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

Objective: Craniopharyngiomas are extremely rare (incidence rate of 1.34 per million). Due to its proximity to the sellar/suprasellar prefrontal regions region, cognitive impairment, behavioral changes, and adverse endocrinological outcomes are common. Further, surgery and radiotherapy can further impact functioning. Currently, there is no parsimonious cognitive profile of adult patients following interventions. This case highlights the role of neuropsychological evaluations in monitoring global psychological functioning and frontal behavioral syndrome in an adult with recurrent craniopharyngioma. Method: The patient is a 39-year-old Black female first evaluated as an inpatient prior to resection surgery. She was evaluated on four additional times post-surgically. At the most recent evaluation, she and her family reported memory problems, apathy, and gait instability. Complicating factors included hypothyroidism, chronic kidney disease, diabetes, obstructive sleep apnea, pulmonary embolism, hypotension, COVID-19, and recurrent tachycardia, with inconsistent adherence to treatment recommendations. Results: She displayed global cognitive deficits two years post-surgery, particularly in language and memory. Neurobehaviorally, she exhibited pervasive signs of severe frontal lobe syndrome, including, abulia, hypophonic and dysarthric speech, psychomotor retardation, bradyphrenia, and anosognosia. Conclusion: Neuropsychological evaluations remain critical in monitoring the patient's neurocognitive status and provide valuable insights into treatment planning and need for additional support and care to optimize patients' quality of life in the context of significant cognitive disability. [ABSTRACT FROM AUTHOR]

Objective: Combining multiple embedded performance validity tests (PVTs) can produce similar classification accuracy to freestanding PVTs. However, there is a lack of research on the incremental predictive power of various combinations of PVTs. Thus, we compared eight embedded PVTs to assess those that best predict classification accuracy on the Dot Counting Test (DCT). Method: Sample included 225 patients (mean age=45.96; mean education=13.96; 56% female, 44% male; 35% White, 40% Black, 17% Hispanic, 5% Asian, 2% Other) undergoing neuropsychological evaluation that included multiple embedded PVTs, including: Brief Visuospatial Memory Test-Revised Recognition Discrimination (BVMT-R RD), Stroop Color and Word Test Word Reading T-Score (Stroop-T), Trail Making Test Part A T-Score (TMT-A), Rey Auditory Verbal Learning Test (RAVLT) Forced Choice, RAVLT Effort Score, Digit Span Age Corrected Scaled Score, Reliable Digit Span, and Letter Fluency T-Score. Patients were classified into valid/invalid groups based on four independent criterion PVTs. Results: A forward stepwise logistic regression was performed to predict DCT pass/fail using the aforementioned embedded PVTs as predictors. The model was achieved in three steps (p<.05); Step 1: BVMT-R RD (Classification Accuracy=87.6%; Nagelkerke R2 =.30), Step 2: BVMT-R RD + Stroop-T (Classification Accuracy=89.6%; Nagelkerke R2 =.44); Step 3: BVMT-R RD + Stroop-T + TMT-A (Classification Accuracy=90.1%; Nagelkerke R2 =.49). Conclusion: BVMT-R RD + Stroop-T + TMT-A reliably predicted the DCT pass/fail group. Thus, this combination of embedded PVTs may be reliable predictors of validity classification when time prohibits delivery of freestanding PVTs, such as the DCT. [ABSTRACT FROM AUTHOR]

Objective: Prior cross-validation studies have demonstrated the utility of embedded Performance Validity Tests (PVT) as reliable indicators of performance validity, though studies of the incremental predictive power from potential combinations of embedded PVTs remain sparse. The goal of the study was to compare the relative utility of eight embedded PVTs to predict pass/fail on the Medical Symptom Validity Test (MSVT). Methods: The study comprised 225 mixed neuropsychiatric patients referred for outpatient neuropsychological evaluation. The sample was 56% female and racially diverse (40% Black, 35% White, 17% Hispanic, 5% Asian, and 2% other ethnicities). The patients were administered the following eight embedded PVTs: Rey Auditory Verbal Learning Test Forced Choice (RAVLT-FC), RAVLT Effort Score, Digit Span Age Corrected Scaled Score (DS-ACSS), Stroop Color and Word Test Word Reading T-Score, Brief Visual Memory Test-Revised Recognition Discrimination (BVMT-RD), Reliable Digit Span, Letter Fluency T-Score, and Trail Making Test Part A T-Score. The patients were classified into valid/invalid groups based on standard MSVT cut scores. Results: A forward entry logistic regression model was attained in three steps (p<.05); Step 1: RAVLT-FC (Classification Accuracy=83.2%; Nagelkerke R2 =.27), Step 2: RAVLT-FC + DS-ACSS (Classification Accuracy=84.2%; Nagelkerke R2 =.36); Step 3: RAVLT-FC + DS-ACSS + Stroop Word-T (Classification Accuracy=85.1%; Nagelkerke R2 =.39). Conclusion: The RAVLT-FC + DS-ACSS + Stroop Word-T combination provides robust predictive power. The study provided a novel approach to selecting embedded PVTs that best stand in place of the MSVT when time constraints limit the use of freestanding PVTs. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to examine the use of dichotomous versus dimensional scores across two social determinant measures regarding their ability to predict cognitive and psychiatric outcomes in a diverse, urban, clinical sample. The goal was to better guide clinicians in the selection of appropriate research methodology pertaining to the use of cut-scores versus dimensional constructs. Method: The study included 215 adults referred for outpatient neuropsychological evaluation. Patients were classified into at-risk/low-risk groups based on predetermined Rapid Estimate of Adult Literacy in Medicine - Revised (REALM-R) and Adverse Childhood Experiences (ACE) cut-scores. Nine cognitive tests and two psychiatric self-report scales were administered. A series of hierarchical regression models were conducted to investigate the predictive power of dichotomous scores alone, and account for the incremental predictive power of dimensional scores. Results: For REALM-R, dichotomous scores alone accounted for significant variance, demonstrating robust predictive power across all cognitive tests (p < 0.001 to p < 0.05), but not for psychiatric outcomes. Dimensional scores provided significant incremental variance in five cognitive tests (p < 0.001to p < 0.05) during which the parameter estimate for the dichotomous scores was reduced to non-significance. Regarding ACE, dichotomous scores were positively associated with psychiatric symptoms (p < 0.001), but not with cognitive outcomes. The addition of dimensional scores did not predict significantly more variance. Conclusion: This study demonstrated the robust predictive power of dichotomous scores in REALM-R and ACE. Further, dimensional scores provided potent incremental predictive power for REALM-R and should be used to enhance clinical decision-making when applicable. [ABSTRACT FROM AUTHOR]

Objective: Adverse childhood experiences (ACEs) are associated with a range of negative health outcomes, including attention-deficit/hyperactivity disorder (ADHD) and neurocognitive deficits. This study identified symptom profiles in adult patients undergoing neuropsychological evaluations for ADHD and examined the association between these profiles and ACEs., Methods: Utilizing unsupervised machine learning models, the study analyzed data from 208 adult patients., Results: The Gaussian Mixture Model revealed two distinct symptom profiles: "Severely Impaired" and "Moderately Impaired". The "Severely Impaired" profile, 23.6% of the sample, was characterized by more severe ADHD symptomatology in childhood and worse neurocognitive performance. The "Moderately Impaired" profile, 76.4% of the sample, had scores in the average range for self-reported internalizing and externalizing psychopathology and better neurocognitive performance. There was a greater number of ACEs reported by patients in the Severely Impaired profile than the Moderately Impaired profile (p = .022). Specifically, using an ACEs cutoff of ≥4, 53.1% of patients in the Severely Impaired profile reported four or more ACEs, compared with 34.6% in the Moderately Impaired profile (p = .020). Profiles were not related to clinician-ascribed diagnosis., Conclusions: Findings underscore the association between ACEs and worse symptom profiles marked by impaired neurocognitive function, increased internalizing and externalizing psychopathology, and heightened perceived stress in adults with ADHD. Future research may explore the effect of ACEs on symptom profiles in diverse populations and potential moderators or mediators of these associations. Findings offers valuable insights for clinicians in their assessment and treatment planning., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)