How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

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.     

Neurocognitive functioning in patients with conversion disorder/functional neurological disorder

Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty-nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color–Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.     

Laterality of repetitive finger movement performance and clinical features of Parkinson’s disease

Impairments in acoustically cued repetitive finger movement often emerge at rates near to and above 2 Hz in persons with Parkinson’s Disease (PD) in which some patients move faster (hastening) and others move slower (bradykinetic). The clinical features impacting this differential performance of repetitive finger movement remain unknown. The purpose of this study was to compare repetitive finger movement performance between the more and less affected side, and the difference in clinical ratings among performance groups. Forty-one participants diagnosed with idiopathic PD completed an acoustically cued repetitive finger movement task while “on” medication. Eighteen participants moved faster, 10 moved slower, and 13 were able to maintain the appropriate rate at rates above 2 Hz. Clinical measures of laterality, disease severity, and the UPDRS were obtained. There were no significant differences between the more and less affected sides regardless of performance group. Comparison of disease severity, tremor, and rigidity among performance groups revealed no significant differences. Comparison of posture and postural instability scores revealed that the participants that demonstrated hastening had worse posture and postural instability scores. Consideration of movement rate during the clinical evaluation of repetitive finger movement may provide additional insight into varying disease features in persons with PD.     

Does content matter? The effect of remorseful tone on length of prison sentence

The expression of remorse by offenders has been found to affect jurors' determination of length of prison sentences. This study explores this phenomenon by contrasting the impact of exercising remorse solely in words or through emotional tone. Remorse consists of guilt, shame and sorrow. This study examines the contribution of each of these emotions to judgements about prison sentences, which is an area seldom explored in the literature. It is shown that regardless of the gender of the offender, participants censured a significantly more severe punishment for the offender who expressed a sense of remorse using words rather than tone. In addition, only shame was a significant predictor of the severity of punishment. These findings are consistent with previous studies and further differentiate the influence of displaying remorse at the content and tonal levels.     

Driver injury severity study for truck involved accidents at highway-rail grade crossings in the United States

Although trucks only account for approximately 4% of all the vehicles based on the Federal Railway Administration (FRA) database, about 25% involved truck accidents happen at highway-rail grade crossings. This study applied an ordered probit model to explore the determinants of injury severity of truck drivers at highway-rail grade crossing in the United States. Given the importance of trucking to the economics of a country and the safety concerns posed by the trucks (as a result of their large size and weight making them difficult to control, maneuver, and stop), a comprehensive research on truck accidents is critical. Based on data analysis results, the strong effects of driver-, environmental-, weather- characteristics on the injury severities in truck accidents happened at highway-rail grade crossings are found. The findings reveal that better speed control for trucks will significantly reduce driver injury severity in accidents occurring at highway-rail grade crossings. In addition, several truck driver behavior characteristics (such as driving under influence of fatigue during peak hour) were found to be statistically significant predictors of high-level injury severity. Thus, education and enforcement targeted to truck drivers could facilitate safety improvements. Moreover, environmental factor (such as area type and roadway pavement) is found to be statistically significant. Truck drivers are more likely to have severe injury in open space area with low traffic volume compared with other areas. The bad weather and visibility condition is found to increase the probability of truck drivers’ high level injury severity.     

The health preoccupation diagnostic interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder

Somatic symptom disorder (SSD) and illness anxiety disorder (IAD) are two new diagnoses introduced in the DSM-5. There is a need for reliable instruments to facilitate the assessment of these disorders. We therefore developed a structured diagnostic interview, the Health Preoccupation Diagnostic Interview (HPDI), which we hypothesized would reliably differentiate between SSD, IAD, and no diagnosis. Persons with clinically significant health anxiety (n = 52) and healthy controls (n = 52) were interviewed using the HPDI. Diagnoses were then compared with those made by an independent assessor, who listened to audio recordings of the interviews. Ratings generally indicated moderate to almost perfect inter-rater agreement, as illustrated by an overall Cohen’s κ of .85. Disagreements primarily concerned (a) the severity of somatic symptoms, (b) the differential diagnosis of panic disorder, and (c) SSD specifiers. We conclude that the HPDI can be used to reliably diagnose DSM-5 SSD and IAD.     

Victims' emotional distress and preventive measures usage: Influence of crime severity,risk perception,and fear

The central thesis of this study is that crime victims' emotional distress, influenced by the severity of the offence experienced, impacts their propensity to utilize preventive measures via its influence on perceived risk of victimization and fear of crime. Path analysis was conducted to test a model of these relationships, utilizing data from a crime victimization survey conducted on the Caribbean Island, Trinidad, in 2015. Results suggest a direct predictive relationship between crime severity and emotional distress and indirect effects of emotional distress on preventive measures through risk perception and fear of crime. Findings were discussed in the context of prior research, comparability, and variances, and practical implications were noted.     

THE NEGATIVE SIDE EFFECTS OF REWARD

The negative side effects of aversive control have been extensively discussed in clinical literature and textbooks. The symmetry between aversive and appetitive control in basic experimental research implies that parallel negative side effects of reward exist. These negative side effects are described and their implications for clinical practice and research are discussed.     

Body weight and weight perception among African and Caribbean university students: Correlation with depression symptoms

The aim of the study was to investigate the association between body weight, weight perception, and depressive symptoms in African and Caribbean university students. In a cross-sectional survey the total sample included 4 964 undergraduate university students (mean age 21.8, SD = 3.4, age range = 18-30 years) from five African and three Caribbean countries. Data on the students’ actual and perceived body weight, as well as depression symptoms, were collected. In logistic regression, perceived rather than measured overweight predicted depressive symptoms in male students with normal weight. For female students, perceived overweight predicted depression symptoms regardless of actual body weight. Male students who overestimated their body weight were at greater risk of depressive symptoms. Body weight self-perceptions appear to influence experience of mood disorder among African and Caribbean country students.     

中小学生的灾难暴露程度对创伤后应激障碍的影响：中介和调节效应

汶川地震后1年时,采用灾难暴露程度问卷、主观害怕程度问卷、社会支持问卷和创伤后应激障碍症状量表,对地震极重灾区的3058名中小学生进行调查,考察灾难暴露程度、主观害怕程度、社会支持与创伤后应激障碍的关系。结果发现：（1）震后1年时中小学生创伤后应激障碍的发生率为9.6%,其中有目睹他人死亡经历的学生的创伤后应激障碍发生率为16.2%;（2）灾难暴露程度能正向预测创伤后应激障碍,而主观害怕程度在灾难暴露程度对创伤后应激障碍的影响中起部分中介作用;（3）社会支持在灾难暴露程度与创伤后应激障碍的关系中起调节作用,但不能调节主观害怕程度与创伤后应激障碍之间的关系。其中,无论支持的性质如何,父母和教师的支持都能缓解灾难暴露程度对创伤后应激障碍的影响,而同学和其他人的支持则不具有调节效应。