1
|
Varela JL, Sperling SA, Block C, O’Leary K, Hart ES, Kiselica AM. A survey of neuropsychological assessment feedback practices among neuropsychologists. Clin Neuropsychol 2024; 38:529-556. [PMID: 37438247 PMCID: PMC10784416 DOI: 10.1080/13854046.2023.2233738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Feedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback. METHODS A survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals. RESULTS Nearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants. CONCLUSIONS Results provide an empirical summary of the "state of current practice" for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.
Collapse
Affiliation(s)
- Jacob L. Varela
- University of Missouri, Columbia, MO, 65211, USA
- Regent University, Virginia Beach, VA, 23464, USA
| | | | - Cady Block
- Emory University, Atlanta, GA, 30322, USA
| | | | - Eric S. Hart
- University of Missouri, Columbia, MO, 65211, USA
| | | |
Collapse
|
2
|
Kiselica AM, Kaser AN, Weitzner DS, Mikula CM, Boone A, Woods SP, Wolf TJ, Webber TA. Development and Validity of Norms for Cognitive Dispersion on the Uniform Data Set 3.0 Neuropsychological Battery. Arch Clin Neuropsychol 2024:acae005. [PMID: 38364295 DOI: 10.1093/arclin/acae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Cognitive dispersion indexes intraindividual variability in performance across a battery of neuropsychological tests. Measures of dispersion show promise as markers of cognitive dyscontrol and everyday functioning difficulties; however, they have limited practical applicability due to a lack of normative data. This study aimed to develop and evaluate normed scores for cognitive dispersion among older adults. METHOD We analyzed data from 4,283 cognitively normal participants aged ≥50 years from the Uniform Data Set (UDS) 3.0. We describe methods for calculating intraindividual standard deviation (ISD) and coefficient of variation (CoV), as well as associated unadjusted scaled scores and demographically adjusted z-scores. We also examined the ability of ISD and CoV scores to differentiate between cognitively normal individuals (n = 4,283) and those with cognitive impairment due to Lewy body disease (n = 282). RESULTS We generated normative tables to map raw ISD and CoV scores onto a normal distribution of scaled scores. Cognitive dispersion indices were associated with age, education, and race/ethnicity but not sex. Regression equations were used to develop a freely accessible Excel calculator for deriving demographically adjusted normed scores for ISD and CoV. All measures of dispersion demonstrated excellent diagnostic utility when evaluated by the area under the curve produced from receiver operating characteristic curves. CONCLUSIONS Results of this study provide evidence for the clinical utility of sample-based and demographically adjusted normative standards for cognitive dispersion on the UDS 3.0. These standards can be used to guide interpretation of intraindividual variability among older adults in clinical and research settings.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Alyssa N Kaser
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Cynthia M Mikula
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | | | - Timothy J Wolf
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Kiselica AM, Lin SSH, Ranum R, Mikula CM, Hermann G, Boone A, Scullin M, Mechanic-Hamilton D, Wolf T, Stevens A, Benge JF. The Technology in Caring Questionnaire: Development and Psychometric Properties. Alzheimer Dis Assoc Disord 2024; 38:77-84. [PMID: 38277628 PMCID: PMC10922679 DOI: 10.1097/wad.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE We developed the Technology in Caring Questionnaire (TCQ) to assess the use of technology-based strategies by dementia caregivers. METHODS One hundred caregivers completed a survey that included TCQ items along with measures of technology proficiency and patient and caregiver-centered outcomes. RESULTS The final 34-item TCQ scale had adequate to excellent internal consistency (raw Cronbach alpha = 0.75; standardized Cronbach alpha = 0.95; Guttman lambda-6 = 0.97). TCQ scores demonstrated modest convergent associations with scores from measures of smartphone ( r = 0.265, P < 0.01) and computer proficiency ( r = 0.230, P < 0.05) but a strong association with overall technology experience scores ( r = 0.578, P < 0.001). Elevated TCQ scores were associated with reduced informant-reported cognitive symptoms ( B = -0.003, P < 0.05), increased ability of caregivers to find support and information ( B = 0.03, P < 0.001), and increased direct care strain ( B = 0.03, P < 0.05), after controlling for dementia severity and demographics. CONCLUSION The TCQ has good psychometric properties for the assessment of technology-based care strategies among dementia caregivers. Findings imply that the use of technologies may aid in symptom management and finding support and information but may also increase caregiver strain.
Collapse
Affiliation(s)
| | | | - Rylea Ranum
- Department of Psychology, University of Houston—Austin
| | - Cynthia M. Mikula
- New York State Psychiatric Institute, Columbia University Irving Medical Center—Austin
| | - Greta Hermann
- Department of Health Psychology, University of Missouri—Austin
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri—Austin
| | - Michael Scullin
- Department of Psychology & Neuroscience, Baylor University—Austin
| | | | - Timothy Wolf
- Department of Occupational Therapy, University of Missouri—Austin
| | - Alan Stevens
- Center for Applied Health Research, Baylor Scott and White Health—Austin
| | - Jared F. Benge
- Department of Neurology and Mulva Clinic for the Neurosciences, University of Texas—Austin
| |
Collapse
|
4
|
Webber TA, Lorkiewicz SA, Kiselica AM, Woods SP. Ecological validity of cognitive fluctuations in dementia with Lewy bodies. J Int Neuropsychol Soc 2024; 30:35-46. [PMID: 37057867 PMCID: PMC10576013 DOI: 10.1017/s1355617723000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVES Cognitive fluctuations are a core clinical feature of dementia with Lewy bodies (DLB), but their contribution to the everyday functioning difficulties evident DLB are not well understood. The current study evaluated whether intraindividual variability across a battery of neurocognitive tests (intraindividual variability-dispersion) and daily cognitive fluctuations as measured by informant report are associated with worse daily functioning in DLB. METHODS The study sample included 97 participants with consensus-defined DLB from the National Alzheimer's Coordinating Center (NACC). Intraindividual variability-dispersion was measured using the coefficient of variation, which divides the standard deviation of an individual's performance scores across 12 normed neurocognitive indices from the NACC neuropsychological battery by that individual's performance mean. Informants reported on daily cognitive fluctuations using the Mayo Fluctuations Scale (MFS) and on daily functioning using the functional activities questionnaire (FAQ). RESULTS Logistic regression identified a large univariate association of intraindividual variability-dispersion and presence of daily cognitive fluctuations on the MFS (Odds Ratio = 73.27, 95% Confidence Interval = 1.38, 3,895.05). Multiple linear regression demonstrated that higher intraindividual variability-dispersion and presence of daily cognitive fluctuations as assessed by the MFS were significantly and independently related to worse daily functioning (FAQ scores). CONCLUSIONS Among those with DLB, informant-rated daily cognitive fluctuations and cognitive fluctuations measured in the clinic (as indexed by intraindividual variability-dispersion across a battery of tests) were independently associated with poorer everyday functioning. These data demonstrate ecological validity in measures of cognitive fluctuations in DLB.
Collapse
Affiliation(s)
- Troy A. Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry/Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sara A. Lorkiewicz
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Steven P. Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| |
Collapse
|
5
|
Benge JF, Aguirre A, Scullin MK, Kiselica AM, Hilsabeck RC, Paydarfar D, Douglas M. Internet-Enabled Behaviors in Older Adults During the Pandemic: Patterns of Use, Psychosocial Impacts, and Plans for Continued Utilization. Work Aging Retire 2024; 10:6-13. [PMID: 38196827 PMCID: PMC10772966 DOI: 10.1093/workar/waac026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In response to social distancing measures during the COVID-19 pandemic, there was a need to increase the frequency of internet enabled behaviors (IEBs). To date, little is known about how the pandemic impacted IEBs in older adults, a population that has historically been linked to lower digital literacy and utilization. We administered an online survey between April and July 2021 to 298 adults who were over age 50 (mean age = 73 years; 93.5% non-Hispanic white; 94% smart phone owners; 83.5% retired). Older adults self-reported IEBs for social, shopping, medical, and leisure activities during the pandemic, plans for continued use of these behaviors, and completed measures of psychosocial functioning. 66.8% of respondents reported an overall increase in IEBs during the pandemic, most notably for online meeting attendance. More frequent online meeting use was associated with less depression (r = -0.12, p = .04) and less loneliness (r = -0.14, p = .02). With regard to plans for continued use, 82.5% of the sample reported at least one IEB (M = 2.18, SD = 1.65) that they increased during the pandemic and planned to maintain over time (e.g., online shopping for household goods). Plans for continued use were more likely in participants who used IEBs more overall during the pandemic (r = 0.56, p < .001), and who frequently sought technical support on search engines (r = 0.22, p < .001), or online video sites (r = 0.16, p = .006). In summary, IEBs during the pandemic were associated with favorable psychosocial functioning and expectations for continued use in this sample of predominantly white older adults who had some baseline technological familiarity.
Collapse
Affiliation(s)
- Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Alyssa Aguirre
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Michael K Scullin
- Department of Psychology and Neurosciences, Baylor University, Waco, TX, United States
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - David Paydarfar
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Michael Douglas
- Georgetown Neuroscience Foundation, Georgetown, TX, United States
| |
Collapse
|
6
|
Kiselica AM, Johnson E, Lewis KR, Trout K. Examining racial disparities in the diagnosis of mild cognitive impairment. Appl Neuropsychol Adult 2023; 30:749-756. [PMID: 34554020 PMCID: PMC8940745 DOI: 10.1080/23279095.2021.1976778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Black individuals are less likely to receive an accurate diagnosis of mild cognitive impairment (MCI) than their White counterparts, possibly because diagnoses are typically made by a physician, often without reference to objective neuropsychological test data. We examined racial differences in actuarial MCI diagnoses among individuals diagnosed with MCI via semi-structured clinical interview (the Clinical Dementia Rating) to examine for possible biases in the diagnostic process. Participants were drawn from the National Alzheimer's Coordinating Center Uniform Data Set and included 491 individuals self-identifying as Black and 2,818 individuals self-identifying as White. Chi-square tests were used to examine racial differences in rates of low scores for each cognitive test (domains assessed included attention, processing speed/executive functioning, memory, language, and visual skills). Next, we tested for racial differences in probability of meeting actuarial criteria for MCI by race. Compared to Black participants diagnosed with MCI via clinical interview, White individuals diagnosed with MCI via clinical interview demonstrated significantly higher rates of low demographically-adjusted z-scores on tests of memory, attention, processing speed, and verbal fluency. Furthermore, White individuals were significantly more likely to meet actuarial criteria for MCI (71.60%) than Black individuals (57.90%). Results suggest there may be bias in MCI classification based on semi-structured interview, leading to over diagnosis among Black individuals and/or under diagnosis among White individuals. Examination of neuropsychological test data and use of actuarial approaches may reduce racial disparities in the diagnosis of MCI. Nonetheless, issues related to race-based norming and differential symptom presentations complicate interpretation of results.
Collapse
Affiliation(s)
- Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Ellen Johnson
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Kaleea R. Lewis
- Department of Public Health, University of Missouri, Columbia, MO, USA
- Department of Women’s and Gender Studies, University of Missouri, Columbia, MO, USA
| | - Kate Trout
- Department of Health Sciences, University of Missouri, Columbia, MO, USA
| |
Collapse
|
7
|
Gabbard J, Sadarangani TR, Datta R, Fabius CD, Gettel CJ, Douglas NF, Juckett LA, Kiselica AM, Murali KP, McCarthy EP, Torke AM, Callahan CM. Career development in pragmatic clinical trials to improve care for people living with dementia. J Am Geriatr Soc 2023; 71:3554-3565. [PMID: 37736669 PMCID: PMC10810339 DOI: 10.1111/jgs.18599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/23/2023]
Abstract
The growing number of people living with dementia (PLWD) requires a coordinated clinical response to deliver pragmatic, evidence-based interventions in frontline care settings. However, infrastructure to support such a response is lacking. Moreover, there are too few researchers conducting rigorous embedded pragmatic clinical trials (ePCTs) to make the vision of high quality, widely accessible dementia care a reality. National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease and Related Dementias Clinical Trials (IMPACT) Collaboratory seeks to improve the pipeline of early career researchers qualified to lead ePCTs by funding career development awards. Even with support from the Collaboratory, awardees face practical and methodological challenges to success, recently exacerbated by the COVID-19 pandemic. We first describe the training opportunities and support network for the IMPACT CDA recipients. This report then describes the unique career development challenges faced by early-career researchers involved in ePCTs for dementia care. Topics addressed include challenges in establishing a laboratory, academic promotion, mentoring and professional development, and work-life balance. Concrete suggestions to address these challenges are offered for early-career investigators, their mentors, and their supporting institutions. While some of these challenges are faced by researchers in other fields, this report seeks to provide a roadmap for expanding the work of the IMPACT Collaboratory and initiating future efforts to recruit, train, and retain talented early-career researchers involved in ePCTs for dementia care.
Collapse
Affiliation(s)
- Jennifer Gabbard
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | | | - Rupak Datta
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Chanee D. Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cameron J. Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Natalie F. Douglas
- Department of Communication Sciences and Disorders, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mt. Pleasant, Michigan
| | - Lisa A Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Andrew M. Kiselica
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, Missouri
| | | | - Ellen P. McCarthy
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexia M. Torke
- Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Christopher M. Callahan
- Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| |
Collapse
|
8
|
Botezatu MR, Miller E, Kiselica AM. Limited connectedness of spontaneous speech may be a marker of dementia due to Alzheimer's disease. Front Aging Neurosci 2023; 15:1252614. [PMID: 37794978 PMCID: PMC10546011 DOI: 10.3389/fnagi.2023.1252614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
The study evaluated the connectedness of spontaneous speech production in individuals with dementia as a potential predictor of dementia severity. Data were derived from the baseline sample of 143 individuals with dementia in the English Pitt corpus. Dementia severity was assessed via the Mini Mental Status Exam, the Mattis Dementia Rating Scale, and the Blessed Dementia Scale. Language abilities were evaluated using verbal fluency and picture description tasks. Graph analysis was carried out for the picture description task using the computational tool SpeechGraphs to calculate connectedness. Results demonstrated that higher educational attainment, higher verbal fluency and strongly-connected spontaneous speech were associated with better cognitive function. Results suggest that automated language processing approaches, such as graph structure analysis, may provide a faster and ecologically valid method of detecting dementia symptoms.
Collapse
Affiliation(s)
- Mona Roxana Botezatu
- Department of Speech, Language and Hearing Sciences, University of Missouri, Columbia, MO, United States
| | - Erika Miller
- Department of Speech, Language and Hearing Sciences, University of Missouri, Columbia, MO, United States
| | - Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
| |
Collapse
|
9
|
Stojanovic M, Waters AB, Kiselica AM, Benge JF. The impact of technology-based compensatory behaviors on subjective cognitive decline in older adults with a family history of dementia. Appl Neuropsychol Adult 2023:1-9. [PMID: 37647340 DOI: 10.1080/23279095.2023.2247109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current study examined whether greater use of technology to help with daily tasks is associated with less subjective cognitive decline (SCD), especially in individuals with a family history of Alzheimer's disease (AD). Individuals over the age of 50 (n = 102; age range 50-85) completed surveys about their digital and analog approaches to daily tasks, physical activity, and SCD. Participants with and without family histories of AD were matched on age, education, sex, and family history of AD using the R package MatchIt. There was no main effect of technology-based behavioral strategies on SCD (p = 0.259). However, a family history of AD moderated the association between technology use and SCD even when controlling for another protective lifestyle factor, physical activity. In individuals with a family history of AD, more reliance on technology-based behavioral strategies was associated with less SCD (p = 0.018), but this relationship was not significant in individuals without family history of AD (p = 0.511). Our findings suggest that technology-based behavioral strategies are associated with less SCD in individuals with a family history of AD, independent of another protective lifestyle factor. Future recommendations provided by healthcare providers to address SCD in cognitively unimpaired older adults might include focusing on technological assistance.
Collapse
Affiliation(s)
- Marta Stojanovic
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, MO, USA
| | - Abigail B Waters
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychology, Suffolk University, Boston, MA, USA
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
10
|
Kiselica AM, Karr JE, Mikula CM, Ranum RM, Benge JF, Medina LD, Woods SP. Recent Advances in Neuropsychological Test Interpretation for Clinical Practice. Neuropsychol Rev 2023:10.1007/s11065-023-09596-1. [PMID: 37594687 DOI: 10.1007/s11065-023-09596-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/28/2023] [Indexed: 08/19/2023]
Abstract
Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA.
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Cynthia M Mikula
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| | - Rylea M Ranum
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA
| | - Jared F Benge
- Department of Neurology, University of Texas-Austin, TX, Austin, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | | |
Collapse
|
11
|
Benge JF, Kiselica AM, Aguirre A, Hilsabeck RC, Douglas M, Paydarfar D, Scullin MK. Technology use and subjective cognitive concerns in older adults. Arch Gerontol Geriatr 2023; 106:104877. [PMID: 36459914 PMCID: PMC9868079 DOI: 10.1016/j.archger.2022.104877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES How technology impacts the day to day cognitive functioning of older adults is a matter of some debate. On the one hand, the use of technologies such as smartphones and social media, may lead to more subjective cognitive concerns (SCC) by promoting distractibility and reliance on devices to perform memory tasks. However, continued digital engagement in older adults may also be related to better cognitive functioning. Given these competing viewpoints, our study evaluated if frequency of digital device use was associated with greater or less subjective cognitive concerns. METHOD Participants were 219 adults over the age of 65 (mean age =75 years) who had internet access. Measures assessing frequency of digital device use along with SCC were administered. Hierarchical multiple regression was used to gage association between frequency of device use and SCC, controlling for relevant demographic and lifestyle factors. RESULTS Increased frequency of digital device use was associated with less SCC, over and above the influence of demographic factors, across cognitive (but especially in executive) domains. This effect was observed for general device usage, with no statistically significant associations were observed between texting/video call, social media use and SCC. DISCUSSION Results were broadly consistent with the technological reserve hypothesis in that digital engagement was associated with better experienced cognitive functioning in older adults. While device use may contribute to distractibility in certain cases, the current results add to a burgeoning literature that digital engagement may be a protective factor for cognitive changes with age.
Collapse
Affiliation(s)
- Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA.
| | | | - Alyssa Aguirre
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA; Steve Hick's School of Social Work, University of Texas at Austin, Austin TX USA
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA
| | | | - David Paydarfar
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA
| | - Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco TX USA
| |
Collapse
|
12
|
Kaser AN, Kaplan DM, Goette W, Kiselica AM. The impact of conventional versus robust norming on cognitive characterization and clinical classification of MCI and dementia. J Neuropsychol 2023; 17:108-124. [PMID: 36124357 PMCID: PMC10006397 DOI: 10.1111/jnp.12289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
We examined the impact of conventional versus robust normative approaches on cognitive characterization and clinical classification of MCI versus dementia. The sample included participants from the National Alzheimer's Coordinating Center Uniform Data Set. Separate demographically adjusted z-scores for cognitive tests were derived from conventional (n = 4273) and robust (n = 602) normative groups. To assess the impact of deriving scores from a conventional versus robust normative group on cognitive characterization, we examined likelihood of having a low score on each neuropsychological test. Next, we created receiver operating characteristic (ROC) curves for the ability of normed scores derived from each normative group to differentiate between MCI (n = 3570) and dementia (n = 1564). We examined the impact of choice of normative group on classification accuracy by comparing sensitivity and specificity values and areas under the curves (AUC). Compared with using a conventional normative group, using a robust normative group resulted in a higher likelihood of low cognitive scores for individuals classified with MCI and dementia. Comparison of the classification accuracy for distinguishing MCI from dementia did not suggest a statistically significant advantage for either normative approach (Z = -0.29, p = .77; AUC = 0.86 for conventional and AUC = 0.86 for robust). In summary, these results indicate that using a robust normative group increases the likelihood of characterizing cognitive performance as low. However, there is not a clear advantage of using a robust over a conventional normative group when differentiating between MCI and dementia.
Collapse
Affiliation(s)
- Alyssa N. Kaser
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David M. Kaplan
- Department of Economics, University of Missouri, Columbia, Missouri, USA
| | - William Goette
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
13
|
Waters AB, Williamson JB, Kiselica AM. Psychometric properties of the Autonomic Symptoms Checklist in the Lewy body disease module of the uniform dataset. Int J Geriatr Psychiatry 2022; 37. [PMID: 36380553 DOI: 10.1002/gps.5838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Autonomic dysfunction is an important feature of Lewy Body Dementia (DLB), but measurement of autonomic symptoms has been limited in both previous research and clinical practice. Accurate measurement of autonomic dysfunction has the potential to improve our understanding of the course and progression of DLB, given that autonomic symptoms typically precede cognitive impairment and are associated with functional impairment. The primary aim of this study was to examine the psychometric properties of the two versions (3.0 and 3.1) of the NACC LBD-module Autonomic Symptom Checklist (ASC). METHODS Psychometric analyses of the ASC (internal consistency, reliability, factor structure, and validity) were conducted on data acquired from 245 individuals with DLB from the NACC database. ASC V3.0 was contrasted on these attributes to V3.1. RESULTS Results suggested an underlying factor structure for the ASC, and confirmatory factor analysis (CFA) revealed 3 factors, which generally aligned with discrete autonomic systems. The ASC V3.0 and CFA-identified scales were comparable in terms of reliability, which were both improved relative to the ASC V3.1. In terms of ecological validity, CFA-identified items related to gastrointestinal/thermoregulation symptoms were significantly more associated with functional outcomes compared to the unitary ASC. CONCLUSION Findings underscore the importance of differentiation within the autonomic system. Future research into autonomic symptom classes and lab-based pathophysiological measurement of autonomic dysfunction in DLB has the potential to support early identification and inform treatment planning.
Collapse
Affiliation(s)
- Abigail B Waters
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA.,Department of Psychology, Suffolk University, Boston, Massachusetts, USA.,North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - John B Williamson
- North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, Florida, USA.,Center for Obsessive Compulsive and Anxiety Related Disorder, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
14
|
Abstract
OBJECTIVE Cognitive fluctuations are characteristic of dementia with Lewy bodies (DLB) but challenging to measure. Dispersion-based intra-individual variability (IIV-d) captures neurocognitive performance fluctuations across a test battery and may be sensitive to cognitive fluctuations but has not been studied in DLB. METHOD We report on 5,976 participants that completed the uniform data set 3.0 neuropsychological battery (UDS3NB). IIV-d was calculated via the intra-individual standard deviation across 12 primary UDS3NB indicators. Separate models using mean USD3NB score and the Montreal cognitive assessment (MoCA) total score tested the reproducibility of the incremental value of IIV-d over-and-above global cognition. Binary logistic regressions tested whether IIV-d could classify individuals with and without clinician-rated cognitive fluctuations. Multinomial logistic regressions tested whether IIV-d could differentiate participants with DLB, participants with Alzheimer's disease (AD), and participants with healthy cognition (CH), as well as the incremental diagnostic utility of IIV-d over-and-above clinician-rated cognitive fluctuations. RESULTS IIV-d exhibited large univariate associations with clinician-rated and non-clinician-informant reported cognitive fluctuations, which persisted when adjusting for MoCA but not the full battery mean. Of diagnostic relevance, greater IIV-d was consistently associated with DLB and AD relative to CH over-and-above global cognition and clinician-rated cognitive fluctuations. Greater IIV-d was less consistently associated with an increased probability of DLB relative to AD when controlling for global cognition. CONCLUSIONS IIV-d accurately differentiates DLB from CH over-and-above global cognition and clinician-rated cognitive fluctuations. IIV-d may supplement a thorough clinical interview of cognitive fluctuations and serve as a standardized performance-based indicator of this transdiagnostic phenomenon. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Troy A. Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | | | | | | |
Collapse
|
15
|
Guess TM, Bliss R, Hall JB, Kiselica AM. Comparison of Azure Kinect overground gait spatiotemporal parameters to marker based optical motion capture. Gait Posture 2022; 96:130-136. [PMID: 35635988 DOI: 10.1016/j.gaitpost.2022.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instrumented measurement of spatiotemporal parameters during walking can provide valuable information on an individual's overall function and health. Efficient, inexpensive, and accurate measurement of overground walking spatiotemporal parameters would be a critical component of providing point-of-care assessments of gait function, concussion recovery, fall-risk, and cognitive decline. Depth cameras combined with skeleton pose tracking algorithms, such as the Microsoft Kinect with body tracking software, have been used to measure walking spatiotemporal parameters. However, the ability of the latest generation Microsoft Kinect sensor, the Azure Kinect, to accurately measure overground walking spatiotemporal parameters has not been evaluated in the literature. RESEARCH QUESTION The purpose of this work was to compare overground walking spatiotemporal parameters measurements from a 12 camera Vicon optical motion capture system to measurements of a single Azure Kinect with body tracking SDK (software development kit). METHODS Spatiotemporal parameters of overground walking were simultaneously collected on twenty young healthy participants. Stride length, stride time, step length and step width were derived from ankle joint center locations and measurements from the two instruments were compared using descriptive statistics, scatter plots, Pearson correlation analyses, and Bland-Altman analyses. RESULTS Pearson correlation coefficients were greater than 0.87 for all spatiotemporal parameters with most parameters demonstrating very strong (> 0.9) agreement. The mean of the differences for stride length between measurements was 35.6 mm for the left limb and 39.1 mm for the right limb, both of which are less than 3% of average stride length. Mean of the differences for step width and stride time were less than 2% and 1% of their averages respectively. SIGNIFICANCE A single Microsoft Azure Kinect with body tracking SDK can provide clinically relevant measurement of walking spatiotemporal parameters, providing accessible and objective measurements that can improve clinical decision making across a variety of patient populations.
Collapse
Affiliation(s)
- Trent M Guess
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
| | - Rebecca Bliss
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Jamie B Hall
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| |
Collapse
|
16
|
Rosado‐Bruno M, Reyes M, Kiselica AM. Norms for Hispanic older adults on the National Alzheimer’s Coordinating Center’s Uniform Data Set 3.0 Neuropsychological Battery. Alzheimers Dement 2021. [DOI: 10.1002/alz.051056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mónica Rosado‐Bruno
- University of Missouri Columbia MO USA
- Carlos Albizu University San Juan PR USA
| | | | | |
Collapse
|
17
|
Kiselica AM, Benge J. An item response theory approach to clinical diagnosis of MCI and dementia: Illustrations from ADNI and NACC data. Alzheimers Dement 2021. [DOI: 10.1002/alz.049773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
18
|
O'Leary K, Kiselica AM. Examining the impact of sleep apnea on the ability to participate in cognitive testing among older adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
19
|
Kiselica AM. Empirically defining the preclinical stages of the Alzheimer's continuum in the Alzheimer's Disease Neuroimaging Initiative. Psychogeriatrics 2021; 21:491-502. [PMID: 33890392 PMCID: PMC8819647 DOI: 10.1111/psyg.12697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
AIM The National Institute on Aging and the Alzheimer's Association published new research criteria defining the Alzheimer's continuum (AC) by the presence of positive amyloid-β biomarkers. Symptom severity of those on the AC is staged across six levels, including two preclinical stages (stages 1 and 2). AC stage 2 is defined by the presence of at least one of the following: (i) transitional cognitive decline; (ii) subjective cognitive decline; or (iii) neurobehavioural symptoms. In contrast, AC stage 1 is defined by the absence of symptoms. METHODS Initial empirical definitions for each symptom class were developed. These empirical criteria were then applied in a sample of 285 cognitively normal, amyloid-positive individuals from the Alzheimer's Disease Neuroimaging Initiative for purposes of AC stage 1 and 2 classification. RESULTS In this sample, 56.10% of participants were asymptomatic and classified as AC stage 1. In contrast, 42.46% of individuals were positive for at least one symptom class: 22.11% for transitional cognitive decline, 20.35% for subjective cognitive decline, and 14.74% for neurobehavioural symptoms. AC stage was a predictor of cognitive/functional decline over 4 years of follow up in a longitudinal growth model (B = 0.33, P < 0.001). CONCLUSIONS Results provide a methodology to operationalize the National Institute on Aging and the Alzheimer's Association AC stage 1 and 2 criteria and include preliminary evidence of the validity of this approach. The methods outlined in this manuscript can be used to test hypotheses regarding prodromal Alzheimer's disease, as well as implemented in clinical trial selection procedures.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| | | |
Collapse
|
20
|
Kosky KM, Phenis R, Kiselica AM. Neuropsychological functioning in dysgenesis of the corpus callosum with colpocephaly. Appl Neuropsychol Adult 2021; 29:1681-1687. [PMID: 33721503 DOI: 10.1080/23279095.2021.1897008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dysgenesis of the corpus callosum is a rare developmental abnormality in brain structure that is associated with changes in physical appearance, as well as behavioral and cognitive consequences. A relatively commonly co-occurring structural abnormality with callosal dysgenesis is colpocephaly, characterized by enlargement of the posterior lateral ventricles and reductions in posterior brain volume. Although some case studies of individuals with this combination of structural malformations exist, they do not often report results of neuropsychological evaluation. Furthermore, those that do contain neuropsychological data may be of limited generalizability due to unique patient characteristics. The current manuscript overcomes these limitations by presenting the case of a 55-year-old male with callosal dysgenesis and colpocephaly identified in adulthood. The paper includes a full profile of his performance on a comprehensive neuropsychological test battery with discussion of differential diagnosis and treatment planning. Findings indicated low average intellectual abilities with deficits in processing speed, executive functions, and social cognition, consistent with expectations based on callosal dysgenesis. One surprising finding was that despite the significant posterior involvement of colpocephaly, visuospatial skills were a relative strength. The manuscript provides a clear characterization of callosal dysgenesis with colpocephaly to facilitate future clinical comparisons and set the stage for future research on this rare neuromorphological presentation.
Collapse
Affiliation(s)
- Karen M Kosky
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | | | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA.,University of Missouri, Columbia, MO, USA
| |
Collapse
|
21
|
Brannick MT, French KA, Rothstein HR, Kiselica AM, Apostoloski N. Capturing the underlying distribution in meta-analysis: Credibility and tolerance intervals. Res Synth Methods 2021; 12:264-290. [PMID: 33543583 DOI: 10.1002/jrsm.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 01/28/2021] [Indexed: 11/08/2022]
Abstract
Tolerance intervals provide a bracket intended to contain a percentage (e.g., 80%) of a population distribution given sample estimates of the mean and variance. In random-effects meta-analysis, tolerance intervals should contain researcher-specified proportions of underlying population effect sizes. Using Monte Carlo simulation, we investigated the coverage for five relevant tolerance interval estimators: the Schmidt-Hunter credibility intervals, a prediction interval, two content tolerance intervals adapted to meta-analysis, and a bootstrap tolerance interval. None of the intervals contained the desired percentage of coverage at the nominal rates in all conditions. However, the prediction worked well unless the number of primary studies was small (<30), and one of the content tolerance intervals approached nominal levels with small numbers (<20) of primary studies. The bootstrap tolerance interval achieved near nominal coverage if there were sufficient numbers of primary studies (30+) and large enough sample sizes (N ≅ 70) in the included primary studies, although it slightly exceeded nominal coverage with large numbers of large-sample primary studies. Next, we showed the results of applying the intervals to real data using a set of previously published analyses and provided suggestions for practice. Tolerance intervals incorporate error of estimation into the construction of proper brackets for fractions of population true effects. In many contexts, such intervals approach the desired nominal levels of coverage.
Collapse
Affiliation(s)
| | - Kimberly A French
- Department of Psychology, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Hannah R Rothstein
- Narendra Paul Loomba Department of Management, Baruch College, New York, New York, USA
| | - Andrew M Kiselica
- Psychology Department, University of South Florida, Tampa, Florida, USA
| | - Nenad Apostoloski
- Department of Economics and Business, Central European University, Budapest, Hungary
| |
Collapse
|
22
|
Kiselica AM, Johnson E, Benge JF. How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores. J Neuropsychol 2021; 15:410-427. [PMID: 33655681 DOI: 10.1111/jnp.12243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow-up evaluations. We analysed data from 9,263 older adults from the National Alzheimer's Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ2 (4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ2 (3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow-up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow-up, χ2 (4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow-up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow-up, χ2 (3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| | - Ellen Johnson
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA.,Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Jared F Benge
- Department of Neurology, University of Texas at Austin, Texas, USA
| |
Collapse
|
23
|
Kiselica AM, Benge JF. Neuropsychological Equivalence of the Clinical Diagnosis of Mild Cognitive Impairment in the National Alzheimer's Coordinating Center Uniform Data Set and Alzheimer's Disease Neuroimaging Initiative. Dement Geriatr Cogn Disord 2021; 50:231-236. [PMID: 34186536 PMCID: PMC8819646 DOI: 10.1159/000516413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Our understanding of Alzheimer's disease may be improved by harmonizing data from large cohort studies of older adults. Differences in the way clinical conditions, like mild cognitive impairment (MCI), are diagnosed may lead to variability among participants that share the same diagnostic label. This variability presents a challenge for cohort harmonization and may lead to inconsistency in research findings. Little research to date has explored the equivalence of the diagnostic label of MCI across 2 of the largest and most influential cohort studies in the USA: the National Alzheimer's Coordinating Center (NACC) and the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS Participants with MCI due to presumed Alzheimer's disease from the NACC Uniform Data Set (n = 789) and ADNI (n = 131) were compared on demographic, psychological, and functional variables, as well as on an abbreviated neuropsychological battery common to the 2 data sets. RESULTS Though similar in terms of age, education, and functional status, the NACC sample was more diverse (17.4% non-White participants vs. 7.6% in ADNI; χ2 = 7.923, p = 0.005) and tended to perform worse on some cognitive tests. In particular, participants diagnosed with MCI in NACC were more likely to have clinically significant impairments on language measures (26.36-31.18%) than MCI participants in ADNI (16.03-19.85%). DISCUSSION The current findings suggest important differences in cognitive performances between 2 large MCI cohorts, likely reflective of differences in diagnostic criteria used in these 2 studies, as well as differences in sample compositions. Such diagnostic heterogeneity may make harmonizing data across these cohorts challenging. However, application of shared psychometric criteria across studies may lead to closer equivalence of MCI groups. Such approaches could pave the way for cohort harmonization and enable "big data" analytic approaches to understanding Alzhei-mer's to be developed.
Collapse
Affiliation(s)
- Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Jared F. Benge
- Department of Neurology, University of Texas – Austin, Austin, TX, USA
| | | |
Collapse
|
24
|
Kiselica AM, Kaser AN, Benge JF. An Initial Empirical Operationalization of the Earliest Stages of the Alzheimer's Continuum. Alzheimer Dis Assoc Disord 2021; 35:62-67. [PMID: 33009036 PMCID: PMC7904575 DOI: 10.1097/wad.0000000000000408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The Alzheimer's Continuum (AC) includes 2 preclinical stages defined by subjective cognitive complaints, transitional cognitive declines, and neurobehavioral symptoms. Operationalization of these stages is necessary for them to be applied in research. METHODS Cognitively normal individuals with known amyloid biomarker status were selected from the National Alzheimer's Coordinating Center Uniform Data Set. Participants and their caregivers provided information on subjective cognitive complaints, neurobehavioral features, and objective cognitive functioning. PATIENTS The sample included 101 amyloid positive (A+) and 447 amyloid negative (A-) individuals. RESULTS Rates of subjective cognitive complaints (A+: 34.90%, A-: 29.90%) and neurobehavioral symptoms (A+: 22.40%, A-: 22.40%) did not significantly differ between A+/- individuals. However, the frequency of transitional cognitive decline was significantly higher among A+ (38.00%) than A- participants (24.90%). We explored various empirical definitions for defining the early stages of the AC among A+ participants. Rates of classification into AC stage 1 versus AC stage 2 varied depending on the number of symptoms required: 57.40% versus 42.60% (1 symptom), 28.70% versus 71.30% (2 symptoms), and 6.90% versus 93.10% (all 3 symptoms). CONCLUSION The presence of 2 of the proposed symptom classes to separate AC stage 2 from stage 1 seems to provide a good empirical balance.
Collapse
Affiliation(s)
| | | | - Jared F. Benge
- Baylor Scott and White Health, Division of Neuropsychology
- Plummer Movement Disorders Center
- Texas A&M College of Medicine
| |
Collapse
|
25
|
Pollack SR, Kiselica AM, Borders A. The Role of Trait Impulsivity in the Associations between Rumination and Alcohol-Related Outcomes. Subst Use Misuse 2021; 56:743-750. [PMID: 33754939 DOI: 10.1080/10826084.2021.1879143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background/Purpose: Emerging adults engage in high rates of alcohol consumption, which contribute to negative alcohol-related consequences and alcohol-related aggression. Rumination, or repetitive thinking about negative experiences, predicts greater negative alcohol-related consequences and alcohol-related aggression. Mechanisms of these associations are not well understood. We examined whether impulsivity mediates the effect of rumination on alcohol-related outcomes. We also tested an alternative model in which impulsivity moderates the effect of rumination on these outcomes. Methods: In a cross-sectional study with 202 undergraduates, we assessed trait rumination, four facets of impulsivity (urgency, premeditation, perseverance, and sensation seeking), recent alcohol use, negative alcohol-related consequences, and alcohol-related aggression. Results: Mediational analyses revealed that rumination indirectly predicted greater negative alcohol-related consequences and alcohol-related aggression via more urgency. Moderational analyses yielded nonsignificant interactions. Conclusion: Although cross-sectional data cannot suggest causality, the pattern of correlations suggests that rumination may lead to more clinically relevant alcohol-related outcomes because it triggers rash responding to negative affect.
Collapse
Affiliation(s)
| | - Andrew M Kiselica
- University of South Florida College of Arts and Sciences, Tampa, Florida, USA
| | | |
Collapse
|
26
|
Kiselica AM, Kaser A, Benge J. Empirically defining preclinical Alzheimer’s disease in the era of biomarkers. Alzheimers Dement 2020. [DOI: 10.1002/alz.036190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Jared Benge
- Baylor Scott & White Healthcare Temple TX USA
| |
Collapse
|
27
|
Kiselica AM, Webber TA, Benge JF. Using multivariate base rates of low scores to understand early cognitive declines on the uniform data set 3.0 Neuropsychological Battery. Neuropsychology 2020; 34:629-640. [PMID: 32338945 PMCID: PMC7484046 DOI: 10.1037/neu0000640] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Low neuropsychological test scores are commonly observed even in cognitively healthy older adults. For batteries designed to assess for and track cognitive decline in older adults, documenting the multivariate base rates (MBRs) of low scores is important to differentiate expected from abnormal low score patterns. Additionally, it is important for our understanding of mild cognitive impairment and preclinical declines to and determine how such score patterns predict future clinical states. METHOD The current study utilized Uniform Data Set Neuropsychological Battery 3.0 (UDS3NB) data for 5,870 English-speaking, older adult participants from the National Alzheimer's Coordinating Center from 39 Alzheimer's disease Research Centers from March 2015 to December 2018. MBRs of low scores were identified for 2,608 cognitively healthy participants that had completed all cognitive measures. The association of abnormal MBR patterns with subsequent conversion to mild cognitive impairment and dementia were explored. RESULTS Depending on the operationalization of "low" score, the MBR of demographically adjusted scores ranged from 1.40 to 79.2%. Posttest probabilities using MBR methods to predict dementia status at 2-year follow up ranged from .06 to .33, while posttest probabilities for conversion to mild cognitive impairment (MCI) ranged from .12-.32. CONCLUSIONS The data confirm that abnormal cognitive test scores are common among cognitively normal older adults. Using MBR criteria may improve our understanding of MCI. They may also be used to enrich clinical trial selection processes through recruitment of at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center
| | - Jared F Benge
- Department of Neurology, Baylor Scott and White Health
| |
Collapse
|
28
|
Benge JF, Kiselica AM. Rapid communication: Preliminary validation of a telephone adapted Montreal Cognitive Assessment for the identification of mild cognitive impairment in Parkinson's disease. Clin Neuropsychol 2020; 35:133-147. [PMID: 32779959 DOI: 10.1080/13854046.2020.1801848] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: In the current pandemic, tele-screening of neuropsychological status has become a necessity. Instruments developed for telephone screening are not as well validated as traditional neuropsychological measures. Therefore, the current study presents preliminary validation of a telephone version of the Montreal Cognitive Assessment (T-MoCA) in individuals with Parkinson's disease (PD).Method: Twenty-one persons with PD completed the T-MoCA along with a traditional neuropsychological battery. Diagnostic accuracy for the presence of PD-related mild cognitive impairment (MCI) and correlations with traditional neuropsychological measures are reported.Results: Individuals with MCI (n = 9) scored lower than individuals without cognitive impairment (17.56 vs. 19.50; t = -2.28, p = .03, d = -1.00). Diagnostic accuracy for MCI ranged from 76% to 81%, with sensitivity ranging from 0.56 to 0.67 and specificity ranging from 0.92 to 1.00. Correlations of T-MoCA derived scores with traditional neuropsychological measures were quite modest, with the exception of the memory impairment scale.Conclusions: This rapid communication presents preliminary validation of the T-MoCA for use in individuals with PD. Caveats and implications for practical use in the current pandemic are discussed.
Collapse
Affiliation(s)
- Jared F Benge
- Department of Neurology, Baylor Scott and White Health, Temple, TX, USA.,Plummer Movement Disorder Center, BSWH Health, Temple, TX, USA.,Texas A&M College of Medicine, Temple, TX, USA
| | - Andrew M Kiselica
- Department of Neurology, Baylor Scott and White Health, Temple, TX, USA
| |
Collapse
|
29
|
Kiselica AM, Kaser AN, Webber TA, Small BJ, Benge JF. Development and Preliminary Validation of Standardized Regression-Based Change Scores as Measures of Transitional Cognitive Decline. Arch Clin Neuropsychol 2020; 35:acaa042. [PMID: 32710607 DOI: 10.1093/arclin/acaa042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE An increasing focus in Alzheimer's disease and aging research is to identify transitional cognitive decline. One means of indexing change over time in serial cognitive evaluations is to calculate standardized regression-based (SRB) change indices. This paper includes the development and preliminary validation of SRB indices for the Uniform Data Set 3.0 Neuropsychological Battery, as well as base rate data to aid in their interpretation. METHOD The sample included 1,341 cognitively intact older adults with serial assessments over 0.5-2 years in the National Alzheimer's Coordinating Center Database. SRB change scores were calculated in half of the sample and then validated in the other half of the sample. Base rates of SRB decline were evaluated at z-score cut-points, corresponding to two-tailed p-values of .20 (z = -1.282), .10 (z = -1.645), and .05 (z = -1.96). We examined convergent associations of SRB indices for each cognitive measure with each other as well as concurrent associations of SRB indices with clinical dementia rating sum of box scores (CDR-SB). RESULTS SRB equations were able to significantly predict the selected cognitive variables. The base rate of at least one significant SRB decline across the entire battery ranged from 26.70% to 58.10%. SRB indices for cognitive measures demonstrated theoretically expected significant positive associations with each other. Additionally, CDR-SB impairment was associated with an increasing number of significantly declined test scores. CONCLUSIONS This paper provides preliminary validation of SRB indices in a large sample, and we present a user-friendly tool for calculating SRB values.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Division of Neuropsychology, Baylor Scott and White Health, Temple, TX, USA
| | - Alyssa N Kaser
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jared F Benge
- Division of Neuropsychology, Baylor Scott and White Health, Temple, TX, USA
- Plummer Movement Disorders Center, Temple, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| |
Collapse
|
30
|
Kiselica AM, Webber TA, Benge JF. The Uniform Dataset 3.0 Neuropsychological Battery: Factor Structure, Invariance Testing, and Demographically Adjusted Factor Score Calculation. J Int Neuropsychol Soc 2020; 26:576-586. [PMID: 32063246 PMCID: PMC7319897 DOI: 10.1017/s135561772000003x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The goals of this study were to (1) specify the factor structure of the Uniform Dataset 3.0 neuropsychological battery (UDS3NB) in cognitively unimpaired older adults, (2) establish measurement invariance for this model, and (3) create a normative calculator for factor scores. METHODS Data from 2520 cognitively intact older adults were submitted to confirmatory factor analyses and invariance testing across sex, age, and education. Additionally, a subsample of this dataset was used to examine invariance over time using 1-year follow-up data (n = 1061). With the establishment of metric invariance of the UDS3NB measures, factor scores could be extracted uniformly for the entire normative sample. Finally, a calculator was created for deriving demographically adjusted factor scores. RESULTS A higher order model of cognition yielded the best fit to the data χ2(47) = 385.18, p < .001, comparative fit index = .962, Tucker-Lewis Index = .947, root mean square error of approximation = .054, and standardized root mean residual = .036. This model included a higher order general cognitive abilities factor, as well as lower order processing speed/executive, visual, attention, language, and memory factors. Age, sex, and education were significantly associated with factor score performance, evidencing a need for demographic correction when interpreting factor scores. A user-friendly Excel calculator was created to accomplish this goal and is available in the online supplementary materials. CONCLUSIONS The UDS3NB is best characterized by a higher order factor structure. Factor scores demonstrate at least metric invariance across time and demographic groups. Methods for calculating these factors scores are provided.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX, USA
| | - Troy A Webber
- Michael E. DeBakey VA Medical Center, Mental Health Care Line, Houston, TX, USA
| | - Jared F Benge
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX, USA
- Plummer Movement Disorders Center, Temple, TX, USA
- Texas A&M College of Medicine, Temple, TX, USA
| |
Collapse
|
31
|
Devora PV, Beevers S, Kiselica AM, Benge JF. Normative Data for Derived Measures and Discrepancy Scores for the Uniform Data Set 3.0 Neuropsychological Battery. Arch Clin Neuropsychol 2020; 35:75-89. [PMID: 31236576 DOI: 10.1093/arclin/acz025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The Uniform Data Set 3.0 (UDS 3.0) neuropsychological battery is a recently published battery intended for clinical research with older adult populations. While normative data for the core measures has been published, several additional discrepancy and derived scores can also be calculated. We present normative data for Trail Making Test (TMT) A & B discrepancy and ratio scores, semantic and phonemic fluency discrepancy scores, Craft Story percent retention score, Benson Figure percent retention score, difference between verbal and visual percent retention, and an error index. METHOD Cross-Sectional data from 1803 English speaking, cognitively normal control participants were obtained from the NACC central data repository. RESULTS Descriptive information for derived indices is presented. Demographic variables, most commonly age, demonstrated small but significant associations with the measures. Regression values were used to create a normative calculator, made available in a downloadable supplement. Statistically abnormal values (i.e., raw scores corresponding to the 5th, 10th, 90th, and 95th percentiles) were calculated to assist in practical application of normative findings to individual cases. Preliminary validity of the indices are demonstrated by a case study and group comparisons between a sample of individuals with Alzheimer's (N = 81) and Dementia with Lewy Bodies (DLB; N = 100). CONCLUSIONS Clinically useful normative data of such derived indices from the UDS 3.0 neuropsychological battery are presented to help researchers and clinicians interpret these scores, accounting for demographic factors. Preliminary validity data is presented as well along with limitations and future directions.
Collapse
Affiliation(s)
- Paulina V Devora
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA
| | - Samantha Beevers
- Baylor Scott and White Research Institute, Temple, TX 76508, USA
| | - Andrew M Kiselica
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA
| | - Jared F Benge
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA.,Texas A&M Health Science Center, Temple, TX 76508, USA.,Plummer Movement Disorders Center, Temple, TX 76508, USA
| |
Collapse
|
32
|
Kiselica AM, Rosen S, Benge JF. Functional neurological symptoms masquerading as Wernicke encephalopathy following bariatric surgery. Proc AMIA Symp 2019; 32:607-609. [PMID: 31656438 PMCID: PMC6794007 DOI: 10.1080/08998280.2019.1651149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022] Open
Abstract
Wernicke encephalopathy (WE), caused by thiamine deficiency, is classically associated with alcoholism but is increasingly recognized among patients who have undergone bariatric surgery. As with other neurocognitive conditions, alternative explanations for symptoms, such as psychiatric, neurological, and motivational factors, must be considered before arriving at a diagnosis of WE. We present a patient after sleeve gastrectomy who was presumed to have WE; after detailed neuropsychological assessment, the condition was better conceptualized as a conversion disorder. The case illustrates the heretofore unrecognized role of bariatric surgery in the development of functional symptoms and demonstrates the importance of neuropsychological assessment in detecting functional symptoms.
Collapse
Affiliation(s)
| | - Sabra Rosen
- Division of Neuropsychology, Baylor Scott & White HealthTempleTexas
| | - Jared F. Benge
- Division of Neuropsychology, Baylor Scott & White HealthTempleTexas
- Plummer Movement Disorders CenterTempleTexas
- Texas A&M College of MedicineBryanTexas
| |
Collapse
|
33
|
Kiselica AM, Benge JF. Quantitative and qualitative features of executive dysfunction in frontotemporal and Alzheimer's dementia. Appl Neuropsychol Adult 2019; 28:449-463. [PMID: 31424275 DOI: 10.1080/23279095.2019.1652175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Behavioral variant fronto-temporal degeneration (bvFTD) is typically distinguished from Alzheimer's disease (AD) by early, prominent dysexecutive findings, in addition to other clinical features. However, differences in executive functioning between these groups are not consistently found. The current study sought to investigate quantitative and qualitative differences in executive functioning between those with bvFTD and AD in a large sample, while controlling for dementia severity and demographic variables. Secondary data analyses were completed on a subset of cases from the National Alzheimer's Coordinating Center collected from 36 Alzheimer's Disease Research Centers and consisting of 1,577 individuals with AD and 406 individuals with bvFTD. Groups were compared on 1) ability to complete three commonly administered executive tasks (letter fluency, Trail Making Test Part B [TMTB], and digits backward); 2) quantitative test performance; and 3) errors on these tasks. Findings suggested that individuals with bvFTD were less likely to complete letter fluency, χ2(2) = 178.62, p < .001, and number span tasks, χ2(1) = 11.49, p < .001), whereas individuals with AD were less likely to complete TMTB, χ2(2) = 460.38, p < .001. Individuals with bvFTD performed more poorly on letter fluency, F(1) = 28.06, p = .013, but there were not group differences in TMTB lines per second or number span backwards. Errors generally did not differentiate the diagnostic groups. In summary, there is substantial overlap in executive dysfunction between those with bvFTD and AD, though individuals with bvFTD tend to demonstrate worse letter fluency performance.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA
| | - Jared F Benge
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA.,Plummer Movement Disorders Center, Baylor Scott and White Health, Dallas, TX, USA.,Texas A&M College of Medicine, Bryan, TX, USA
| |
Collapse
|
34
|
Kiselica AM, Duhig A, Montoya I, Skolnick P, Floyd J, Byars C. A Survey of Payer Perspectives on Cannabis Use Disorder. Subst Use Misuse 2018; 53:2257-2264. [PMID: 29927691 DOI: 10.1080/10826084.2018.1473432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cannabis use disorder (CUD) as described/defined in DSM 5, is characterized by impaired control of marijuana use and related personal, health, and legal consequences. CUD is a serious public health problem, affecting nearly 6 million individuals in the United States. There are no FDA approved medications to treat this disorder. The lack of available treatment options contributes to uncertainties by drug sponsors about formulary and reimbursement decision-making for CUD pharmacotherapies. OBJECTIVE To addresses this gap by presenting the first findings on managed care payers' perceptions of CUD treatments and clinical trial end points. METHODS An online survey was conducted with 50 payers from managed care organizations. The survey inquired about perceptions of unmet need in CUD treatment, relevant clinical trial end points, disease knowledge, and likelihood of review of new pharmacotherapies. RESULTS The majority of payers (62%) reported that they were at least moderately familiar with CUD treatment end points. Most (80%) rated the unmet need for new pharmacotherapies for CUD as at least moderately important. Payers rated the most important end points for clinical trials as abstinence and decreased resource utilization. Most participants said an FDA approved CUD treatment would be formally reviewed by payers within 6 months (58%) or a year (36%). CONCLUSIONS Based on these findings, payers see an unmet need for CUD treatment. Furthermore, FDA-approved pharmacotherapies for CUD will likely be reviewed quickly by payers, especially if data are provided on the likelihood of achieving abstinence and reduced resource utilization.
Collapse
Affiliation(s)
- Andrew M Kiselica
- a Department of Psychology , University of South Florida , Tampa , Florida , USA.,b Xcenda L.L.C., Health Economics and Outcomes Research , Palm Harbor , Florida , USA
| | - Amy Duhig
- b Xcenda L.L.C., Health Economics and Outcomes Research , Palm Harbor , Florida , USA
| | - Ivan Montoya
- c National Institute on Drug Abuse , Division of Therapeutics and Medical Consequences , Bethesda , Maryland , USA
| | - Phil Skolnick
- d Opiant Pharmaceuticals, Inc. , Chief Scientific Officer, Santa Monica , California , USA
| | - Jennifer Floyd
- b Xcenda L.L.C., Health Economics and Outcomes Research , Palm Harbor , Florida , USA
| | - Cigi Byars
- b Xcenda L.L.C., Health Economics and Outcomes Research , Palm Harbor , Florida , USA
| |
Collapse
|
35
|
Kiselica AM, Webber TA, Bornovalova MA. Validity of the alcohol purchase task: a meta-analysis. Addiction 2016; 111:806-16. [PMID: 26616514 DOI: 10.1111/add.13254] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/21/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Behavioral economists assess alcohol consumption as a function of unit price. This method allows construction of demand curves and demand indices, which are thought to provide precise numerical estimates of risk for alcohol problems. One of the more commonly used behavioral economic measures is the Alcohol Purchase Task (APT). Although the APT has shown promise as a measure of risk for alcohol problems, the construct validity and incremental utility of the APT remain unclear. This paper presents a meta-analysis of the APT literature. METHODS Sixteen studies were included in the meta-analysis. Studies were gathered via searches of the PsycInfo, PubMed, Web of Science and EconLit research databases. Random-effects meta-analyses with inverse variance weighting were used to calculate summary effect sizes for each demand index-drinking outcome relationship. Moderation of these effects by drinking status (regular versus heavy drinkers) was examined. Additionally, tests of the incremental utility of the APT indices in predicting drinking problems above and beyond measuring alcohol consumption were performed. RESULTS The APT indices were correlated in the expected directions with drinking outcomes, although many effects were small in size. These effects were typically not moderated by the drinking status of the samples. Additionally, the intensity metric demonstrated incremental utility in predicting alcohol use disorder symptoms beyond measuring drinking. CONCLUSIONS The Alcohol Purchase Task appears to have good construct validity, but limited incremental utility in estimating risk for alcohol problems.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Troy A Webber
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | |
Collapse
|
36
|
Webber TA, Kiselica AM, Arango A, Rojas E, Neale MC, Bornovalova MA. Unidirectionality Between Borderline Personality Disorder Traits and Psychopathology in a Residential Addictions Sample: A Short-Term Longitudinal Study. J Pers Disord 2015; 29:755-70. [PMID: 25562538 PMCID: PMC4836848 DOI: 10.1521/pedi_2014_28_172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is a barrier to treatment, yet the relationship between BPD features and other psychopathology symptoms in residential addictions treatment samples is understudied. Using a sample of adults enrolled in a residential drug treatment facility measured at baseline and 2-3 month follow-up, the authors examined the prospective relationship between BPD features and five indices of psychopathology: depression, anxiety, interpersonal sensitivity, hostility, and psychoticism, as well as psychopathology global severity. There was no effect of time on any of the forms of psychopathology, but females reported higher levels of BPD features, anxiety symptoms, and interpersonal sensitivity than males. A series of latent change score models indicated that BPD features predicted increases in all psychopathology scales at follow-up, while the reverse was not true. These results suggest that targeting BPD features in residents of drug treatment facilities may reduce the emergence of new psychopathology in the short term.
Collapse
Affiliation(s)
- Troy A. Webber
- Department of Psychology, University of South Florida, Tampa, FL
| | | | - Alejandra Arango
- Department of Psychology, University of South Florida, Tampa, FL
| | - Elizabeth Rojas
- Department of Psychology, University of South Florida, Tampa, FL
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Marina A. Bornovalova
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL
| |
Collapse
|
37
|
Abstract
Distress tolerance (DT), or the ability to withstand psychological distress, is a popular construct in the psychological literature. However, research has not specified the nomological network of DT across self-report measures. The purpose of the current investigation was to understand what personality features, environmental stressors, current affective states, and behaviors contribute to DT in two different samples: college students and those in residential substance use treatment. Correlations revealed that self-reported DT was most strongly associated with trait negative emotionality, state negative affect, impulsivity, and perceived stress. In comparisons across samples, self-harm exhibited a stronger relationship with self-reported DT in the drug treatment than in the student sample, whereas perceived stress had a stronger association in the student sample. Correlations between self-report and behavioral measures of DT were nonsignificant. To understand this lack of associations, associations of outcomes with behavioral measures were assessed. In contrast to self-reported DT, behavioral DT was more closely related to achievement orientation, state negative affect, and state positive affect, but was not significantly related to psychopathology and maladaptive behaviors. It is necessary to continue investigating the construct validity of behavioral DT measures via the use of incremental utility analyses and experimental approaches.
Collapse
Affiliation(s)
| | | | | | - Chad Dube
- University of South Florida, Tampa, FL, USA
| |
Collapse
|
38
|
Kiselica MS, Kiselica AM. The complicated worlds of adolescent fathers: Implications for clinical practice, public policy, and research. Psychology of Men & Masculinity 2014. [DOI: 10.1037/a0037043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
39
|
Kiselica AM, Webber T, Bornovalova MA. Stability and change in distress tolerance and its prospective relationship with borderline personality features: A short-term longitudinal study. ACTA ACUST UNITED AC 2014; 5:247-56. [DOI: 10.1037/per0000076] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
Kiselica AM, Ruscio J. Scientific communication in clinical psychology: examining patterns of citations and references. Clin Psychol Psychother 2014; 21:13-20. [PMID: 22941805 DOI: 10.1002/cpp.1815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 05/14/2012] [Accepted: 07/09/2012] [Indexed: 11/08/2022]
Abstract
Previous studies of scientific communication used citation mapping, establishing psychology as a 'hub science' from which many other fields draw information. Within psychology, the clinical and counselling discipline is a major 'knowledge broker'. This study analyzed scientific communication among three major subdisciplines of clinical psychology-the cognitive-behavioural, psychodynamic and humanistic schools of thought-by examining patterns of references within and citations to 305 target articles published in leading journals of these subdisciplines. The results suggest that clinical researchers of each theoretical orientation engage in more insular scientific communication than an integrationist would find desirable and that cognitive-behavioural articles are more closely connected to mainstream psychology and related fields. KEY PRACTITIONERS MESSAGE Eclectic practitioners draw on several different theoretical orientations to inform their practice; as such, they should be interested in understanding the patterns of scientific communication within and across theoretical orientations. Practitioners work in a variety of different mental health settings, with a variety of other professionals in psychology-related fields, and should be interested in how much influence their particular theoretical orientation has on the work of colleagues. Many practitioners rely on new, evidence-based research to inform their work. The results of this study provide these individuals with an objective measure of the influence of empirical work in different areas of clinical psychology.
Collapse
|
41
|
Kiselica AM, Borders A. The reinforcing efficacy of alcohol mediates associations between impulsivity and negative drinking outcomes. J Stud Alcohol Drugs 2013; 74:490-9. [PMID: 23490580 DOI: 10.15288/jsad.2013.74.490] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE One predictor of negative drinking outcomes in college populations is impulsivity. Individual differences in the reinforcing efficacy of alcohol, which reflects willingness to drink despite potential costs, may serve as a mechanism by which impulsivity is associated with alcohol-related problems. The purpose of this study was to determine whether two measures of the reinforcing efficacy of alcohol-demand intensity (consumption when drinks are free) and Omax (maximum expenditure on alcohol)-statistically mediated the associations between four facets of impulsivity and negative drinking outcomes. METHOD We gave 202 undergraduate social drinkers a hypothetical task in which they indicated how many drinks they would consume across a range of prices. They also completed measures of impulsivity, alcohol use, and alcohol-related problems. RESULTS Path models revealed that two facets of impulsivity-sensation seeking and urgency-were associated with higher reinforcing efficacy and worse alcohol problems. Moreover, the associations between both of these impulsivity facets and alcohol-related problems were sequentially mediated by reinforcing efficacy and alcohol use. CONCLUSIONS Individuals who respond impulsively to negative emotions or have sensation-seeking tendencies may exhibit greater willingness to consume and purchase alcohol. As a result, they may in fact drink more, leading to worse drinking-related problems. These findings suggest a need for more research into the mechanisms of interventions that successfully reduce problem drinking. They also indicate that more study is needed on whether decreasing the availability of low-cost alcohol reduces alcohol-related problems in impulsive individuals.
Collapse
Affiliation(s)
- Andrew M Kiselica
- Psychology Department, The College of New Jersey, Ewing, New Jersey, USA
| | | |
Collapse
|