Browsing by Subject "Neuropsychological Tests"
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Item Abbreviated and Expanded Forms of the Montreal Cognitive Assessment for Dementia Screening(2015-07-15) Horton, Daniel Kevin; Cullum, C. Munro; Hynan, Linda S.; Lacritz, Laura H.; Rossetti, Heidi; Weiner, Myron F.Cognitive screening is becoming increasingly important as the general population ages and the prevalence of dementia rises. However, popular cognitive screening tools have been criticized for their insensitivity to subtle cognitive impairment, poor specificity, excessive administration time, and/or questionable methods of test development. The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity which has demonstrated increased sensitivity to mild cognitive impairment (MCI), but takes roughly 10-15 minutes to administer and was developed without an empirically-driven item selection process. We devised two studies to address common limitations of cognitive screening tools using the MoCA. The aim of Study 1 was to create a short form of the MoCA (SF-MoCA) including only the items found to be most sensitive to MCI and Alzheimer disease (AD) and compare the diagnostic classification accuracy of the SF-MoCA to the Mini-Mental State Examination (MMSE) and standard MoCA. Results revealed delayed recall, orientation, and serial subtraction items to be most useful in differentiating the diagnostic groups. Overall, diagnostic accuracy of the SF-MoCA was superior to the MMSE and comparable to the standard MoCA, suggesting that some MoCA items do not add to the sensitivity of the instrument in these populations. Given the brevity and sensitivity of the SF-MoCA, we suggested this measure may be useful for early detection of cognitive impairment in primary care and other settings where evaluation time is limited. Despite the advantages of the SF-MoCA, this tool only assesses three cognitive domains and may not be appropriate in settings where clinicians may want to efficiently assess additional domains affected in AD and MCI to gain a clearer picture of global functioning and assist in differential diagnosis. Therefore, we conducted a second study to determine if diagnostic accuracy of the SF-MoCA might be enhanced through the addition of several brief and well-validated neuropsychological measures shown to be sensitive to cognitive impairment. Results revealed that the addition of measures of processing speed, category fluency, and verbal recall resulted in an Expanded SF-MoCA with diagnostic classification accuracy superior to both the standard MoCA and SF-MoCA. Findings of these studies have implications for current cognitive screening procedures and techniques used to develop these tools.Item Analysis of Practice Effects Across Cognitive Domains in Mild Cognitive Impairment(2014-09-01) Rao, Shruthi; Lacritz, Laura; Cullum, C. Munro; Martin-Cook, KristinSerial assessments provide clinically useful information about progression of a disease. Since individuals with mild cognitive impairment are less likely to show decline in cognitive areas other than memory, it is important to analyze which domains are more susceptible to practice effects than others. The appearance of practice effects in serial assessments is a common challenge for clinicians interpreting neuropsychological tests. Detecting true change can be altered by factors such as test intervals, standardization procedures, alternate forms, respondent characteristics, and cognitive domains impaired in a clinical population. Some cognitive domains such as learning, memory, and executive functioning are known to be more susceptible to practice effects than others such as processing speed, attention, and language. Normal adults are also shown to have greater practice effects over multiple exposures than disease populations. The review supports the claim that healthy adult individuals are more likely to improve and show greater practice effects during serial assessments than clinical populations. In patients with mild cognitive impairment (MCI), domains that rely on recall and learning test rules like learning, memory, and executive functioning tend to be more susceptible to practice effects than crystallized and skill - based domains such as language, processing speed, and attention. Future research should focus on developing reliable change indices for each cognitive domain and possibly each neuropsychological test to help provide a comparison and detect true change in test scores. Studies should also focus on developing alternate equivalent forms, which would help minimize practice effects across populations.Item Assessing Approach Motivation in Depressed Individuals with a History of Concussion(2020-12-01T06:00:00.000Z) Cecil, Audrey Lorraine; Cullum, C. Munro; Trivedi, Madhukar; Cooper, Crystal; Greer, Tracy L.; Carmody, Thomas; Pop, RaduDepression is the leading cause of disability worldwide. Anhedonia, a core symptom of depression, has been described as a lack of pleasure or interest, though it is a much more complex process than simply lack of pleasure. Anhedonia is made up of anticipation, motivation, enjoyment, and learning related to rewards. When an individual's motivation is impaired, reward perception is blunted as the drive to work for it is reduced. This "approach motivation" is generally subserved by the ventral striatum and orbitofrontal cortex, two areas which can be affected in a variety of neurologic conditions, including traumatic brain injury, as these subcortical structures can be affected by pathophysiological sequalae of trauma. To explore this concept, we examined data from a large ongoing study of adult depression (Dallas 2K). A total of 110 participants with depression with (n=40) and without a history (n=70) of self-reported concussion were tested on a measure of approach motivation, the Energy Expenditure for Rewards Task (EEfRT). We also analyzed depression symptom severity and the relationship between anhedonia severity to approach motivation on the EEfRT. Results revealed no significant differences between depressed adults with and without a history of concussion on approach motivation. Exploratory analyses revealed differences between high and low depression severity groups, such that high depression severity participants were less likely to select low probability/high reward tasks, but this was irrespective of concussion history. Though the main study results were nonsignificant, exploratory analyses present an opportunity for future direction of studies related to approach motivation and cognition in co-morbid depression and concussion.Item Characterization and Differences Between Possible and Probable Mild Cognitive Impairment(2009-06-15) Denney, David Austin; Lacritz, Laura H.Mild Cognitive Impairment (MCI) is the period of subtle cognitive decline that occurs between normal aging and clinical Alzheimer's Disease (AD). Patients' subjective memory complaints (SMCs) are essential to the diagnosis of MCI. In cases where memory complaints are not verifiable by objective measures, patients are left without a formal diagnosis of cognitive impairment. The current proposal describes a study designed to compare the cognitive features and risk factors of AD in subgroups of patients with SMCs with (Probable MCI) and without (Possible MCI) objective memory deficits in relation to controls. It is predicted that the Probable MCI group will demonstrate lower performance and have a greater decline on neuropsychological measures than patients diagnosed with Possible MCI, who will demonstrate lower performance and have a greater decline on those measures than controls. Also, it is predicted that Probable MCI patients will have greater incidence of vascular risk factors and presence of the apolipoprotein element 4 (APOE-4) allele than the Possible MCI patients, who will have higher incidence of these variables than controls. There is also a demographic analysis designed to identify any differences in age, education, and gender between the groups. Implications of possible outcomes of the study are then discussed.Item Characterization and Differences Between Possible and Probable Mild Cognitive Impairment in an Alzheimer’s Disease Center(2015-08-31) Weaver, Victoria Allison; Rossetti, Heidi; Lacritz, Laura H.; Silver, Cheryl H.BACKGROUND: Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and dementia. A subjective cognitive complaint (SCC) is a key component in the diagnosis of MCI. However, some individuals with SCCs do not show objective impairment on neuropsychological measures and there has been debate about the role of SCCs for the characterization of MCI. This study aimed to examine the differences in neurocognitive function and other risk factors between MCI subtypes and better understand the role of the SCC when objective cognitive impairment is not present. SUBJECTS: This retrospective study includes 395 participants [age (M, SD) =67.5(7.2), education (M, SD)=15.10(2.7)], from the Alzheimer’s Disease Center (ADC) at the University of Texas Southwestern Medical Center who were English speaking and between the ages of 50-90. Participants received a comprehensive clinical assessment including neuropsychological testing and diagnosis, which was made via multidisciplinary group consensus. This study consisted of participants classified at their baseline ADC visit as individuals with SCC but normal cognitive performance (possible MCI, n=83), individuals with SCC and abnormal cognitive performance (probable MCI, n=121), and normal controls (n=191). METHOD: Differences in performance on neuropsychological measures among possible MCI, probable MCI, and normal control groups were examined using MANOVA. Differences in the frequency of selected cognitive and vascular risk factors, including APOE4, hypertension, high cholesterol, and diabetes mellitus, were examined using chi square test of independence. Demographic differences (age, education, gender, depression, and premorbid intelligence) across groups were compared using either ANOVA or chi square. RESULTS: Normal controls performed significantly better than the probable MCI group on the MMSE, TMT-A, TMT-B, Block Design, WCST, FAS, Animal Fluency, and BNT (p<.05). On the CVLT, normal controls demonstrated fewer intrusion errors, higher total learning scores, and better long delay free recall than both the possible and probable MCI groups, and similarly, the possible MCI group performed significantly better than the probable MCI group. The frequency of APOE4 did not differ significantly among groups (p>.05). The probable MCI and possible MCI group had significantly higher rates of hypertension (58%, 59%) compared to the normal control group (46%). The probable MCI group had significantly higher rates of high cholesterol (66%) than the possible MCI group (18%). The probable MCI group had significantly more males, lower education, and higher GDS scores compared to NC groups (p<.05). DISCUSSION: This study demonstrated that the probable MCI group differed from normal controls on measures of memory, executive function, and language, and had higher rates of hypertension and high cholesterol. Although statistically significant differences among all three groups on measures other than complex verbal memory were not seen; closer examination of the neurocognitive test scores showed that the possible MCI group performances were qualitatively more similar to that of the probable MCI group rather than the NC group. This may support the notion that individuals with a SCC but without overt impairment on testing do share commonalities with those with clear MCI, indicating that SCC do carry clinical significance and warrant evaluation and monitoring over time in older individuals.Item Do Concussion History and Gender Influence Neurocognitive Testing Performance(2016-11-21) Borque, Brandy; Silver, Cheryl H.; Cullum, C. Munro; Resch, JacobBACKGROUND: To date, the literature regarding sport concussion (SC) has concentrated primarily on male athletes. Generally, as research on female athletics has increased, there is an overall agreement that female athletes show more impairment post-injury than males. However, more data are needed to determine how SC impacts the female athlete and if that impact is influenced by factors such as age or history of prior concussion. SUBJECTS: Subjects with and without a previous history of concussion at the high school and college level were included and carefully matched for age, gender, height, and weight. After careful matching, five high school athletes with a history of prior SC were compared with five high school athletes without a concussion history, and 14 college athletes with a history of prior SC were compared with 14 matched college athletes without a concussion history. METHOD: Data for this study were acquired from a larger study conducted at the University of Texas at Arlington that examined sport concussion in high school and college athletes. Variables included previous concussion history and baseline scores from the ImPACT test. It was hypothesized that female athletes with a previous SC would show more impairment on baseline neurocognitive measures and would report greater symptom severity at baseline testing compared to athletes without a prior SC. In addition, it was hypothesized that female athletes with a previous SC at the high school level would show more impairment on baseline neurocognitive measures than college athletes with prior SC and that high school players would show greater symptom severity compared to college athletes at baseline. RESULTS: No significant differences were seen on any ImPACT baseline composite scores between athletes with and without a reported history of prior concussion. Similarly, no differences on ImPACT baseline total symptom scores were seen between athletes with concussion versus without a history of prior concussion. Finally, there were no differences on ImPACT composite or total symptom scores between college and high school athletes.Item ImPACT™ Performance of High School Student Athletes with ADHD(2015-08-31) Gomez, Brooke Marie; Silver, Cheryl H.; Resch, Jacob; Cullum, C. MunroBACKGROUND: To date, two studies demonstrate that adolescents with ADHD tend to perform poorer on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT; Lovell, 2013) at baseline than do adolescents without ADHD at baseline (Elbin et al., 2013; Zuckerman, Lee, Odom, Solomon, & Sills, 2013). In an effort to replicate and extend these studies, the baseline and immediate post-concussion performance of high school athletes with and without ADHD were evaluated to identify potential differences between groups on the ImPACT’s domains. SUBJECTS: Student athletes were recruited from a private high school. Baseline testing was conducted biannually to establish pre-injury/baseline levels of individual participants. Thirty-eight students with ADHD and a matched control group of thirty-eight students without ADHD were used to test the first hypothesis. Twenty-three students with ADHD and a matched control group of twenty-three students without ADHD who sustained a concussion were used to test the second and third hypotheses. Additional analyses were performed on data from four student athletes with ADHD who sustained a concussion. METHOD: Data were used from a larger study conducted by a large public metropolitan university. Variables included demographic information and the ImPACT. All data were stored on an encrypted computer or in a locked file cabinet. RESULTS: Independent samples t-tests revealed significant differences between athletes with ADHD and non-ADHD athletes at baseline on the Impulse Control (t (74) = 2.73, p < .01) and the Total Symptoms (t(74)= 2.63, p < .05) scores of the ImPACT. A multivariate analysis of variance (MANOVA) was conducted on data from two time periods. A statistically significant difference (F(6, 39) = 2.86, p = .02; Wilks’ ? = 0.694; ?2 = .31) in ImPACT performance was found between non-concussed athletes with ADHD tested at baseline and concussed athletes without ADHD tested within 72 hours of injury (M = 1.83 days). Further analysis using independent samples t-tests found that athletes with ADHD at baseline performed significantly better than concussed athletes without ADHD tested within 72 hours of injury, on the following composites: Verbal Memory (t(44)= 2.25, p < .05), Visual Motor Speed (t(44)= 2.33, p < .05), Reaction Time (t(44)= -3.42, p < .01), and Total Symptoms (t(44)= -3.52, p < .01). No significant between-group differences were found on the Visual Memory or Impulse Control composites of the ImPACT. DISCUSSION: These findings indicate that administration of the ImPACT to individuals with ADHD is appropriate. At baseline, both groups performed similarly on Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time. However, the overlap in ADHD and concussion profiles on Impulse Control and Visual Memory warrant caution in the clinical interpretation of the ImPACT profiles of individuals with ADHD. Nevertheless, these findings suggest that the overall use of normative data within an ADHD population is appropriate, and baseline testing has values for athletes with ADHD.Item Neuropsychological Predictors of Time to Conversion from Mild Cognitive Impairment to Alzheimer's Disease(August 2021) Parker, Allison Nicol; Cullum, C. Munro; McClintock, Shawn Michael; Rossetti, Heidi; Hynan, Linda S.; Nguyen, TrungMild Cognitive Impairment (MCI) is a risk state for the development of Alzheimer's disease (AD), though individual outcomes vary. Accurately predicting which MCI patients are likely to develop AD and how long they have until the onset of dementia could provide both patients and their families sufficient time to prepare. Neuropsychological tests have the advantage of objectively quantifying cognitive impairments, and may be useful in predicting time to conversion. The present project aimed to 1) compile the available literature concerning neuropsychological predictors of conversion from MCI to AD using systematic review and meta-analytic techniques and 2) to determine if neuropsychological profiles differentiate MCI patients who convert to AD sooner, those who convert later, and those who do not convert utilizing a statistical technique known as profile analysis. Findings from the systematic review illuminated several gaps in the literature such as the small number of studies that follow patients over longer periods of time. Results from the meta-analysis suggested that word recall and recognition tasks, complex figure recall tasks, simple shape recall tasks, Trail Making Task B (TMT-B), semantic fluency, and the Mini Mental State Examination (MMSE) differentiated between MCI patients who convert sooner (within three years) from those who maintain an MCI diagnosis over three years. Results from the second part of the project found that verbal memory measures best distinguished those who converted sooner from those who converter later. In comparison with those who convert within three years, the group that maintained an MCI diagnosis completed TMT-B more quickly and performed better on memory measures. Neuropsychological measures did not distinguish between those who maintained an MCI diagnosis and those who converted after three years. Taken together, results from the two studies suggest that clinicians may wish to rely upon memory measures and TMT-B performance when considering recommendations regarding length of follow-up and planning for the onset of dementia in patients with MCI. In order to better understand predictors of time to conversion from MCI to AD, future studies should follow participants over several years and make direct comparisons between those who convert sooner and those who convert later.Item Performance on the Texas Functional Living Scale (TFLS) In Mild Cognitive Impairment(2007-08-08) Binegar, Dani Lyn; Cullum, C. MunroMild cognitive impairment (MCI) describes the transitional state between normal aging and dementia for many individuals, although debate continues over whether MCI represents an initial, separate condition, or if it is, in fact, the earliest presentation of dementia. One criterion for the diagnosis of MCI is an absence of impairment in activities of daily living; however, there is growing evidence that many individuals with MCI have difficulties with some instrumental activities of daily living (IADLs), such as managing finances and medications. The current study examined the performance of individuals diagnosed with MCI and normal control subjects (NC) on a brief, quantifiable measure of IADLs, the Texas Functional Living Scale (TFLS). Additional goals of this study were to examine how the TFLS relates to standard neuropsychological measures of global cognitive function, memory, language, executive functioning, and attention, and to determine whether performance on the TFLS declines over time in MCI. As predicted, the MCI sample (n = 30) scored significantly lower than the NC group (n = 30) on the TFLS total score (t (58) = 2.34, p = .011) and on the TFLS Memory subscale (t (58) = 3.29, p = .002). Performance on the TFLS was significantly correlated with performance on the MMSE (ρ = .26) and The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD; r = .37). Scores on the TFLS Memory and Communication subscales were also correlated with the CERAD total score (r = .45 and .22, respectively). Across all subjects, the TFLS was associated with standard measures of memory and language (ρ's = .22 to .31). Although the difference did not reach statistical significance, subgroups of MCI and NC were followed over time, and 50% of individuals with MCI declined on the TFLS, compared with 29% of NC sample. These findings suggest that subtle changes in cognitive-related IADLs may be present in individuals with MCI, and that the TFLS is sensitive to such changes.Item The Relationship of Coronary Atherosclerosis Progression to Cognition(2014-07-25) Carter, Kirstine Renee; Rossetti, Heidi; Lacritz, Laura H.; Cullum, C. Munro; Hynan, Linda S.; Khera, Amit; Weiner, Myron F.Subclinical atherosclerosis has been linked to poorer cognitive performance. Most of the literature investigating the relationship between atherosclerosis and cognitive functioning has utilized the carotid artery as an indicator. Few studies have examined the association between cognitive performance and atherosclerosis in areas where it accumulates early in the progression process, such as the coronary artery. This project aimed to examine the relationship between change in subclinical coronary atherosclerosis and cognitive performance in a large, community-based sample. Participants included 1,386 individuals with Dallas Heart Study data for coronary artery calcium (CAC) levels obtained at two time points (DHS-1 and DHS-2, approximately 7 years later) and Montreal Cognitive Assessment (MoCA) scores at DHS-2 (mean age in years (SD)=52 (9.0); 57% female, 48% Black). A subset of DHS participants (N=101, mean age (SD)= 66 (5.1), 58% female, 38% Black) returned 5 years later for comprehensive neuropsychological testing as part of the Dallas Heart and Brain Aging Study (DHBAS) at the UT Southwestern Alzheimer Disease Center. CAC progression was examined as an increase from baseline calcium levels and based on CAC progression groups (i.e., None, Incidence, Non-Progressor, Progressor) in relationship to MoCA Total Score using linear multiple regression and ANOVA to compare MoCA performance between groups. Neuropsychological test data were aggregated into functional domains, and then into a Global Composite Score. The relationship between CAC progression and this global score was examined using linear multiple regression and MANOVA. ANCOVA and MANCOVA were also used to control for sociodemographic variables, traditional vascular risk factors, and baseline CAC. In the DHS sample, CAC progression was weakly but significantly associated with MoCA scores, but this relationship was attenuated by sociodemographic factors. Membership in the CAC Progressor group was significantly associated with poorer MoCA scores after controlling for baseline CAC, race, age, sex, education, hypertension, diabetes, hypercholesterolemia, and waist to hip ratio; however, when participants with stroke were excluded Progressor group membership was no longer a predictor. There was no relationship between CAC change and subsequent cognitive performance on comprehensive neuropsychological testing. Overall, there was minimal relationship between CAC progression and global cognitive performance in a large, relatively young, community-based sample.Item Use of a Pre-Employment Multitasking Instrument and Neuropsychological Measures to Predict Field Performance in Police Officers(2017-07-27) Galusha, Jeanine Marie; Cullum, C. Munro; McGarrahan, Antoinette; Hynan, Linda S.; Proctor, Timothy; Bishopp, StephenThe role of the police officer has evolved drastically since the inception of pre-employment psychological evaluations in the 1960s and increasingly relies on adequate multitasking ability to keep up with the demands of the job. However, though necessary, multitasking is not directly assessed. Conversely, some agencies make use of a multitasking test (CritiCall) to evaluate prospective 911 operators during the application process. Thus, the goals of this study were to evaluate the utility of standard neuropsychological tests and CritiCall in predicting police officer success and to evaluate the relationship between the multitasking instrument and neuropsychological measures. North Texas police officers were administered the NIH Toolbox Cognition and Emotion Batteries along with several traditional neuropsychological measures of attention, working memory, and mental flexibility, and a subset completed the CritiCall test. Each officers' direct supervisor completed a standard Supervisor Survey which served as the primary outcome measure. Spearman correlations were used to compare performance on CritiCall to the NIH Toolbox Cognition Battery and standard neuropsychological test scores, and all scores were tested for predictive ability in relation to the Supervisor Survey via stepwise linear regression. Aspects of the multitasking instrument were associated with performance on measures of processing speed, attention, working memory, mental flexibility, and crystallized cognitive abilities. No subtests or composite scores from the NIH Toolbox Cognition Battery were predictive of the Supervisor Survey, whereas several subtests from the NIH Toolbox Emotion Battery were significant predictors. Standard neuropsychological tests combined with subtests from the Emotion Battery were found to be some of the strongest predictors, specifically the combination of a measure of perceived stress and working memory. Primary results provide evidence for a relationship between neuropsychological factors and police field performance ratings. Continued research is needed to further evaluate and validate the Supervisor Survey and to confirm these findings in additional settings.Item Use of Regional Brain Volume, the Montreal Cognitive Assessment, and Self-Reported Cognitive Complaint to Predict Future Cognition(2016-07-18) Brown, Daniel Solomon Martin; Lacritz, Laura H.; Rossetti, Heidi; Weiner, Myron F.; Hynan, Linda S.; Whittemore, Anthony W.Early and accurate prediction of future cognitive impairment can promote increased use of interventions, which in turn can lead to delayed decline and therefore higher quality and potentially longer length of life. There are a number of known risk factors/biomarkers that predict future cognition; however, prior literature is mixed and incomplete. Further, previous studies suggest that combining multiple risk factors may lead to increased utility above and beyond that of any single predictor, and a limited number of risk score algorithms have been derived accordingly, though more research is needed. The present study examined the ability of regional brain volumes, the Montreal Cognitive Assessment (MoCA), and self-reported cognitive complaint to predict future cognitive status (cognitively impaired or unimpaired), and a risk score algorithm was derived based on these findings. Exploratory analyses were also conducted to examine the ability of the aforementioned factors, excluding the MoCA, to predict future performance in various neuropsychological domains. Total brain volume, left hippocampal volume index, MoCA total score, and cognitive complaint significantly (all p's < .05) predicted diagnostic group (cognitively impaired or unimpaired), with a correct classification rate of 73.8%, controlling for sex (Nagelkerke R2 = .33, p < .001; Hosmer-Lemeshow p = .21). A risk score algorithm was created using these variables, which yielded an area under the curve (AUC) of .81 (p < .001). Regarding the exploratory analyses, whole brain volume was retained in models for all cognitive domain composites except verbal memory; and cognitive complaint was retained in models predicting global, language, and processing speed and attention composites. While a number of regional brain volume variables were retained in exploratory analyses, the majority of results were opposite the direction expected. The present study yielded a theoretically and statistically sound approach in producing a simple risk score algorithm to predict future cognitive decline that requires minimal resources and can be implemented across clinical settings, pending cross validation. Its use could lead to earlier intervention and ultimately improved preparation for, as well as reduced risk, delayed onset, and slower rate of, cognitive decline, thereby resulting in higher quality and potentially even length of life.Item Utility of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Battery Total Score in the Progression of Alzheimer's Disease(2007-08-08) Rossetti, Heidi Christine; Lacritz, Laura H.The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) created a neuropsychological battery that is both brief and sensitive to dementia (Morris et al., 1989). Chandler et al. (2005) put forth a method of calculating a Total Score for the CERAD along with normative data. The objective of this study was to determine the utility of the Total Score as a measure of progression of Alzheimer's disease (AD). Subjects included CERAD registry normal controls (NC; N = 383) and AD subjects (N = 655) with a baseline assessment and at least one follow-up assessment. Change Scores were calculated along with Reliable Change Indexes (RCI). The AD sample declined an average of -7.2 points per year, compared to a 1.0 point annual increase obtained by the NC sample. By the third annual assessment, the majority of AD subjects (65.2%) exceeded the confidence interval established by the RCI. Annualized CERAD Change Scores significantly correlated with change scores on the MMSE (r = .66), CDR Sum of Boxes (r = -.42), and BDRS (r = -.38). The impact of race, gender, education, and age-at-baseline on AD progression was examined with analysis of covariance and multiple regression. Demographic variables accounted for only 4% of the variance in annualized change in CERAD performance, with greater annualized decline in Total Score observed in Caucasians (M = -7.64, SD = 6.82) versus African- Americans (M = -4.60, SD = 7.03); males (M = -8.22, SD = 6.70) versus females (M = 6-.44, SD = 7.04); and younger age-at-baseline (M = -8.72, SD = 6.44) versus older age-at-baseline (M = -6.85, SD = 7.01). Neither education nor dementia severity significantly impacted annualized Change Scores. The current study provides support for the validity of the CERAD Total Score as a measure of progression in AD.Item Validation of a Neuropsychological Wada Procedure(2005-08-11) Eisenman, Daniel David; Lacritz, Laura H.The Intracarotid amobarbital procedure (IAP) is considered an essential part of the presurgical neurodiagnostic evaluation in most epilepsy centers throughout the country. Despite the IAP's mainstream use, there is great variability in how the test is being performed across centers. The main purpose of this study was to validate a standardized IAP memory measure and explore its value in predicting lateralization as well as treatment outcome. The IAP memory measure had good overall reliability for all three Forms (Cronbach's Alpha = .85 for Form I, .83 for Form II, and .69 for Form III). The majority of items on Form I and II had acceptable item difficulty values, item discrimination values, and item-total correlations. There were a few items on Forms I and II that may be candidates for revision, but most items were only slightly below predicted ranges for what defines a "good" measure, and the majority of items contributed to the reliability of the test. In terms of construct validity, correlations with other memory tests provided some evidence of convergent validity for the IAP memory measure, but were generally low. In terms of divergent validity, both Forms I and II had low or no correlations with the executive functioning measures, providing preliminary support for the construct validity of the measure. When utilizing a discrepancy score to predict lateralization in subjects with temporal lobe epilepsy, asymmetry scores from the IAP memory measure were able to classify 92% of subjects with either left or right TLE after applying a correction factor for left injection scores. There was limited data regarding post-operative seizure outcome. However, seizure-free subjects had a higher percentage of DS greater than 20% than those subjects who reported at least one seizure postoperatively. In addition, there was a significant difference on Form I of the IAP memory measure between subjects who reported they were seizure free following temporal resection as compared to subjects who continued to report symptoms. Overall, the IAP memory measure demonstrated good psychometric properties and this study represents one of the most thorough analyses of the IAP memory test to date.