Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Moyamoya disease (MMD) is a rare noninflammatory disorder involving progressive intracranial vasculopathy and impaired cerebral blood flow in the anterior circulation, resulting in stroke and cognitive impairment. We aimed to characterize cognitive impairment and the possible predictive value of sociodemographic and clinical characteristics of adults with MMD. METHODS:This cross-sectional study examined neurocognitive performance in a group of 42 consecutive adult patients (mean age = 40.52 years; 69% female) referred for a presurgical neuropsychological evaluation. Neuropsychological functioning was assessed with a comprehensive battery, and cognitive dysfunction was defined as 1.5 SDs below the mean. Neurocognitive performance correlated with clinical/demographic characteristics and disease markers. RESULTS:Most patients (91%) had a history of stroke, and 45% had cognitive deficits, most notably on measures of attention/speed (48%), executive functioning (47%), visuoconstruction (41%), and memory (31%-54%). Only higher educational attainment and poor collateral blood flow in the right hemisphere differentiated cognitively impaired (n = 19) and intact groups (n = 23), and MMD-related characteristics (eg, disease duration, stroke history) did not differentiate the 2 groups. CONCLUSION/CONCLUSIONS:Consistent with previous work, frontal-subcortical cognitive deficits (eg, deficits in mental speed, attention, executive functioning) were found in nearly half of patients with MMD and better cognitive performance was associated with factors related to cognitive reserve. Angiographic metrics of disease burden (eg, Suzuki rating, collateral flow) and hemodynamic reserve were not consistently associated with poorer cognitive outcomes, suggesting that cognition is a crucial independent factor to assess in MMD and has relevance for treatment planning and functional status.

OBJECTIVE/UNASSIGNED:Adverse childhood experiences (ACEs) are early life experiences that influence mental health outcomes, though there are mixed findings reported in relation to attention deficit hyperactivity disorder (ADHD) symptoms. The current study compared adults who experienced ACEs on measures of ADHD symptom reporting, psychological symptoms, and neurocognitive test performance. METHOD/UNASSIGNED: = 1.99); and was 35% male/65% female and racially/ethnically diverse. Participants completed measures of ACEs, ADHD symptoms, psychopathology, and perceived stress, as well as neuropsychological tests. RESULTS/UNASSIGNED:The high ACEs group endorsed higher levels of childhood/adulthood inattentive, impulsive, and hyperactive symptoms, and overall childhood symptoms when compared to the low ACEs group. CONCLUSIONS/UNASSIGNED:This study provides a more comprehensive understanding of the association between ACEs and cognitive/mental health outcomes. Greater ACEs resulted in higher ADHD symptom reporting but not significantly greater psychological symptoms or worse neurocognitive performance.

OBJECTIVE:Despite widespread use of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), it is surprisingly understudied among adults with attention-deficit/hyperactivity disorder (ADHD). This is significant as ADHD is a frequent referral for neuropsychological evaluation; however, the core symptom of attention difficulty is a nonspecific sequela of many psychological disorders. This study aimed to characterize MMPI-2-RF profiles among adults with ADHD and examine the effect of comorbid psychopathology. METHOD/METHODS:A large, demographically diverse sample of 413 consecutive adults referred for neuropsychological evaluation to assist with differential diagnosis of ADHD who completed the MMPI-2-RF was examined. Profiles of the 145 patients diagnosed with ADHD-only were compared to 192 with ADHD and a comorbid psychological disorder and a 55-patient non-ADHD psychiatric comparison group. Among the ADHD-only group, profiles also were compared based on ADHD-presentation type (Predominantly Inattentive vs. Combined presentation). RESULTS:The ADHD/psychopathology and psychiatric comparison groups scored higher than the ADHD-only group across nearly all scales with widespread clinical elevations. Conversely, the ADHD-only group displayed an isolated elevation on the Cognitive Complaints scale. Comparison between ADHD presentations revealed several small-moderate significant differences, the largest of which occurred on the Externalizing and Interpersonal scales. CONCLUSIONS:Adults with ADHD alone, and no other psychopathology have a unique MMPI-2-RF profile characterized by isolated elevation on the Cognitive Complaints scale. These results support use of the MMPI-2-RF in assessment of adults with ADHD as it can help distinguish ADHD alone from ADHD/comorbid psychopathology and identify relevant psychiatric comorbidities that may be contributing to patients' inattention complaints.

This study investigated the individual and combined utility of 10 embedded validity indicators (EVIs) within executive functioning, attention/working memory, and processing speed measures in 585 adults referred for an attention-deficit/hyperactivity disorder (ADHD) evaluation. Participants were categorized into invalid and valid performance groups as determined by scores from empirical performance validity indicators. Analyses revealed that all of the EVIs could meaningfully discriminate invalid from valid performers (AUCs = .69-.78), with high specificity (≥90%) but low sensitivity (19%-51%). However, none of them explained more than 20% of the variance in validity status. Combining any of these 10 EVIs into a multivariate model significantly improved classification accuracy, explaining up to 36% of the variance in validity status. Integrating six EVIs from the Stroop Color and Word Test, Trail Making Test, Verbal Fluency Test, and Wechsler Adult Intelligence Scale-Fourth Edition was as efficacious (AUC = .86) as using all 10 EVIs together. Failing any two of these six EVIs or any three of the 10 EVIs yielded clinically acceptable specificity (≥90%) with moderate sensitivity (60%). Findings support the use of multivariate models to improve the identification of performance invalidity in ADHD evaluations, but chaining multiple EVIs may only be helpful to an extent.

BACKGROUND:Assessing neurodevelopmental functioning in early infancy is essential as this is a critical period for infant development. Infants born to mothers with HIV are at a greater risk of developmental delays than those born to mothers without HIV. In this study, we analyzed differences in early neurodevelopmental functioning for infants with HIV exposure versus HIV infection to inform infant screening and early intervention. METHODS:Participants were recruited from community health centers in Mpumalanga Province, South Africa. Prenatally, mothers completed baseline demographic assessment at 8 to 24-week gestation periods. Infant neurodevelopment was assessed using the Bayley Infant Neurodevelopmental Screener (BINS) 12 months postnatally. Five areas of development were assessed: cognition, receptive communication, expressive communication, fine motor ability, and gross motor ability. FINDINGS:Postnatal infant assessment using the BINS revealed that infants were at risk for neurodevelopmental delays across all domains assessed. Notably, infants exposed to HIV, regardless of HIV status, were 'at emerging risk' or 'at clear risk' for cognitive (43.5%), receptive communication (38.2%), expressive communication (53.1%), fine motor (49.9%), and gross motor delays (55.6%). Differences were noted by HIV status in the cognition domain, such that HIV-exposed infants were more likely to be at emerging or clear risk than HIV-infected infants. There was a different trend with gross motor delays, such that HIV-infected infants were at a greater risk for motor delays than HIV-exposed, uninfected infants. CONCLUSION:Screening tools for this vulnerable population provide valuable early life assessment to determine infant needs for intervention and treatment planning. Such interventions may mitigate the impact of HIV status on neurodevelopmental health generally and cognition.

The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a collateral-rated measure of behavioral and psychological symptoms commonly found in dementia (BPSD). Several factor structures have been published, but they have not been systematically compared. Furthermore, the possibility of hierarchical models or presence of measurement invariance around cognitive stage or dementia syndrome has not been previously evaluated. This study addressed these gaps with confirmatory factor analyses using a multicenter sample (n = 41,801; M

OBJECTIVE:Reliable Digit Span (RDS), RDS-Revised (RDS-R), and age-corrected scaled score (ACSS) have been previously validated as embedded performance validity tests (PVTs) from the Wechsler Adult Intelligence Scale-IV Digit Span subtest (WAIS-IV DS). However, few studies have directly compared the relative utility of these and other proposed WAIS-IV DS validity indicators within a single sample. METHOD/METHODS:This study compared classification accuracies of 10 WAIS-IV DS indices in a mixed neuropsychiatric sample of 227 outpatients who completed a standardized neuropsychological battery. Participants with ≤1 PVT failures of the four, freestanding criterion PVTs constituted the valid group (n = 181), whereas those with ≥2 PVT failures formed the invalid group (n = 46). Among the valid group, 113 met criteria for mild cognitive impairment (MCI). RESULTS:Classification accuracies for all DS indicators were statistically significant across the overall sample and subsamples with and without MCI, apart from indices derived from the Forward trial in the MCI sample. DS Sequencing ACSS, working memory RDS (wmRDS), and DS ACSS emerged as the most effective predictors of validity status, with acceptable to excellent classification accuracy for the overall sample (AUCs = 0.792-0.816; 35%-50% sensitivity/88%-96% specificity). CONCLUSIONS:Although most DS indices demonstrated clinical utility as embedded PVTs, DS Sequencing ACSS, wmRDS, and DS ACSS may be particularly robust to cognitive impairment, minimizing risk of false positive errors while identifying noncredible performance. Moreover, DS indices incorporating data from multiple trials (i.e., wmRDS, DS ACSS) also generally yielded greater classification accuracy than those derived from a single trial.

Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB's classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106 seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65-.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation (M