Cognitive and psychomotor tests as predictors of on-road driving ability in older primary care patients

This study examined the accuracy with which different cognitive and psychomotor assessment tools were able to predict driving ability among older primary care patients. A cross-sectional study of 50 older drivers (with an average age of 73.1 ± 7.0 years) was conducted. Participants who had been referred by their physicians for psychological assessment following a fitness-to-drive examination underwent both an on-road driving test and a cognitive assessment protocol that included the Senior Drivers Battery (SDB) that is currently administered at the Mobility and Land Transports Institute (MLTI) in Portugal, the Useful Field of View (UFOV) test, the Stroke Drivers Screening Assessment (SDSA), Addenbrooke’s Cognitive Examination Revised (ACE-R), the Trail Making Test, the Key Search test, and the Wechsler Adult Intelligence Scale (WAIS-III) Vocabulary and Block Design tests. Logistic regression analysis revealed that the performances of the participants on the SDSA, ACE-R, UFOV and SDB were the best predictors of on-road driving. Specific measures of processing speed and divided attention, visuospatial abilities, executive functions, psychomotor speed and global cognitive functioning may be useful for predicting unsafe driving. The practical implications of these findings are discussed with a view to developing new assessment models for determining driving fitness in older adults.     

Adult Needs and Strengths Assessment-Abbreviated Referral Version to specify psychiatric care needed for incoming patients: exploratory analysis

The present study examined the Adult Needs and Strengths Assessment-Abbreviated Referral Version ratings for a group of 272 incoming psychiatric patients over a 2-yr. period to assess whether the rating scale was useful in predicting clinical placement for psychiatric treatment. Participants were patients (125 women) admitted to Regional Mental Health Care, St. Thomas, Canada between April 2004 and June 2006. Most participants were Euro-Canadian and ranged in age from 16 to 87 years. Clinical cutoff scores were established using observed mean differences in the patients' total scores and are expected to help guide psychiatric triage and longer term rehabilitation placement decisions. A canonical discriminant function analysis showed 85.9% of original level of care placements were correctly classified. The rating scale is a valid and reliable tool to specify level of psychiatric care needed for adults with mental disorders.     

A longitudinal comparison of couples with sex-typical and non-sex-typical orientations to intimacy

The present study was designed to investigate the relationship experience of males and females who do not conform to sex-typical orientations to intimacy. One hundred sixty-three couples' and 88 nondating singles' (total N=414) responses to the Relationship World Index—Version 2 (RWI-2) were analyzed via discriminant analysis to determine if subjects' sex could be predicted accurately upon the basis of their RWI-2 scores. One discriminant function was found which was significant by the Wilks' lambda test [x²(60)=140.57, p<.001]; the procedure correctly classified 76% of the respondents. Those who were classified correctly were considered sex-typical and the remaining 24% of the sample was considered non-sex-typical in their orientations to intimacy. Additional analyses using data from a 6-month longitudinal study located qualities which significantly distinguished sex-typical from non-sex-typical subjects and couples in which at least one member was non-sex-typical from couples in which both members were classified as sex-typical.     

Neuropsychological aspects of driving after a stroke—in the simulator and on the road

Thirty patients with stroke and 30 matched controls participated in the study (mean age 68 years, mean interval since stroke onset 8.6 months). The patients performed significantly worse on cognitive and attentional processing measured by a neuropsychological test battery. The patients had significantly greater difficulty in allocating processing resources to a secondary information processing task during driving in an advanced simulator. The patients performed worse driving in real traffic, and had less driving skill; fifty per cent did not pass the driving test. The neuropsychological test battery showed a pattern with three factors: (1) attentional processing (2) executive capacity, and (3) cognitive processing. Regression models based on simulator driving variables and neuropsychological test variables respectively, overall classified correctly in 85% and 83% of the cases with respect to driving skill. Decreased cognitive and attentional processing were suggested to be associated with an overall speed impairment. Copyright © 2000 John Wiley & Sons, Ltd.     

The usefulness of the Western Aphasia Battery for differential diagnosis of Alzheimer dementia and focal stroke syndromes: preliminary evidence.

We assessed the usefulness of the Western Aphasia Battery for distinguishing the language disturbances caused by Alzheimer dementia (AD) from those caused by stroke. Using discriminant function analyses, the multiple variable "aphasia quotient--reading quotient--writing quotient" classified 29 (72.5%) of the 40 patients correctly. These 29 patients included 8 of 10 patients with left hemisphere infarction and fluent aphasia; 6 of 10 with AD; 5 of 10 patients with right hemisphere infarction; and all 10 of the neurologically normal control subjects. The patients with AD and those with right hemisphere stroke were the most difficult to classify using the aphasia battery.     

Prediction of driving ability after stroke and the effect of behind-the-wheel training

The aim of this study was to examine the predictive value of a neuropsychological test battery relating to an on-the-road driving evaluation and to determine whether patients who failed the driving test could improve their driving through behind-the-wheel training. Thirty-four stroke patients were compared with 20 healthy, matched controls. Patients who failed the driving test were offered driving practice at a driving school and were then reassessed (neuropsychologically and practically). On most of the cognitive tests, patients performed significantly less well than control subjects. Almost 50% of the controls and the patients failed the driving evaluation. None of the neuropsychological tests was able to predict the driving outcome. Of the patients who failed the first driving evaluation, 85% passed the second evaluation after driving practice. There are few controlled studies focusing on the stroke population and the effect of behind-the-wheel training. It is suggested that more controlled studies are needed with more homogenous patient-groups and reliable and quantitative outcome measures.     

Alternative Techniques for Predicting Success in Air Controller School

The Armed Services Vocational Aptitude Battery (ASVAB) is the principal cognitive test battery used for military classification-that is, for assignment of individuals to specific job categories. Successful entrance into a specific job category requires satisfactory completion of relevant training. Therefore, it is necessary that the ASVAB accurately predict the likelihood that individuals will complete training. Presently, the U.S. Navy classifies enlisted personnel based on a unit-weighted linear combination of scores derived from a subset of tests currently composing the ASVAB test battery. This research explored the development of new classification models estimated by using linear regression, logistic regression, discriminant analysis, and artificial neural networks, and it compared their classification accuracy with models developed using unit- weighted regression. Models were estimated and cross-validated using data from individuals admitted into the Navy's Air Controlman training during fiscal years 1988 and 1989. Accuracy was measured by the proportion of individuals correctly classified as graduates or as academic failures and by the ability to rank students-that is, to predict the highest scores for graduates and the lowest scores for attrites.     

Identifying Positive Dissimulation by Substance-Abusing Individuals on the Personality Assessment Inventory: A Cross-Validation Study

The accuracy of a classification equation (which combined scores on the Drug Problems, Alcohol Problems, and Positive Impression scales from the Personality Assessment Inventory [PAI], Morey, 1991), developed by Fals-Stewart (1996) to identify test-taking response sets among substance-abusing individuals, was evaluated. As in the Fals-Stewart (1996) study, three groups of participants completing the PAI were assessed: (a) substance-abusing patients administered the inventory under standard instructions (n = 25); (b) substance-abusing patients asked to respond defensively (n = 25) combined with a group of individuals suspected of abusing drugs, referred for art evaluation by the criminal justice system, who had reasons to conceal their drug use (n = 25); and (c) non-substance-abusing respondents administered the test under standard instructions (n = 25). Significant validity shrinkage in the classification equation was found when applied to the new sample; only 68% of participants were correctly classified into their respective groups, compared to 82% of participants correctly assigned in the Fals-Stewart (1996) investigation.     

Factor-derived categories of chronic aphasia

A large sample of patients with aphasia (N = 118), unselected for etiology, were administered the Porch Index of Communicative Ability more than 6 months after the onset of aphasia. Factor analysis of PICA subtest scores identified five factors which accounted for 83.9% of the total variance. The factors were labeled speaking, writing, comprehension, gesturing, and copying. Cluster analyses of the factor scores yielded five patient categories which differed in the pattern of impairment on the language factors as well as in overall severity of aphasia. A subgroup of the parent sample consisting of 52 patients with localized left-hemisphere CVA had cluster analyses repeated after having first been studied as part of the larger sample. The factor-derived categories for the subgroup were similar to those of the entire group. Discriminant functions of the PICA raw scores of the 52-patient subsample correctly classified all of the patients. When discriminant functions were based upon the factor scores of the 118-patient parent sample, 80.7% of the 52 patients were correctly classified into the five categories.     

A brief neuropsychological screening battery to detect brain damage in a psychiatric population

Seventy-five patients admitted to the psychiatric unit of a general hospital were administered a brief neuropsychological screening battery. Discharge diagnoses obtained from the medical records revealed that 20% had brainbased pathology. A discriminant function analysis resulted in a five-variable model (Symbol-Digit Modalities Test, educational level, Psychiatric-Organic subscale of the MMPI, and Shipley Vocabulary and Abstraction scores) which correctly classified 84% of the subjects, with 87% correct identification of the brain-damaged group. A jackknife cross-validation procedure resulted in comparable hit rates.     

Discriminant validity of the General Behavior Inventory: an outpatient study

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.     

Discriminant Validity of the General Behavior Inventory: An Outpatient Study

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.     

The Adolescent Behavior Checklist: Validation Using Structured Diagnostic Interviews

The purpose of this study was to evaluate the discriminant validity of scores from the Adolescent Behavior Checklist (ABC), a self-report measure of ADHD symptomatology for adolescents ages 11–17 years. Validity was assessed through correlational, univariate, and discriminant function analyses using three groups: (1) adolescents diagnosed with ADHD, (2) adolescents currently experiencing a mood and/or anxiety disorder, and (3) adolescents with no major psychological disorder. Convergent and divergent validity of the ABC factor scores was demonstrated through correlational results with (1) parent and adolescent report of ADHD symptoms during structured psychiatric interviews and (2) scores on questionnaires measuring related and nonrelated constructs. Univariate analyses indicated that the ADHD group obtained significantly higher scores than did the nonclinical adolescents across all ABC factors. Additionally, the ADHD group scored significantly higher than did the psychiatric controls on the following ABC factors: Conduct Problems, Impulsivity/Hyperactivity, and Social Problems. Results from discriminant analyses supported the reliability of ABC scores in correctly classifying participants into groups. Compared to the Youth Self-Report, the ABC was found to be somewhat better at classifying when used in a multiinformant discriminant analysis. Therefore, overall results from the current study suggest that the ABC is a valid and useful self-report screening measure for ADHD symptoms and related difficulties.     

Discriminant validity of the ZKPQ in a sample meeting BPD diagnosis vs. normal-range controls

Widiger and Simonsen (2005) state that given the limitations of the categorical model of Personality Disorders classification proposals are to be expected for dimensional classifications. The purpose of this paper is to test the alternative five factorial model (AFFM) of personality in a sample with PDs. Subjects were administered the ZKPQ to test the discriminant capacity of the AFFM in classifying subjects diagnosed with BPD (n = 74) vs normal-range controls (n = 148) paired by age and sex, and identifying sensitive and/or specific dimensions that can be of help in diagnosing BPD. The results showed that high scores on N-Anx and Imp-SS, and low scores on Act are prognostic factors for being diagnosed with BPD. Likewise, this model correctly classified 88% of subjects with a kappa index of 0.73. The AFFM of personality appears to have a substantial power for predicting SCID-II interview-based BPD diagnosis.     

Comparative accuracy of the MMPI-2 and the MMPI-A in the diagnosis of psychopathology in 18-year-olds

Both the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory--Adolescent (MMPI-A) may be administered to 18-year-olds. Each test was administered to 18-year-old participants classified as psychopathology present (PP) or psychopathology absent (PA) to assess (a) the degree of correspondence between the 2 test versions in yielding clinically elevated or nonclinically elevated profiles and (b) the relative accuracy of the 2 test versions in identifying the presence of psychopathology. The 2 tests produced profiles that were inconsistent in clinical elevation status in 70 of 152 participants (46%). All 70 participants with incongruent profiles had clinically elevated MMPI-2 scores and normal-range MMPI-A scores. Analyses of incongruent profiles obtained by PP and PA participants indicated that 18-year-olds were overpathologized by the MMPI-2 and underpathologized by the MMPI-A.     

Clinical tests of memory in dementia, depression, and healthy aging

In Study 1, carefully screened elderly adults with primary degenerative dementia or major depression were compared to healthy aged control subjects on three tests of learning and memory: the Benton Visual Retention Test, Inglis Paired-Associate Learning Test, and the Fuld Object-Memory Evaluation (OME). The sharpest distinction in performance among the groups was observed on the OME, and discriminant equations based on this test correctly classified a high percentage (greater than or equal to 90%) of participants. Study 2 applied the classification rules derived in the first investigation to an unselected series of geropsychiatry inpatients referred for neuropsychological evaluation. There was agreement between memory test classification and general categories of clinical discharge diagnosis (organic vs. functional) for 21 of 25 patients, and with status at follow-up approximately 18 months later. Predictive value computations suggested that the OME is more accurate in confirming true dementia than in detecting dementia syndromes associated with functional disorders.     

Validity of Social Behavior Assessment in discriminating emotionally disabled from nonhandicapped students

Discriminant analyses and stepwise multiple regression techniques were applied to teacher ratings of 184 kindergarten through eighth-grade students using Stephen's Social Behavior Assessment (SBA) inventory and were used to predict group membership as emotionalyy disabled (ED) or non-ED. The results suggested that the SBA was highly effective in correctly discriminating ED from non-ED students. The linear discriminant function derived from the 30 SBA subcategories correctly classified 83% of the subjects, yielding a highly significant separation of groups of ED and non-ED children. While the results of the discriminant analyses have not yet been cross-validated, these findings support the discriminant validity of the SBA for ED versus non-ED classification and suggest that the SBA is potentially a useful instrument for school psychologists as one source of information in a multifactored assessment regarding the identification of children as ED.     

Cross-cultural diagnostic applicability of the Pictogram Test

The aim of this study was to determine whether the Pictogram Test (PT; Vygostsky, 1960) a test of logical memory that was developed in Russia, is applicable for diagnosing and understanding thought disturbances in schizophrenia within an English-speaking population. Participants included 62 patients with schizophrenia or schizoaffective disorders and 80 community nonpatients from Russia and the United States. We used correlational analysis to organize PT variables into Concrete (CI), Attribute (AI), and Geometric (GI) indexes. Discriminant function analysis revealed that only AI and GI had significant discriminatory power. These indexes correctly classified 91% of English-speaking and 86% of Russian-speaking participants as either patients or nonpatients. Controlling for age and education, multivariate analysis revealed that patients had significantly lower AI and significantly higher GI scores relative to nonpatients, and those differences were similar across languages. These results indicate that the PT can discriminate between patients with schizophrenia or schizoaffective disorders and nonpatients, which suggests that characteristics of the PT could be used to understand the mechanism of logical thinking in patients and nonpatients.