Utility of a clinically derived abbreviated form of the WAIS-III

Early life Adversity, functional connectivity and cognitive performance in Schizophrenia: The mediating role of IL-6

OBJECTIVE

Exposure to childhood trauma (CT) is associated with cognitive impairment in schizophrenia, and deficits in social cognition in particular. Here, we sought to test whether IL-6 mediated the association between CT and social cognition both directly, and sequentially via altered default mode network (DMN) connectivity.

METHODS

Three-hundred-and-eleven participants (104 patients and 207 healthy participants) were included, with MRI data acquired in a subset of n = 147. CT was measured using the childhood trauma questionnaire (CTQ). IL-6 was measured in both plasma and in toll like receptor (TLR) stimulated whole blood. The CANTAB emotion recognition task (ERT) was administered to assess social cognition, and cortical connectivity was assessed based on resting DMN connectivity.

RESULTS

Higher IL-6 levels, measured both in plasma and in toll-like receptor (TLR-2) stimulated blood, were significantly correlated with higher CTQ scores and lower cognitive and social cognitive function. Plasma IL-6 was further observed to partly mediate the association between higher CT scores and lower emotion recognition performance (CTQ total: β_indirect -0.0234, 95% CI: -0.0573 to -0.0074; CTQ physical neglect: β_indirect = -0.0316, 95% CI: -0.0741 to -0.0049). Finally, sequential mediation was observed between plasma IL-6 levels and DMN connectivity in mediating the effects of higher CTQ on lower social cognitive function (β_indirect = -0.0618, 95% CI: -0.1523 to -0.285).

CONCLUSION

This work suggests that previous associations between CT and social cognition may be partly mediated via an increased inflammatory response. IL-6's association with changes in DMN activity further suggest at least one cortical network via which CT related effects on cognition may be transmitted.

Childhood trauma, brain structure and emotion recognition in patients with schizophrenia and healthy participants

Childhood trauma, and in particular physical neglect, has been repeatedly associated with lower performance on measures of social cognition (e.g. emotion recognition tasks) in both psychiatric and non-clinical populations. The neural mechanisms underpinning this association have remained unclear. Here, we investigated whether volumetric changes in three stress-sensitive regions—the amygdala, hippocampus and anterior cingulate cortex (ACC)—mediate the association between childhood trauma and emotion recognition in a healthy participant sample (N = 112) and a clinical sample of patients with schizophrenia (N = 46). Direct effects of childhood trauma, specifically physical neglect, on Emotion Recognition Task were observed in the whole sample. In healthy participants, reduced total and left ACC volumes were observed to fully mediate the association between both physical neglect and total childhood trauma score, and emotion recognition. No mediating effects of the hippocampus and amygdala volumes were observed for either group. These results suggest that reduced ACC volume may represent part of the mechanism by which early life adversity results in poorer social cognitive function. Confirmation of the causal basis of this association would highlight the importance of resilience-building interventions to mitigate the detrimental effects of childhood trauma on brain structure and function.

Do cognitive deficits predict negative emotionality and aggression in schizophrenia?

Schizophrenia is associated with an elevated risk of aggression. Cognitive deficits have been associated with inpatient aggression and future violence. The relationship between cognitive deficits and violent behavior has however been inconsistent across studies. In addition, studies have failed to inform how cognitive deficits may contribute to aggression in schizophrenia. The current study examined the association of cognitive deficits with schizophrenia-related aggression and violent offending. It also explored the putative mediating role of negative emotionality on the impact of cognitive deficits on aggression. People with schizophrenia and schizoaffective disorder (N = 78) were recruited from a state hospital. Participants were classified based on their history of violent offending. Participants completed measures of cognition, symptoms, and aggression. Deficits in working memory, reasoning/problem-solving, and verbal learning were the most prioritized for the prediction of violent offender status. Violent offenders demonstrated greater impairments in most cognitive domains especially working memory and verbal learning. Offenders also demonstrated greater negative emotionality, excitement/agitation, and incidents of verbal and physical aggression. Negative emotionality and excitement/agitation fully transmitted the effect of cognitive deficits on impulsive aggression in meditational models. Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states.

Clinical validity of the Japanese version of WAIS-III short forms: Adaptation for patients with mild neurocognitive disorder and dementia

We investigated the Japanese WAIS-III short form utility in mild neurocognitive disorder and dementia. Our sample consisted of 108 old patients (ages: 65-89; mean age = 78.3). Fifteen short forms (SFs) and full-scale (FS) IQs were compared. The SFs included Dyads (SF1, SF2), Triads (SF3), Tetrads (SF4, SF5, SF6, SF7), Pentad (SF8), Six-subtest (SF9), Seven-subtests (SF10(a)(b), SF11(a)(b), SF12), and Nine-subtest (SF13). Correlations between SFIQs and FSIQ were all significant. Significant differences also were found in paired t-test between FSIQ and 5 SFIQs (SF2: t = -4.16, SF5: t = -7.06, SF7; t = 2.59, SF10(a): t = 2.56, SF12: t = -4.82; p < .05). On the point of clinical accuracy, two SFs led to an appropriate estimated IQ (SF11(a): 84.3%, SF13: 91.7%; within 95% confidence interval and 2 standard error of measurements of FSIQ). However, SF13 was considered to still have a long administration time. The present results suggest that SF11(a) could be the most useful to estimate IQ for Japanese speaking patients with mild neurocognitive disorder and dementia. SF11(a) consists of seven subtests of Similarities, Arithmetic, Digit Span, Information, Picture Completion, Digit Symbol-Coding, and Matrix Reasoning (Ryan & Ward, 1999), and the formula (Axelrod et al., 2001) should be adopted to convert scaled scores into estimated IQ scores.

Depression, marijuana use and early-onset marijuana use conferred unique effects on neural connectivity and cognition

OBJECTIVE

Marijuana (MJ) use is common. Research shows risks for psychiatric illnesses, including major depressive disorder (MDD) and cognitive deficits with MJ use, particularly early-onset use. We investigated cognitive function, functional connectivity, and genetic risk with MDD alone and combined with MJ use, and differences between early-vs. late-onset/non-MJ use in youth.

METHOD

A total of 74 youth in four groups were studied: healthy control, MDD, frequent MJ use and current/past MDD plus frequent MJ use. Psychiatric symptoms, cognitive performance and demographics were measured. Default mode network (DMN) brain connectivity was determined. Risk alleles in six genes of interest were evaluated.

RESULTS

DMN differences among groups in reward-processing and motor control regions were found; the effects of MJ use and MDD were distinct. Early-onset MJ use was associated with lower IQ and hyperconnectivity within areas of the DMN. Early-onset MJ use was associated with the BDNF risk allele.

CONCLUSIONS

Cognitive deficits linked with early-onset MJ use were present within several years after MJ use began and may result from, predispose to, or share a common cause with early-onset MJ use. The DMN was affected by MDD, MJ and their combination, as well as by early-onset MJ use. BDNF carrier state may predispose to early-onset MJ use.

WAIS-IV Seven-Subtest Short Form: Validity and Clinical Use in Schizophrenia

OBJECTIVE

This study assesses the psychometric properties of Ward's seven-subtest short form (SF) for WAIS-IV in a sample of adults with schizophrenia (SZ) and schizoaffective disorder.

METHOD

Seventy patients diagnosed with schizophrenia or schizoaffective disorder were administered the full version of the WAIS-IV. Four different versions of the Ward's SF were then calculated. The subtests used were: Similarities, Digit Span, Arithmetic, Information, Coding, Picture Completion, and Block Design (BD version) or Matrix Reasoning (MR version). Prorated and regression-based formulae were assessed for each version.

RESULTS

The actual and estimated factorial indexes reflected the typical pattern observed in schizophrenia. The four SFs correlated significantly with their full-version counterparts, but the Perceptual Reasoning Index (PRI) correlated below the acceptance threshold for all four versions. The regression-derived estimates showed larger differences compared to the full form. The four forms revealed comparable but generally low clinical category agreement rates for factor indexes. All SFs showed an acceptable reliability, but they were not correlated with clinical outcomes.

CONCLUSIONS

The WAIS-IV SF offers a good estimate of WAIS-IV intelligence quotient, which is consistent with previous results. Although the overall scores are comparable between the four versions, the prorated forms provided a better estimation of almost all indexes. MR can be used as an alternative for BD without substantially changing the psychometric properties of the SF. However, we recommend a cautious use of these abbreviated forms when it is necessary to estimate the factor index scores, especially PRI, and Processing Speed Index.

Psychometric qualities of a tetrad WAIS-III short form for use in individuals with mild to borderline intellectual disability

OBJECTIVE

To investigate the reliability and validity of a Wechsler Abbreviated Scale of Intelligence-based Wechsler Adult Intelligence Scale - third edition (WAIS-III) short form (SF) in a sample of individuals with mild to borderline intellectual disability (MBID) (N = 117; M(IQ) = 71.34; SD(IQ) = 8.00, range: 52-85).

METHODS

A full WAIS-III was administered as a standard procedure in the diagnostic process.

RESULTS

The results indicate an excellent reliability (r = 0.96) and a strong, positive correlation with the full WAIS-III (r = 0.89). The SF correctly identified ID in general and the correct IQ category more specifically in the majority of cases (97.4% and 86.3% of cases, respectively). In addition, 82.1% of the full scale IQ (FSIQ) estimates fell within the 95% confidence interval of the original score.

CONCLUSIONS

We conclude that the SF is a reliable and valid measure to estimate FSIQ. It can be used in clinical and research settings when global estimates of intelligence are sufficient.

Highways of the emotional intellect: white matter microstructural correlates of an ability-based measure of emotional intelligence

Individuals differ in their ability to understand emotional information and apply that understanding to make decisions and solve problems effectively - a construct known as Emotional Intelligence (EI). While considerable evidence supports the importance of EI in social and occupational functioning, the neural underpinnings of this capacity are relatively unexplored. We used Tract-Based Spatial Statistics (TBSS) to determine the white matter correlates of EI as measured by the ability-based Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Participants included 32 healthy adults (16 men; 16 women), aged 18-45 years. White matter integrity in key tracts was positively correlated with the Strategic Area branches of the MSCEIT (Understanding Emotions and Managing Emotions), but not the Experiential branches (Perceiving and Facilitating Emotions). Specifically, the Understanding Emotions branch was associated with greater fractional anisotropy (FA) within somatosensory and sensory-motor fiber bundles, particularly those of the left superior longitudinal fasciculus and corticospinal tract. Managing Emotions was associated with greater FA within frontal-affective association tracts including the anterior forceps and right uncinate fasciculus, along with frontal-parietal cingulum and interhemispheric corpus callosum tracts. These findings suggest that specific components of EI are directly related to the structural microarchitecture of major axonal pathways.

A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia

Cognitive remediation has proven efficacy for improving neurocognition in people with schizophrenia. The current study evaluated the benefits of cognitive remediation on neurocognition, functioning, psychotic symptoms, and aggression in a sample of forensic and mental health patients. Care recipients with schizophrenia or schizoaffective disorder (N = 78) receiving services in the forensic and mental health units of a state hospital were randomized to participate in cognitive remediation versus computer games control activities. Participants' neurocognition, functional capacity, experiential recovery, psychotic symptoms, and aggression incidents were assessed at baseline and posttreatment. Cognitive remediation was associated with improvements in several neurocognitive domains and circumscribed domains of functional capacity. People assigned to cognitive remediation experiences greater reductions in negative symptoms, agitation/excitement, and verbal and physical aggression. In addition to improving neurocognition in long-term hospitalized forensic and mental health patients, cognitive remediation may enhance efforts at reducing negative symptoms, emotion dysregulation, and aggression incidents. Forensic settings may represent a new frontier for the clinical dissemination of cognitive remediation.

Accuracy of Short Forms of the Dutch Wechsler Preschool and Primary Scale of Intelligence

This article investigated the accuracy of six short forms of the Dutch Wechsler Preschool and Primary Scale of Intelligence–Third edition (WPPSI-III-NL) in estimating intelligent quotient (IQ) scores in healthy children aged 4 to 7 years ( N = 1,037). Overall, accuracy for each short form was studied, comparing IQ equivalences based on the short forms with the original WPPSI-III-NL Full Scale IQ (FSIQ) scores. Next, our sample was divided into three groups: children performing below average, average, or above average, based on the WPPSI-III-NL FSIQ estimates of the original long form, to study the accuracy of WPPSI-III-NL short forms at the tails of the FSIQ distribution. While studying the entire sample, all IQ estimates of the WPPSI-III-NL short forms correlated highly with the FSIQ estimates of the original long form (all rs ≥ .83). Correlations decreased significantly while studying only the tails of the IQ distribution ( rs varied between .55 and .83). Furthermore, IQ estimates of the short forms deviated significantly from the FSIQ score of the original long form, when the IQ estimates were based on short forms containing only two subtests. In contrast, unlike the short forms that contained two to four subtests, the Wechsler Abbreviated Scale of Intelligence short form (containing the subtests Vocabulary, Similarities, Block Design, and Matrix Reasoning) and the General Ability Index short form (containing the subtests Vocabulary, Similarities, Comprehension, Block Design, Matrix Reasoning, and Picture Concepts) produced less variations when compared with the original FSIQ score.

Wechsler Adult Intelligence Scale-IV Dyads for Estimating Global Intelligence

All possible two-subtest combinations of the core Wechsler Adult Intelligence Scale-IV (WAIS-IV) subtests were evaluated as possible viable short forms for estimating full-scale IQ (FSIQ). Validity of the dyads was evaluated relative to FSIQ in a large clinical sample (N = 482) referred for neuropsychological assessment. Sample validity measures included correlations, mean discrepancies, and levels of agreement between dyad estimates and FSIQ scores. In addition, reliability and validity coefficients were derived from WAIS-IV standardization data. The Coding + Information dyad had the strongest combination of reliability and validity data. However, several other dyads yielded comparable psychometric performance, albeit with some variability in their particular strengths. We also observed heterogeneity between validity coefficients from the clinical and standardization-based estimates for several dyads. Thus, readers are encouraged to also consider the individual psychometric attributes, their clinical or research goals, and client or sample characteristics when selecting among the dyadic short forms.

To cut a short test even shorter: reliability and validity of a brief assessment of intellectual ability in schizophrenia--a control-case family study

BACKGROUND

The potential inclusion of cognitive assessments in the DSM-V and large time-consuming assessments drive a need for short tests of cognitive impairments. We examined the reliability and validity of a brief, 15-minute, version of the Wechsler Adult Intelligence Scale-III (WAIS-III).

METHODS

The sample consisted of patients diagnosed with schizophrenia (n=75), their siblings without schizophrenia (n=74) and unrelated healthy controls (n=84). A short WAIS-III consists of the Digit Symbol Coding subtest, and every second (or third) item of Block Design, Information, and Arithmetic. Psychometric analyses were implemented using item-response theory (IRT) to determine the best minimal item short version, while maintaining the sensitivity and reliability of the IQ score.

RESULTS

The proposed 15-minute WAIS-III gave reliable estimates of the Full Scale IQ (FSIQ) in all three groups in the sample. The 15-minute (select-item) version yielded an overall R of.95 (R(2)=.92) and IRT yielded an R of .96 (R(2)=.92). All four subtests performed well in differentiating patients, relatives, and healthy controls. Multivariate analysis showed a significant difference in FSIQ-estimate between patients, relatives, and healthy controls, F(2, 202) = 19.00, p < .0001. Regression modelling showed that the three versions of the WAIS had similar associations with functional outcome after a 3-year follow-up.

CONCLUSIONS

Our proposed 15-minute version of the WAIS may serve as a useful screening device for general intellectual ability in research or clinical settings, and is recommended when a quick and accurate IQ estimate is desired.

Cognição e hipertensão: influência da escolaridade

É comum no envelhecimento a presença de hipertensão arterial. Embora esta pareça exercer impacto negativo na cognição, resultados de estudos que as relacionam não são consensuais. Dentre as escalas cognitivas, a Escala Wechsler de Inteligência para Adultos-III e suas formas abreviadas constituem-se como padrão-ouro. Objetivou-se descrever e comparar a cognição de hipertensos e não hipertensos, discriminados pela escolaridade, utilizando a forma abreviada 8 e resultados obtidos com o Miniexame do Estado Mental. Investigaram-se 118 idosos da comunidade de uma cidade mineira, sendo 63 hipertensos com idade média de 77,52 anos (DP=8,89), escolaridade média de 5,83 anos (DP=4,55) e predomínio feminino (71,2%). Entre aqueles com baixa escolaridade, apenas o Índice de Compreensão Verbal não obteve diferença significativa para hipertensos e não hipertensos. Entre os participantes de alta escolaridade não foram encontradas diferenças significantes na cognição. Identificaram-se associações fortes entre os resultados do Miniexame do Estado Mental e a forma abreviada com oito subtestes da Escala Wechsler de Inteligência para Adultos-III, nos grupos de hipertensos e não hipertensos. Estudos futuros devem aprofundar a relação entre esses instrumentos.

Criterion validity of a Wechsler-III Scale Short Form in a sample of brazilian elderly

Although a normative process, changes in cognitive functioning vary among older adults. The differential diagnosis between normal and pathological aging must be made early using psychometrically adequate measures.

Função executiva em idosos: um estudo utilizando subtestes da escala WAIS-III

Avaliar funções executivas é relevante por apresentarem declínio precoce com a idade. Disponibilizar instrumentos para pesquisa e avaliação de idosos é necessário em face do aumento dessa população. Este estudo transversal objetivou avaliar funções executivas de idosos utilizando cinco subtestes da WAIS-III, identificando associações com idade, gênero e escolaridade. A amostra comunitária constituiu-se de 346 idosos com média etária de 74,14 anos (DP = 8,49) e escolaridade de 7,2 anos (DP = 4,5). Mediu-se validade de construto com testes de Fluência Verbal (convergente) e CES-D (divergente). Univariadas determinaram diferença significativa segundo gênero, com melhor desempenho masculino. Idade correlacionou-se negativa e significativamente com tarefas executivas. Escolaridade afetou a velocidade de processamento, mas não a atenção, raciocínio e organização perceptovisuomotora. Concluiu-se pela adequação dos subtestes para avaliação executiva de idosos. Recomenda-se estabelecimento de pontos de corte para possibilitar diferenciação entre envelhecimento normal e patológico.