Is performance on the Wechsler test of adult reading affected by traumatic brain injury?

Deficits in the pupillary response associated with abnormal visuospatial attention allocation in mild traumatic brain injury

INTRODUCTION

The ability to allocate visual attention is known to be impaired in patients with mild traumatic brain injury (mTBI). In the present study, we investigated a possible neural correlate of this cognitive deficit by examining the pupil response of patients with mTBI whilst performing a modified Posner visual search task.

METHOD

Two experiments were conducted in which the target location was either not cued (Experiment 1) or cued (Experiment 2). Additionally, in Experiment 2, the type of cue (endogenous vs exogenous cue) and cue validity were treated as independent variables. In both experiments, search efficiency was varied by changing shape similarity between target and distractor patterns. The reaction time required to judge whether the target was present or absent and pupil dilation metrics, particularly the pupil dilation latency (PDL) and amplitude (PDA), were measured. Thirteen patients with chronic mTBI and 21 age-, sex-, and IQ -matched controls participated in the study.

RESULTS

In Experiment 1, patients with mTBI displayed a similar PDA for both efficient and inefficient search conditions, while control participants had a significantly larger PDA in inefficient search conditions compared to efficient search conditions. As cognitive load is positively correlated with PDA, our findings suggest that mTBI patients were unable to apply more mental effort whilst performing visual search, particularly if the task is difficult when visual search is inefficient. In Experiment 2, when the target location was cued, patients with mTBI displayed no significant pupil dilation response to the target regardless of the efficiency of the search, nor whether the cue was valid or invalid. These results contrasted with control participants, who were additionally sensitive to the validity of the cue in which PDA was smaller for cue-valid conditions than invalid conditions, particularly for efficient search conditions.

CONCLUSION

Pupillometry provided further evidence of attention allocation deficits following mTBI.

Estimating premorbid intelligence in persons with traumatic brain injury: an examination of the Test of Premorbid Functioning

Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The Test of Premorbid Functioning (ToPF), a word reading test co-normed with the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV), was examined as a tool for estimating premorbid intelligence in persons with a history of TBI. Fifty-two participants with mild, moderate, or severe TBI were administered the ToPF and WAIS-IV between two weeks and 19 months post-injury. The independent ability of the ToPF/demographic score and the Verbal Comprehension Index (VCI) to predict WAIS-IV Full Scale IQ (FSIQ) was examined, as were discrepancies between ToPF and WAIS-IV scores within and between participants. The ToPF/demographic predicted FSIQ accounted for a significant proportion of variability in actual FSIQ, above and beyond that accounted for by education or time since injury. ToPF and WAIS-IV scores did not differ by injury severity. In our sample, the ToPF/demographic predicted FSIQ underestimated intelligence in a substantial portion of our participants (31%), particularly in those with high average to superior intelligence. Finally, VCI scores were more predictive of actual FSIQ than the ToPF/demographic predicted FSIQ. The ToPF frequently underestimated post-injury intelligence and is therefore not accurately measuring premorbid intelligence in our sample, particularly in those with above average to superior intelligence. Clinicians are encouraged to administer the entire WAIS-IV, or at minimum the VCI subtests, for a more accurate measure of intelligence in those with above average intelligence and history of TBI.

Seizures and Cognitive Outcome After Traumatic Brain Injury: A Post Hoc Analysis

INTRODUCTION

Seizures and abnormal periodic or rhythmic patterns are observed on continuous electroencephalography monitoring (cEEG) in up to half of patients hospitalized with moderate to severe traumatic brain injury (TBI). We aimed to determine the impact of seizures and abnormal periodic or rhythmic patterns on cognitive outcome 3 months following moderate to severe TBI.

METHODS

This was a post hoc analysis of the multicenter randomized controlled phase 2 INTREPID²⁵⁶⁶ clinical trial conducted from 2010 to 2016 across 20 United States Level I trauma centers. Patients with nonpenetrating TBI and postresuscitation Glasgow Coma Scale scores 4-12 were included. Bedside cEEG was initiated per protocol on admission to intensive care, and the burden of ictal-interictal continuum (IIC) patterns, including seizures, was quantified. A summary global cognition score at 3 months following injury was used as the primary outcome.

RESULTS

142 patients (age mean + / - standard deviation 32 + / - 13 years; 131 [92%] men) survived with a mean global cognition score of 81 + / - 15; nearly one third were considered to have poor functional outcome. 89 of 142 (63%) patients underwent cEEG, of whom 13 of 89 (15%) had severe IIC patterns. The quantitative burden of IIC patterns correlated inversely with the global cognition score (r =  - 0.57; p = 0.04). In multiple variable analysis, the log-transformed burden of severe IIC patterns was independently associated with the global cognition score after controlling for demographics, premorbid estimated intelligence, injury severity, sedatives, and antiepileptic drugs (odds ratio 0.73, 95% confidence interval 0.60-0.88; p = 0.002).

CONCLUSIONS

The burden of seizures and abnormal periodic or rhythmic patterns was independently associated with worse cognition at 3 months following TBI. Their impact on longer-term cognitive endpoints and the potential benefits of seizure detection and treatment in this population warrant prospective study.

Reading and alexia

Alexia refers to a reading disorder caused by some form of acquired brain pathology, most commonly a stroke or tumor, in a previously literate subject. In neuropsychology, a distinction is made between central alexia (commonly seen in aphasia) and peripheral alexia (a perceptual or attentional deficit). The prototypical peripheral alexia is alexia without agraphia (pure alexia), where patients can write but are impaired in reading words and letters. Pure alexia is associated with damage to the left ventral occipitotemporal cortex (vOT) or its connections. Hemianopic alexia is associated with less extensive occipital damage and is caused by a visual field defect, which creates problems reading longer words and passages of text. Reading impairment can also arise due to attentional deficits, most commonly following right hemisphere or bilateral lesions. Studying patients with alexia, along with functional imaging studies of normal readers, has improved our understanding of the neurobiological processes involved in reading. A key question is whether an area in the left ventral occipitotemporal cortex is specialized for or selectively involved in word processing, or whether reading relies on tuning of more general purpose perceptual areas. Reading deficits may also be observed in dementia and traumatic brain injury, but often with less consistent deficit patterns than in patients with focal lesions.

Word-reading ability as a "hold test" in cognitively normal young adults with history of concussion and repetitive head impact exposure: A CARE Consortium Study

Objective: Neuropsychological evaluations include hold tests like word-reading ability as estimates of premorbid intellect thought to be resilient to the effects of neurologic insult. We tested the alternative hypothesis that exposure to concussion or repetitive subclinical head impacts throughout early life may stunt acquisition of word-reading skills.Method: Data were obtained from student-athletes within the CARE Consortium that completed the Wechsler Test of Adult Reading (WTAR). Measures of head trauma burden included self-reported concussion history and cumulative years of exposure to collision sports. We evaluated the effects of head trauma, sociodemographic (race, SES), and academic (SAT/ACT scores, learning disorder) variables on WTAR standard score using linear regression. Analyses were repeated in a football-only subsample estimating age of first exposure to football as a predictor.Results: We analyzed data from 6,598 participants (72.2% white, 39.6% female, mean ± SD age = 18.8 ± 1.2 years). Head trauma variables collectively explained 0.1% of the variance in WTAR standard scores, with years of collision sport exposure weakly predicting lower WTAR standard scores (β = .026-.035, very small effect). In contrast, sociodemographic and academic variables collectively explained 20.9-22.5% of WTAR standard score variance, with strongest effects noted for SAT/ACT scores (β = .313-.337, medium effect), LD diagnosis (β = -.115 to -.131, small effect), and SES (β = .101-.108, small effect). Age of first exposure to football did not affect WTAR scores in a football-only sample.Conclusion: Wechsler Test of Adult Reading performance appears unrelated to history of self-reported concussion(s) and/or repetitive subclinical head trauma exposure in current collegiate athletes. Sociodemographic and academic variables should be incorporated in test score interpretations for diverse populations like athletes.

The Role of Cognitive Reserve in Recovery From Traumatic Brain Injury

OBJECTIVE

To examine whether cognitive reserve (CR) attenuates the initial impact of traumatic brain injury (TBI) on cognitive performance (neural reserve) and results in faster cognitive recovery rates in the first year postinjury (neural compensation), and whether the advantage of CR differs on the basis of the severity of TBI.

SETTING

Inpatient/outpatient clinics at an academic medical center.

PARTICIPANTS

Adults with mild TBI (mTBI; n = 28), complicated mild TBI (cmTBI; n = 24), and moderate to severe TBI (msevTBI; n = 57), and demographically matched controls (n = 66).

DESIGN

Retrospective, longitudinal cohort assessed at 1, 6, and 12 months postinjury.

MAIN MEASURES

Outcomes were 3 cognitive domains: processing speed/executive function, verbal fluency, and memory. Premorbid IQ, estimated with the Wechsler Test of Adult Reading, served as CR proxy.

RESULTS

Higher premorbid IQ was associated with better performance on cognitive domains at 1 month postinjury, and the effect of IQ was similarly beneficial for all groups. Cognitive recovery rate was moderated only by TBI severity; those with more severe TBI had faster recovery in the first year.

CONCLUSION

Results support only the neural reserve theory of CR within a TBI population and indicate that CR is neuroprotective, regardless of the degree of TBI. Higher premorbid CR does not allow for more rapid adaptation and recovery from injury.

The Influence of Cognitive Reserve on Recovery from Traumatic Brain Injury

Objective

we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance.

Method

retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury.

Results

regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model.

Conclusions

cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.

Nih toolbox premorbid ability adjustments: Application in a traumatic brain injury sample

PURPOSE/OBJECTIVE

Metrics to estimate premorbid cognitive ability, such as word reading tests, are important for clinical determination of cognitive changes following brain injury. In the present study, reading adjusted scores for the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) fluid tests were developed and validated with a sample of individuals with traumatic brain injury (TBI), to evaluate the clinical utility of reading-adjusted scores. Research Method/Design: The development sample included 843 adult participants, ages 20-85, from the NIHTB-CB standardization sample. A sample of 158 participants with complicated mild or moderate TBI (n = 74) or severe TBI (n = 84) were administered the NIHTB-CB, and comprised the validation sample. Scores were derived for the five fluid tests using four adjustment models: age-only, demographic-only, age-and-reading, and demographic-and-reading referenced scores.

RESULTS

Estimated premorbid ability varies depending on the reference model. Scores from each of the four reference models differentiated the comparison and TBI samples at the group level. However, performance varied by premorbid ability.

CONCLUSIONS/IMPLICATIONS

Premorbid ability affects identification of cognitive difficulties after TBI. Reading referenced scores provide an individualized estimate of the effects of premorbid ability than demographic characteristics alone. Each model identified a similar number of individuals as having cognitive difficulties; however, the models differed on which individuals had cognitive difficulties. The models had higher disagreement rates in the clinical compared with the comparison sample, particularly for individuals with lower premorbid ability. Clinical use and caveats are discussed. (PsycINFO Database Record

Acute prediction of outcome and cognitive-communication impairments following traumatic brain injury: The influence of age, education and site of lesion

BACKGROUND

Communication impairment following a traumatic brain injury (TBI) has been well documented, yet information regarding communication skills in the acute period following the injury is limited in the literature. Also, little is known about the influence of TBI severity (mild, moderate or severe) on cognitive-communication impairments and how these impairments are related to short-term functional outcome. The goal of this study was to assess the performance of adults with mild, moderate and severe TBI on different language tests and to determine how this performance is related to functional capacity. We also aimed to explore which variables among age, sex, education, TBI severity and site of cerebral damage would predict initial language impairments.

METHODS

Several language tests were administered to a sample of 145 adult patients with TBI of a range of severities admitted to an acute care service and to 113 healthy participants from the community.

RESULTS

TBI patients of a range of severities performed poorly on all language tests in comparison to the healthy controls. In addition, patients with mild TBI performed better than the moderate and severe groups, except on the reading test and on the semantic naming test. In addition, their performance on verbal fluency, conversational discourse and procedural discourse tasks predicted acute functional outcome. Finally, age, education and TBI severity and site of lesion predicted some language performance. A left temporal lesion was associated with poorer performance in conversational discourse and auditory comprehension tasks, a left frontal lesion with a decrease in the verbal fluency results and a right parietal lesion with decreased auditory comprehension and reasoning skills.

CONCLUSION

Health care professionals working in the acute care setting should be aware of the possible presence of cognitive-communication impairments in patients with TBI, even for those with mild TBI. These deficits can lead to functional communication problems and assistance may be required for tasks frequently encountered in acute care requiring intact comprehension and expression.

The Wechsler Test of Adult Reading as a Measure of Premorbid Intelligence Following Traumatic Brain Injury

OBJECTIVE

The current study sought to determine whether the Wechsler Test of Adult Reading (WTAR) provides a stable estimate of premorbid intellectual ability in acutely injured patients recovering from traumatic brain injury (TBI).

METHOD

A total of 135 participants (43 mild TBI [mTBI], 40 moderate/severe TBI [msevTBI], 52 healthy controls) were administered the WTAR at 1 and 12 months post-injury.

RESULTS

Despite similar demographic profiles, participants with msevTBI performed significantly worse than controls on the WTAR at both time points. Moreover, the msevTBI group had a significant improvement in WTAR performance over the 1-year period. In contrast, those participants with mTBI did not significantly differ from healthy controls and both the mTBI and control groups demonstrated stability on the WTAR over time.

CONCLUSIONS

Results indicate that word-reading tests may underestimate premorbid intelligence during the immediate recovery period for patients with msevTBI. Clinicians should consider alternative estimation measures in this TBI subpopulation.

Rates of Abnormally Low TOPF Word Reading Scores in Individuals Failing Versus Passing Performance Validity Testing

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer’s dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.

Deficits in comprehension of speech acts after TBI: The role of theory of mind and executive function

Theory of mind (ToM) is critical to effective communication following traumatic brain injury (TBI) however, whether impairments are specific to social cognition, or reflective of executive demands is unclear. This study examined whether ToM impairments are predicted by executive function difficulties using everyday conversation tasks. Twenty-five individuals with severe-TBI were compared to 25 healthy controls on low- and high-ToM tasks across four conditions: (1) low cognitive load, (2) high flexibility, (3) high working memory (WM) and (4) high inhibition. TBI individuals were impaired on high-ToM tasks in the WM condition. When the WM demands of the task were controlled, the impairments were no longer apparent. TBI individuals were not impaired on high-ToM tasks in the inhibition and flexibility conditions, suggesting these tasks may not have been sufficiently demanding of ToM abilities. The results suggest that ToM impairments in everyday communication may arise due to WM demands, in individuals with TBI.

Abnormal White Matter Blood-Oxygen-Level-Dependent Signals in Chronic Mild Traumatic Brain Injury

Concussion, or mild traumatic brain injury (mTBI), can cause persistent behavioral symptoms and cognitive impairment, but it is unclear if this condition is associated with detectable structural or functional brain changes. At two sites, chronic mTBI human subjects with persistent post-concussive symptoms (three months to five years after injury) and age- and education-matched healthy human control subjects underwent extensive neuropsychological and visual tracking eye movement tests. At one site, patients and controls also performed the visual tracking tasks while blood-oxygen-level-dependent (BOLD) signals were measured with functional magnetic resonance imaging. Although neither neuropsychological nor visual tracking measures distinguished patients from controls at the level of individual subjects, abnormal BOLD signals were reliably detected in patients. The most consistent changes were localized in white matter regions: anterior internal capsule and superior longitudinal fasciculus. In contrast, BOLD signals were normal in cortical regions, such as the frontal eye field and intraparietal sulcus, that mediate oculomotor and attention functions necessary for visual tracking. The abnormal BOLD signals accurately differentiated chronic mTBI patients from healthy controls at the single-subject level, although they did not correlate with symptoms or neuropsychological performance. We conclude that subjects with persistent post-concussive symptoms can be identified years after their TBI using fMRI and an eye movement task despite showing normal structural MRI and DTI.

Visuospatial Learning in Traumatic Brain Injury: An Examination of Impairments using the Computerised Austin Maze Task

An important aspect of cognitive functioning that is often impaired following traumatic brain injury (TBI) is visuospatial learning and memory. The Austin Maze task is a measure of visuospatial learning that has a long history in both clinical neuropsychological practice and research, particularly in individuals with TBI. The aim of this study was to evaluate visuospatial learning deficits following TBI using a new computerised version of the Austin Maze task. Twenty-eight individuals with moderate-to-severe TBI were compared to 28 healthy controls on this task, together with alternative neuropsychological measures, including the WAIS-III Digit Symbol and Digit Span subtests, the Trail Making Test, WMS-III Logical Memory, and Rey Osterrieth Complex Figure Test. The results demonstrated that TBI individuals performed significantly more poorly on the Austin Maze task than control participants. The Austin Maze task also demonstrated good convergent and divergent validity with the alternative neuropsychological measures. Thus, the computerised version of the Austin Maze appears to be a sensitive measure that can detect visuospatial learning impairments in individuals with moderate-to-severe TBI. The new computerised version of the task offers much promise in that it is more accessible and easier to administer than the conventional form of the test.

Risky sexual behavior among college students With ADHD: is the mother-child relationship protective?

OBJECTIVE

This study examined the extent to which ADHD was associated with risky sexual behaviors (RSBs) in a sample of 92 undergraduates with (n = 44) and without (n = 48) ADHD. Mother-child relationship quality was examined as a potential moderator.

METHOD

We conducted comprehensive assessments for ADHD and comorbid conditions and collected measures of RSB and mother-child relationship quality.

RESULTS

Female students with ADHD were least likely to use condoms than males overall and females without ADHD. An interaction between ADHD and mother-child relationship quality accounted for significant variance in the number of past-year sexual partners, such that a high-quality relationship was protective only for students with ADHD. No other significant associations were found between ADHD and RSB.

CONCLUSION

Results suggest that female college students with ADHD are at risk for unprotected sex. Moreover, a positive mother-child relationship may be protective for college students with ADHD in relation to RSB.

Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes

OBJECTIVE

Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2 ) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions.

METHODS

This randomized, double-blind, sham-controlled study was conducted at the Naval Air Station in Pensacola, Florida on 61 male Marines with a history of mTBI and PCS. Intervention consisted of 40 once daily 60-minute hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA) at 1 of 3 randomly preassigned oxygen fractions, resulting in respective blinded groups with an oxygen-breathing exposure equivalent to (1) surface air (sham), (2) 100% oxygen at 1.5ATA, or (3) 100% oxygen at 2.0ATA. The main outcome measure was the Rivermead Post-Concussion Questionnaire-16 (RPQ-16) collected before compressions and at 2 later points.

RESULTS

The interaction of time by intervention group was not significant for improvement on the RPQ-16. Nor was there evidence of efficacy on the RPQ-16 for any subgroup. No significant time by intervention interaction was found for any functional, cognitive, or psychomotor secondary outcome measure at an unadjusted 0.05 significance level.

INTERPRETATION

Using a randomized control trial design and analysis including a sham, results showed no evidence of efficacy by 3 months post-compression to treat the symptomatic, cognitive, or behavioral sequelae of PCS after combat-related mTBI.

Randomized, Sham-Controlled, Feasibility Trial of Hyperbaric Oxygen for Service Members With Postconcussion Syndrome: Cognitive and Psychomotor Outcomes 1 Week Postintervention

Background Mild traumatic brain injury (mTBI) and residual postconcussion syndrome (PCS) are common among combatants of the recent military conflicts in Iraq and Afghanistan. Hyperbaric oxygen (HBO2) is a proposed treatment but has not been rigorously studied for this condition. Objectives In a secondary analysis, examine for possible effects on psychomotor (balance and fine motor) and cognitive performance 1 week after an HBO2 intervention in service members with PCS after mTBI. Methods A randomized, double-blind, sham control, feasibility trial comparing pretreatment and posttreatment was conducted in 60 male active-duty marines with combat-related mTBI and PCS persisting for 3 to 36 months. Participants were randomized to 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) at 2.0 atmospheres absolute (ATA), resulting in respective groups with an oxygen exposure equivalent to (1) breathing surface air (Sham Air), (2) 100% oxygen at 1.5 ATA (1.5 ATAO2), and (3) 100% oxygen at 2.0 ATA (2.0 ATAO2). Over a 10-week period, participants received 40 hyperbaric chamber sessions of 60 minutes each. Outcome measures, including computerized posturography (balance), grooved pegboard (fine motor speed/dexterity), and multiple neuropsychological tests of cognitive performance, were collected preintervention and 1-week postintervention. Results Despite the multiple sensitive cognitive and psychomotor measures analyzed at an unadjusted 5% significance level, this study demonstrated no immediate postintervention beneficial effect of exposure to either 1.5 ATAO2 or 2.0 ATAO2 compared with the Sham Air intervention. Conclusions These results do not support the use of HBO2 to treat cognitive, balance, or fine motor deficits associated with mTBI and PCS.

Structural and functional changes of the cingulate gyrus following traumatic brain injury: relation to attention and executive skills

Impairments of attention and executive functions are common sequelae of traumatic brain injury (TBI). The anterior cingulate is implicated in conflict-related task performance, such as the Stroop, and is susceptible to TBI-related injury due to its frontal location and proximity to the rough surface of the falx cerebri. We investigated the relationship between cingulate cortex volume and performance on tasks of selective attention and cognitive flexibility (single-trial Stroop and Auditory Consonant Trigrams [ACT]). Participants consisted of 12 adults with severe TBI and 18 controls. T1-weighted volumetric MRI data were analyzed using automated cortical reconstruction, segmentation, parcellation, and volume measurement. Cortical volume reductions were prominent bilaterally in frontal, temporal, and inferior parietal regions.Specific regional reduction of the cingulate cortex was observed only for cortical volume of right caudal anterior cingulate(cACC). The TBI group performed significantly worse than control participants on the Stroop and ACT tasks. Findings suggest that atrophy of the right cACC may contribute to reduced performance on executive function tasks, such as the Stroop and ACT, although this is likely but one node of an extensive brain network involved in these cognitive processes.

The STROBE statement and neuropsychology: lighting the way toward evidence-based practice

Reporting appropriate research detail across clinical disciplines is often inconsistent or incomplete. Insufficient report detail reduces confidence in findings, makes study replication more difficult, and decreases the precision of data available for critical review including meta-analysis. In response to these concerns, cooperative attempts across multiple specialties have developed explicit research reporting standards to guide publication detail. These recommendations have been widely adopted by high impact medical journals, but have not yet been widely embraced by neuropsychology. The STROBE Statement (STrengthening the Reporting of Observational studies in Epidemiology) is particularly relevant to neuropsychology since clinical research is often based on non-funded studies of patient samples. In this paper we describe the STROBE Statement and demonstrate how STROBE criteria, applied to reporting of neuropsychological findings, will maintain neuropsychology's position as a leader in quantifying brain-behavior relationships. We also provide specific recommendations for data reporting and disclosure of perceived conflicts of interest that will further enhance reporting transparency for possible perceived sources of bias. In an era in which evidence-based practice assumes an increasingly prominent role, improved reporting standards will promote better patient care, assist in developing quality practice guidelines, and ensure that neuropsychology remains a vigorous discipline in the clinical neurosciences that consciously aspires to high methodological rigor.

Adjustment of cognitive scores with a co-normed estimate of premorbid intelligence: implementation using mindstreams computerized testing

Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of +/-1 SD and 6 normalized units for scores of +/-2 SD. The present approach shows promise as a practical solution for assessment of high- and low-intelligence individuals.