Fatigue,emotional functioning,and executive dysfunction in pediatric multiple sclerosis

Objective: Fatigue, depression, anxiety, and executive dysfunction are associated with multiple sclerosis (MS) in adults. Existing research suggests similar problems in pediatric MS, but relationships between these variables have not been investigated. This study investigates the associations between executive functioning and fatigue, emotional functioning, age of onset, and disease duration in pediatric MS.

Methods: Twenty-six MS or Clinically Isolated Syndrome (CIS) patients, ages 7 to 18, were evaluated through a multidisciplinary demyelinating diseases clinic. Participants completed neuropsychological screening including Verbal Fluency, Digit Span, and Trail-Making Test. Parents completed rating forms of behavioral, emotional, and executive functioning. Patients and parents completed questionnaires related to the patient’s quality of life and fatigue. Pearson’s correlation coefficients were calculated to investigate relationships between fatigue, emotional functioning, and executive functioning, as well as to examine correlations between parent and child reports of fatigue.

Results: Rates of parent-reported anxiety, depression, fatigue, and executive dysfunction varied widely. Means were below average on the Trail-Making Test and average on Verbal Fluency and Digit Span, though scores varied widely. Various fatigue and emotional functioning indices—but not age of onset or disease duration—significantly correlated with various performance-based measures of executive functioning.

Conclusion: Results indicate pediatric MS is associated with some degree of fatigue, emotional difficulties, and executive dysfunction, the latter of which is associated with the two former. Notably, age of onset and disease duration did not significantly correlate with executive functioning. Results advance understanding of psychological and clinical variables related to neurocognitive outcomes in pediatric MS.     

Performance of chronotypes on memory tests during the morning and the evening shifts

Memory consists of several phases or processes that can be influenced by many factors, including the individual's circadian rhythm and the time of day at which tests are performed. The present objective was to evaluate the performance on memory tests of different chronotypes during the morning and the evening shifts. Subjects (21 men and 26 women, between the ages of 20 and 35 yr.) were evaluated for memory and metamemory differences in the morning and in the afternoon, using a battery of neuropsychological tests composed of the Word List with Emotional Content, Visual Memory, Scale-Semantic Memory, Digit Span, Word-Pairs Associated, Verbal Fluency Test, and Metamemory questionnaire. In the evening shift, there was a statistical difference among chronotypes on the Word List with Neutral Content and on the Verbal Fluency Test. In the morning, there were no statistically significant differences; however, the morning-type subjects had higher scores on the metamemory tests (p<.01), while the evening-type subjects had higher scores in the afternoon (p<.01). In spite of their perception, on Word-Pairs Associated and Word List with Emotional Content, the subjects, independently of their chronotype, showed better performance by the evening than by the morning shift. These results highlight the importance of controlling the shift of day and chronotype in studies with the objective of exploration of human performance.     

Psychometric validity of proration and Digit Span substitution for estimating WISC--R verbal and Full Scale IQs

This study investigated the merits of substituting the Digit Span subtest for an invalid Verbal Scale subtest versus a proration method in calculating WISC--R Verbal and Full Scale IQ. Subjects were 93 child and adolescent psychiatric patients (67 boys and 26 girls) who ranged in age from 8 to 16 yr. Analysis indicated that the use of Digit Span as a substitute for the regularly administered Verbal subtests was inferior to the use of the comparable proration method. Although relatively few cases of misclassification occurred for either method in relation to Full Scale IQ, the rate of Verbal IQ misclassification by the Digit Span substitution method was significantly greater than with use of its proration. When faced with a choice, clinicians should attach greater validity to prorated estimates of a child's WISC--R Verbal IQ.     

Normative data for a brief neuropsychological screening battery. Multicenter AIDS Cohort Study.

This study reports normative data for a group of 733 homosexual/bisexual men stratified by age (range 25 to 54 years) and by education on the following six neuropsychological tests: (1) Digit Span (WAIS-R), (2) Rey Auditory Verbal Learning Test, (3) Symbol Digit Modalities Test, (4) Controlled Oral Word Association Test, (5) Grooved Pegboard, and (6) The Trail Making Test. Analysis demonstrates that both age and education are important determinants of performance for several of these measures.     

Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders

To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children-III (WISC-III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC-III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.     

Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder

Abstract

The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.     

Conceptual tempo as a moderator variable in predicting first grade achievement test scores

This study examined the utility of a set of tests for predicting the academic achievement of separate samples of impulsive and reflective first graders. The predictor tests were the Peabody Picture Vocabulary Test, the Columbia Mental Maturity Scale, Wepman's Auditory Discrimination Test, the ITPA Sound Blending Subtest, the WISC Digit Span Subtest, and Kaufman's WISC-R Verbal Comprehension Factor (Comprehension, Information, Similarities, and Vocabulary). The criterion measures were drawn from the Stanford Achievement Test and included scores for Total Auditory, Total Mathematics, Total Reading, Vocabulary and Listening Comprehension. Multiple regression analyses revealed that (a) for three of the five criterion variables, the optimal equations for predicting the achievement test scores differed for impulsives and reflectives, and (b) given the same predictor scores, the predicted achievement of impulsive and reflective children different considerably. It was concluded that conceptual tempo is an important moderator variable in predicting academic performance.     

Wechsler Digit Span subtest: diagnostic usefulness with dyslexic children

The current study supports Levinson's contention (1988) that the diagnosis of dyslexia cannot be based solely on neurophysiological evidence but must be made in conjunction with reading and educational test scores. Contrary to much current research, in the present study specific WISC-R profiles are identified within a stringently defined subgroup of 57 9- to 12-yr-old dyslexic children. Well-defined subtest scatter can differentiate dyslexics from proficient readers. In particular, the Digit Span subtest, which is not routinely administered by psychologists or included in computing Verbal IQ, can be considered an important component of a diagnostic battery. Unexpectedly, Coding emerged with Digit Span as a third factor in a principal component analysis; statistically significant sex differences appeared on the Coding task. Findings appear to confirm the phonological encoding deficiencies displayed by dyslexics on the Digit Span subtest. This study strongly supports consideration of WISC-R subtest differences, along with correlated factors, neurophysiological and perceptual evidence, when diagnosing dyslexic children. Cross-validation is planned.     

Cognitive skills among Nepalese child labourers

The cognitive skills of 61 Nepalese 10–14‐year‐old working children with at least 2 years working experience (WE) were compared to two groups of children, beginners (N=29) with less than 1 year of WE and a school group (N = 104) matched for age and ethnic background. All the children (N=194) were tested by the Bender test, WISC‐R for Arithmetic, Digit Span, and the Word Fluency test. The main results showed that the school group was better in all the cognitive tests, except for Digit Span Backwards, where the working group had the highest average score. The second main finding shows no major differences in cognitive skills between the beginner and working groups. However, the work experience as such was related to decreasing visuoconstructive skills and improving Digit Span Forward scores. This suggests that work in the carpet factories seem to develop the verbal short‐term memory functions of the children, while their visuoconstructive skills decrease by work experience. The third main finding showed that the boys were better in arithmetic skills than the girls when they had long working experience.     

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.     

Imagination and Emotion

A study was conducted for the purpose of determining whether or not the addition of one or both of the supplementary WISC subtests, Digit Span of the Verbal Scale—and Mazes of the Performance Scale, materially affected the obtained IQs for high achieving fifth grade subjects. All 12 subtests of the WISC were individually administered to 44 Ss, and IQs were then calculated in such a manner that specific comparisons could be made. These comparisons were between Verbal, Performance, and Full Scale IQs composed of the maximum number of subtests, and Verbal, Performance, and Full Scale IQs exclusive of Digit Span, Mazes, or both subtests. Analyses by use of t tests for correlated means revealed highly significant differences. The addition of Digit Span and Mazes in the WISC battery served to depress the Verbal, Performance, and Full Scale IQs of the high achieving Ss.     

Effects of Age,Domain, and Processing Demands on Memory Span: Evidence for Differential Decline

Analysis of cross-sectional data from the normative sample of the Wechsler Memory Scale - Third Edition (WMS-III) revealed different patterns of age-related differences in memory span measures depending on the type of memory item, processing demands, and the age of the older adult group. Regression of memory span on age revealed that the slope for Spatial Span raw scores was significantly more negative than the slope for Digit Span raw scores. There was no significant difference, however, either between the slopes for forward and backward Digit Span or between the slopes for forward and backward Spatial Span. Regression of Letter-Number Sequencing raw scores on age showed a distinctive, curvilinear pattern. Taken together, the present findings suggest that at least two mechanisms are involved in age-related differences in memory span. One mechanism, associated with a relatively linear decrease in memory span as a function of age, may differentially affect the storage of different types of information (e.g., sequences of digits vs. spatial locations). The other mechanism, evidenced by the curvilinear trend in Letter-Number Sequencing scores, may be tentatively attributed to a decline in executive aspects of working memory that becomes increasingly pronounced with age.     

Revisiting the factor structure of the WAIS-R: insights through nested factor modeling

Past attempts to model via confirmatory factor analysis (CFA) the Wechsler Adult Intelligence Scale-Revised (WAIS-R) intersubtest covariation have used an oblique factor or a higher order modeling approach. The attempts have failed to yield adequate model fit, based on current CFA recommendations. Using the WAIS-R standardization data, it is demonstrated that the WAIS-R can be better conceptualized as measuring a first-order general factor and three orthogonal group-level factors. The results are discussed in relation to Verbal and Performance Intelligence scoring and failed attempts to find relationships between VIQ/PIQ difference scores and external criteria. Because Arithmetic and Digit Span did not share any variance with the other VIQ subtests, independent of General Intelligence, clinicians should reconsider interpreting a VIQ score that includes information from Arithmetic and Digit Span in nonclinical populations. Researchers are encouraged to model intelligence factors as nested factor models, considering their superior model fit, and the increased clarity in the interpretations of relationships between IQ indices and criteria.     

Assessing executive abilities following acute stroke with the trail making test and digit span

The Trail Making Test and Digit Span are neuropsychological tests widely used to assess executive abilities following stroke. The Trails B and Digits Backward conditions of these tests are thought to be more sensitive to executive impairment related to frontal lobe dysfunction than the Trails A and Digits Forward conditions. Trails B and Digits Backward are also thought to be more sensitive to brain damage in general. Data from the Stroke and Lesion Registry maintained by the Washington University Cognitive Rehabilitation Research Group were analyzed to compare the effects of frontal versus nonfrontal strokes and to assess the effects of stroke severity. Results showed that the performance of patients with frontal and nonfrontal strokes was comparable in each condition of both the Trail Making Test and Digit Span, providing no support for the widely held belief that Trails B and Digits Backward are more sensitive to frontal lobe damage. Further, Trails A was as strongly correlated with stroke severity as Trails B, whereas Digits Backward was more strongly correlated with stroke severity than Digits Forward. Overall, the Trail Making Test and Digit Span are sensitive to brain damage but do not differentiate between patients with frontal versus nonfrontal stroke.     

On the use of the WISC-R supplementary subtests as alternates

If a regularly administered WISC-R subtest cannot be administered properly or is invalidated, the manual suggests that a supplementary subtest, either Digit Span or Mazes, can serve as a substitute, but perhaps prorating the sum of scaled scores on the remaining subtests would be better. Data from the WISC-R standardization sample were analyzed to investigate the psychometric properties of these two variants of the standard procedure. Proration consistently resulted in higher validities (i.e., correlations between scores on the variant Verbal, Performance, or Full Scale and scores on the corresponding original scale), whereas substitution almost as consistently resulted in higher reliabilities, but in both cases the differences were small. Examiners may decide for themselves whether or not to use the supplementary subtests as alternates.     

Associations between evaluation anxiety,cognitive interference and performance on working memory tasks

According to Cognitive Interference Theory, evaluation anxiety leads to increased negative off‐task self‐dialogue which then results in diminished cognitive performance. Given that negative off‐task self‐dialogue is primarily verbal, the phonological loop and central executive components of the working memory system should be most affected by evaluation anxiety. Eighty‐eight participants were randomly assigned to receive evaluation anxiety inducing instructions or supportive instructions prior to administration of three tests (Digit Span, Visual Memory Span, and StroopColour‐Word) that measured the phonological loop, visuospatial sketchpad, and central executive components of working memory. Measures of evaluation anxiety and negative off‐task self‐dialogue were obtained during and after testing. Results showed that participants receiving anxiety inducing instructions reported significantly more evaluation anxiety and off‐task self‐dialogue. They also had significantly lower performance on the Digit Span Test and the StroopColour‐Word Test. Negative off‐task self‐dialogue also mediated the relationship between evaluation anxiety and performance on the Digit Span Test. Copyright © 2011 John Wiley & Sons, Ltd.     

Pilot study of light therapy and neurocognitive performance of attention and memory in healthy subjects

The aim of this pilot study was to investigate whether light therapy improves healthy subjects' neurocognitive performance of attention, memory, and language. Ten subjects were treated with white bright light for 5 days and a control group of 10 with no treatment were assessed with a battery of neurocognitive tests which included the Stroop Colour Word Interference Test, the Verbal Fluency Test, the Story Recall Test, and the Word Pairs Recall Test. Analysis showed improvements in cognitive scores in both groups, although on all the cognitive tests the mean difference scores between baseline and endpoint were significantly larger in the light-treated group. These preliminary results suggest that short-term bright light may exert beneficial effects on cognitive functions.     

Multivariate base rates for the assessment of executive functioning among children and adolescents

This study provides observed base rates of low executive functioning test scores among healthy children and adolescents, stratifies those base rates by narrow intellectual functioning and age groupings, and provides normative classification ranges to aid the interpretation of performances on the Delis-Kaplan Executive Function System (D-KEFS) in clinical practice and research. Participants included 875 children and adolescents between 8 and 19 years old from the D-KEFS normative sample (48% male; 52% female). Among these participants, 838 had complete data and were included in the current study. The racial/ethnic composition of the sample was: White (73.7%), African American (12.4%), Hispanic (11.1%), and other racial/ethnic backgrounds (2.7%). The Overall Test Battery Mean (OTBM) and the prevalence of low scores at various clinical cut-offs were calculated for the 13 primary scores from the D-KEFS Trail Making Test, Verbal Fluency Test, and Color-Word Interference Test. The OTBM and base rates were also calculated separately for those scores reflecting executive functioning (n = 7) and processing speed (n = 6). Healthy children and adolescents commonly obtained low scores on the D-KEFS tests considered here. Younger age, lower estimated full-scale intelligence quotient, and more test scores interpreted were associated with a greater frequency of low scores. Clinicians and researchers are encouraged to consider these multivariate base rates when assessing and attempting to identify executive functioning impairment among children and adolescents with the D-KEFS.     

A revised spatial serial learning and memory procedure using Corsi's Block-tapping apparatus

The purpose of this study was to use Corsi's Block Tapping Test as a spatial analog of Benton's Serial Digit Learning Test, using the cognitive neuroscience approach utilized in the California Verbal Learning Test. 60 normal participants, ages 19-52 years, were included and administered an 8-block sequence for 9 trials or until they recalled the entire sequence for 3 consecutive errorless trials. The score was the number of blocks tapped in the correct serial order. An interference trial was administered. Following a 10-min. delay, free recall of the original sequence, cued recall, and recognition measures were obtained. Retroactive interference was significant, but no proactive interference emerged. Scores showed a strong primacy effect. Most participants who learned the sequence to the criterion of three successive errorless trials recalled the sequence after the 10-min. delay. Scores on the cued recall and recognition trials tended to support their validity as less demanding retrieval tasks. The use of this spatial learning and memory procedure allows finer discriminations among nonverbal memory deficits and may facilitate direct comparisons with scores on verbal memory tasks such as Serial Digit Learning and the California Verbal Learning Test.     

Memory in traumatic brain injury: The effects of injury severity and effort on the Wechsler Memory Scale‐III

This study examined the effects of traumatic brain injury (TBI) on Wechsler Memory Scale‐III (WMS‐III) performance. Since poor effort potentially contaminates results, effort was explicitly assessed and controlled using two well‐validated cognitive validity indicators, the Portland Digit Recognition Test (PDRT) and Reliable Digit Span (RDS). Participants were 44 mild TBI patients with good effort, 48 mild TBI patients with poor effort, and 40 moderate–severe TBI patients with good effort. A dose–response relationship between injury severity and WMS‐III performance was demonstrated. Effect size calculations showed that the good effort mild TBI patients did not differ from normal (average Cohen's d= 0.07) while moderate–severe TBI had a moderate effect on WMS‐III scores (average Cohen's d=?0.52). Consistent with previous literature, the moderate–severe TBI group scored the lowest on WMS‐III Visual indices. Effort had a larger effect than injury severity on WMS‐III scores (average Cohen's d=?1.27). Clinical implications of these findings are discussed.