on scientific research and specialized knowledge that would assist in the trier of fact.

Neuropsychological assessment outcomes of nonacquired immunodeficiency syndrome patients with primary central nervous system lymphoma before and after blood-brain barrier disruption chemotherapy

The risk of neurotoxicity was evaluated in eight consecutive patients with non-acquired immunodeficiency syndrome (AIDS) primary central nervous system lymphoma who had survived disease free for more than 1 year after completion of treatment with osmotic opening of the blood-brain barrier and chemotherapy (methotrexate, cytoxan, procarbazine, and decadron). Trends in neuropsychological assessment results between baseline and follow-up (1 to 7 years) were analyzed for all eight nonradiated survivors. This serial assessment design addressed the specific issue of neurotoxic risk potential of treatment, when confounding factors of tumor persistence/recurrence and cranial irradiation were ruled out. Follow-up results of an extensive battery of tests to assess higher cortical function provided evidence of the safety of chemotherapy protocol with the blood-brain barrier disruption. These findings stand in contrast to well-known cognitive risks associated with cranial radiotherapy. Long-term follow-up suggests that chemotherapy can be given in conjunction with osmotic opening of the blood-brain barrier in nonradiated patients without cognitive manifestations of neurotoxicity.

Behavioral assessment of the effects of psychotropic medications on demented nursing home residents

The effects of different psychotropic medications were examined for the control of behavior problems associated with dementia in three elderly nursing home residents. A reversal design was used in which the medications were introduced and withdrawn, and their effects were assessed on various resident behaviors using behavioral and motor performance assessments. All medications were effective in decreasing aberrant behaviors, but they also increased sedation in all three subjects. Performance on the motor assessments decreased for all subjects after the introduction of medication and improved after the medication was withdrawn. The results highlight the utility of behavioral assessment strategies for assessing the effects of psychotropic medication on elderly nursing home residents.

Neuropsychological performance and treatment outcome in male alcoholics

Commonly used neuropsychological tests were administered to 91 detoxified alcoholics at the beginning of treatment. Statistically significant relationships were observed between test scores and post-treatment consumption determined 8 months after completing treatment for 72 patients. The results varied depending upon the particular measure of posttreatment consumption evaluated and the type of statistical analysis used. The most consistent relationships were often counter to the notion that increased neuropsychological performance is correlated with a more favorable treatment outcome. Neuropsychological evaluation is of limited clinical utility in predicting posttreatment alcohol consumption.

Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery

As part of a prospective study of the neurologic and neuropsychological complications of coronary artery bypass graft surgery, 312 patients were compared with a control group of 50 patients undergoing major surgery for peripheral vascular disease. The purpose of comparing the 2 groups was to determine to what extent neurologic complications after heart surgery can be attributed to cardiopulmonary bypass. The 2 groups were similar with respect to age, preoperative neurologic and intellectual status, anesthetic methods, duration of operation, perioperative complications, and time spent in the intensive therapy unit. Certain potential risk factors for cerebrovascular disease were more common in the control than the coronary bypass patients. The important difference between the 2 groups was that only the latter group underwent cardiopulmonary bypass. In this group 191 of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic and neuropsychological complications. By the time of hospital discharge 17% had neurologic disability and 38% had significant neuropsychological symptoms. In the control group 9 of 50 (18%) developed neurologic complications resulting largely from trauma to lower limb sensory nerves. Two patients developed primitive reflexes. Fifteen of 48 (31%) showed neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe intellectual dysfunction was not seen in the control patients in contrast to the 24% thus affected in the coronary bypass group. The difference in frequency and severity of central nervous system complications between the 2 groups is likely to reflect cerebral injury resulting from cardiopulmonary bypass.

The Luria-Nebraska and Halstead-Reitan Neuropsychological Test batteries: a cross-cultural study in English and Arabic

In the present study, the Luria-Nebraska and the Halstead-Reitan Neuropsychological Test batteries were administered to 112 male and female Arabic and English speaking Egyptians enrolled at the American University in Cairo. The aims of the study were to establish normative data, test the effects of language and order of administration upon performance, and examine practice effects and test-retest reliability of the two batteries. Only minimal differences were found between the Arabic and the English administrations. Results revealed strong test-retest reliability coefficients for the HRB and moderate ones for the LNNB. Practice effects were detected on six LNNB scales as well as on the HRB complex problem solving tests (Category and Tactual Performance Test). No other effects were detected. Thus, the initial performance on one battery did not interfere with nor enhance performance on the other battery.

Finger tapping: effects of trials and sessions

18 normal, self-reported dextral subjects (9 men, 9 women) were assessed with a Halstead Manual Finger Tapping device, with 10 trials per hand for 10 consecutive wk. The test-retest reliability of the 10-trial average between the 10 sessions averaged .94 for men and .86 for women, for both preferred and nonpreferred hands. There were no statistically significant effects of increases in performance over sessions or effects of fatigue over trials for either sex or hand. There were, however, significant increases over trials for men for both preferred and nonpreferred hands.

Hand dynamometer: effects of trials and sessions

12 normal, self-reported dextral subjects (6 men, 6 women) were assessed with a hand dynamometer with 10 trials per hand for 10 consecutive wk. The test-retest reliability of the 10-trial average across the 10 sessions averaged .91 for men and .94 for women for both preferred and nonpreferred hands. Fatigue effects over trials were statistically significant for both sexes and hands except for women's preferred hand. Skill acquisition effects over sessions were only statistically significant for men's nonpreferred and women's preferred hands.

WAIS and neuropsychological tests: common and unique variance within an epileptic population

Neuropsychological assessment batteries, which traditionally require lengthy administration times, may be composed of multiple tests which measure essentially the same performance attributes. Test redundancies of this nature compromise the adequacy of a test battery from a cost containment perspective. The present study evaluated the common and unique variance of the WAIS relative to a modified and expanded Halstead-Reitan test battery to determine if information obtained from the WAIS is sufficiently nonredundant to justify its inclusion as part of this assessment battery. Cross-validated estimates of bivariate and multivariate relationships between these instruments were generated from two samples (n = 125) of epileptics. Results indicated statistically significant redundancies, yet, when interpreted from a clinical perspective it was evident that neuropsychological tests could not accurately duplicate information provided by the WAIS. Accordingly, it was not recommended that the WAIS be eliminated from this test battery in order to reduce test administration time.

Comparison of the TPT 10 and 6 hole form board

The 10 hole (Adult Version) Tactile Performance Test (TPT) or Form Board is too difficult for patients with moderate to severe brain damage. A series of studies were done to enable an examiner to substitute the simpler 6 hole board (TPT 6 - Child's Version) for such patients. Eighty subjects (61 brain damaged and 19 controls) were given both boards in a counter-balanced order. It was found that: (1) the TPT 10 was inadequate for severe damage; (2) the TPT 6 can be used with severe impairment; (3) a method of prorating blocks into time was developed; (4) the TPT 10 and TPT 6 are strongly correlated; (5) there were no order effects when both boards were given; (6) both boards significantly separated controls from brain-damaged subjects; (7) criteria for substitution of the TPT 6 were established; and (8) comparable scales were established for both boards so that an examiner can substitute either TPT for the other.

Base rate data for the WAIS-R: test-retest stability and VIQ-PIQ differences

The data analyzed were the 14 WAIS-R scores from each of the individuals who comprised the WAIS-R standardization sample. Examined was the individual VIQ-PIQ difference from only the initial examination of each of the 1880 subjects, as well as the test-retest change in each of the 14 WAIS-R scores for each of the 119 subjects who were retested. The results revealed that, although the WAIS-R has excellent psychometric reliability as reflected in its standard error of measurement of a VIQ-PIQ difference and its impressively high test-retest Pearson r values, the actual magnitudes of the differences between the VIQ and PIQ assessed in a single examination, or the magnitudes of gain or loss in the 14 scores on retest, for some of these normal individuals were sufficiently high that such base-rate data should be routinely considered by clinical neuropsychologists and other practitioners.

Comparison of the Wisconsin Card Sorting Test and the Halstead Category Test

Correlational comparisons of the Wisconsin Card Sorting Test and the Halstead Category Test (Pendleton & Heaton, 1982) are criticized as inadequate to assess the degree to which these two tests call upon the same cognitive processes. Asking patients to "think aloud" while performing on the tests is recommended as a more direct approach to understanding the cognitive components of the tests. Some results of analysis of such think-aloud protocols are presented that suggest the differences and areas of overlap of the two tests.

Recovery from severe closed head injuries: repeat testings with the Halstead-Reitan Neuropsychological Battery

Evaluated 15 adult patients who were suffering severe, coma-producing closed head injuries for neuropsychological and intellectual impairment with the Halstead-Reitan Neuropsychological Battery and the Wechsler Adult Intelligence Scale. All Ss were tested shortly after the time of their accidents and were reevaluated at approximately 1 year posttrauma to document residual deficits and rate of recovery. A group of 15 neurologically normal control Ss, matched for age, education, and sex, received the same battery of psychological tests. Although the brain-injured group demonstrated improvement on essentially all of the dependent measures from first testing to second, comparisons made with the control group revealed numerous areas of residual impairment, which suggests only partial recovery during the first year posttrauma.

The Luria-Nebraska Neuropsychological Battery: a promise that may be partly fulfilled

This paper reviews the literature to date on the Luria-Nebraska Neuropsychological Battery (LNNB). Consideration of the literature leads to the conclusion that the battery does not meet the stated goal of combining Luria's qualification of the symptom approach with a standardized, quantitative approach to neuropsychological assessment. While the LNNB does not approximate Luria's approach, there are data to suggest that the battery may have potential as a quantitative, standardized battery. However, numerous substantial statistical and methodological problems with the research base preclude the endorsement of the battery for clinical use. Nevertheless, the efficacy of the LNNB in clinical situations will rest, not on the developer's and publisher's claims, or on detractor's critiques, but on carefully planned and well-executed research. Until such research appears, caution is urged to those who would attempt to use this instrument in clinical situations.

MMPI profiles among neuropsychology patients

Examined MMPI profiles in a sample of 345 patients who were referred for neuropsychological evaluation because of known or suspected brain damage in an effort to determine how these profiles compare to MMPI profiles among general mental health outpatients. The relationship between the severity of brain damage as determined by the neuropsychological evaluation and the severity of emotional problems as reflected by the MMPI also was examined. A third part of the study focused on two MMPI "organic" codes ("29" and "139") to determine whether these code types reflect brain disorders at greater than chance level. Results indicate that a large majority of neuropsychology patients exhibit significant emotional problems as evidenced by one or more scale elevations on the MMPI. These patients differ considerably from general outpatients in terms of the scales most frequently elevated. In contrast to earlier findings, present results suggest only a low relationship between the severity of emotional problems and the severity of brain damage with much of this relationship reflected in Sc scale elevations.

Reliability of the Speech Sounds Perception Test

Several studies have examined the test-retest reliability of the Halstead-Reitan battery of which the Speech Sounds Perception Test is one component. However, there are no data on internal reliability. Clinical experience with the test suggests that the subtests are not equally difficult. The present study examined the internal reliability in two independent samples (ns = 106 and 81). In both samples, a significantly greater number of errors was found on the first half of the test. Also in both samples, the largest number of errors occurred on Subtests B and A, while the fewest errors were found on Subtests E and D. The split-half reliability coefficients for the two samples were .74 and .87. There was also some tentative support for the use of an abbreviated version. A formula was generated (Series A + Series B + Series C + 2) which correctly classified a high percentage of patients in both samples (96% and 90%) using performance above and below the conventional cutoff score of eight errors.

Test-retest IQ changes of epilepsy patients: assessing the influence of practice effects

A number of recent studies have emphasized the role of practice effect on test-retest changes in performance often seen on neuropsychological tests. An attempt is made to separate the influence of practice effect from other functional changes in the test-retest differences observed on the WAIS for a sample of adult epilepsy patients. Fifty-eight epilepsy patients were divided into three groups based on their WAIS test-retest score changes. Their corresponding test-retest performance on the Halstead-Reitan Battery and changes in seizure frequency were compared and analyzed. Results indicated that there was a correspondence between improvement in neuropsychological test performance, reduced seizure frequency, and improvement on the WAIS. It was concluded that test-retest changes in neuropsychological test performance reflected changes in psychological functioning of these individuals rather than the influence of practice effect. Some general issues relating to the question of disentangling the influence of practice effect from other functional changes in status were raised and discussed.

Test-retest reliability of the Halstead Impairment Index in hospitalized alcholic and nonalcoholic males with mild to moderate neuropsychological impairment

Seven measures of neuropsychological functioning, the resulting Impairment Index described by Halstead, and Trails A and B were administered to drug-free alcoholic inpatients (n=91) within 7 days of their last drink and again 17 days later. Nonalcoholic medical inpatients (n=20) with similar education, age, and socioeconomic characteristics were also given these tests twice, with 2 to 3 weeks separating the test administrations. Both groups showed levels of mild to moderate impairment on the first testing and were judged to have stable brain functioning between the first and second testing. Significant Pearson's coefficients of correlation between test-retest scores indicated similar psychometric reliabilities in both groups. In contrast, the reliability of the tests was judged to be questionable when Halstead's binary classification of "normal" versus "abnormal" was used to classify individual patients. Consequently, and consistent with clinical experience, we urge caution in interpreting these clinical neuropsychological tests when they are administered repeatedly within a 2- to 3-week period to a single individual with stabilized brain functioning.

"Optimal" lateralization on the Tapping Test

The present study was designed to test the general "imbalance" hypothesis in regard to the Tapping Test, a motor measure of finger-oscillation speed from the Halstead-Reitan neuropsychological battery. The study was prompted by a recent spate of reports linking cerebral lateralization to a variety of conditions. It was hypothesized that it would be possible to determine an "optimal," midrange of lateralization, to be identified by faster tapping speeds. As hypothesized, those offenders with "moderate" laterality achieved faster speeds than those with "extreme" laterality ("extreme" defined as either less or more laterality than for the moderates). The same range appeared optimal over several demographic groups. A second goal of the present study was to pursue hints from a previous study that had suggested a lateralization measure might prove to be free of some unwanted variations by demographics. As hypothesized, the lateralization measure appeared free of variations according to age, sex, and handedness. Applications and future directions were suggested.

Neuropsychological consequences of posttreatment drinking behavior in male alcoholics

A prospective study was designed to determine the neuropsychological consequences of continued alcohol consumption after treatment for alcoholism. Performance on 24 commonly used clinical neuropsychological tests was examined in 56 male alcoholics approximately 7 months after completion of an inpatient alcoholism treatment program. Abstainers (n = 17) performed better than those who resumed alcohol consumption. Although there was a significant decrease in alcohol consumption, posttreatment drinking behavior still predicted cognitive performance, with increased frequency and quantity per occasion having more deleterious consequences even at consumption levels that are deemed by some to be socially acceptable. It is concluded that alcohol consumption by former alcoholics might serve to maintain cognitive performance at reduced levels, and that this possibility should be considered in determining appropriate treatment goals for alcoholic patients.