BACKGROUND:Embedded performance validity tests (PVTs) provide an efficient means of assessing validity in neuropsychological evaluations. Multiple embedded PVTs have been developed for the Rey Auditory Verbal Learning Test (RAVLT), most notably the Effort Score (ES) and Forced Choice (FC) recognition paradigms. However, there is limited research examining whether ES and FC provide nonredundant information, particularly across levels of cognitive impairment. This study examined the independent and combined accuracy of the RAVLT ES and FC embedded PVTs for detecting invalid neuropsychologist test performance. METHODS:Data came from 487 mixed neuropsychiatric outpatients evaluated at an academic medical center who completed the RAVLT and four independent criterion PVTs. Study validity groups were defined invalid based on failure of two or more criterion PVTs (22%). Valid participants were further classified as no impairment, mild, or major neurocognitive disorder. RESULTS:Significant performance differences were observed across all RAVLT scores with large effects. ES and FC were moderately correlated overall, with weaker correlations in the no impairment group. FC was a consistent predictor across all impairment groups, whereas ES showed reduced predictive utility among the mild impairment group. Combined models demonstrated improved classification accuracy compared to either indicator alone. CONCLUSION:RAVLT ES and FC represent distinct but complementary embedded PVTs. FC is more robust in genuine cognitive impairment and should be prioritized in impaired populations, whereas ES provides incremental value in cognitively intact individuals. These findings support the use of multiple embedded RAVLT PVTs in clinical practice.
OBJECTIVE:The aim of this study was to evaluate the central auditory processing abilities of patients with Obstructive Sleep Apnea Syndrome (OSAS). METHODS:A total of 86 individuals aged between 20 and 55 years, with normal pure-tone averages and no history of any pathology that could affect hearing, were included in the study. The study group consisted of 43 individuals diagnosed with OSAS by polysomnography, while the control group comprised 43 individuals without an OSAS diagnosis or related symptoms. All participants underwent pure-tone audiometry test, speech reception threshold (SRT), speech discrimination score (SDS), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), Gaps-in-Noise Test (GIN), and Masking Level Difference (MLD) test. RESULTS:According to the findings, pure-tone thresholds in the study group were significantly higher than those of the control group bilaterally across the 125-8000 Hz frequency range, except at 2000 Hz. The mean SRT values were also significantly higher in the study group compared to the control group. No significant difference was found between the groups in terms of SDS. The mean score of the study group in the DPT was significantly higher than that of the control group. No significant differences were observed between the groups in the FPT, GIN, or MLD tests. However, in the SPT, FPT, and GIN tests, the OSAS group exhibited poorer performance compared to the control group. CONCLUSION:In conclusion, both peripheral hearing and central auditory processing abilities were found to be adversely affected in individuals with Obstructive Sleep Apnea Syndrome.
Noninvasive neuromodulatory interventions, particularly repetitive Transcranial Magnetic Stimulation (rTMS) and intermittent Theta Burst Stimulation (iTBS), are increasingly emerging as alternative and complementary approaches for symptomatic management of Multiple Sclerosis (MS). This systematic review and exploratory meta-analysis synthesized evidence from 11 Randomized Controlled Trials (RCTs) evaluating the clinical efficacy and underlying mechanisms of rTMS. Across individual trials, directionally consistent short-term improvements were observed in spasticity, fatigue, balance, gait, dexterity, and cerebellar functions. Exploratory Meta-analytic results indicated a reduction in spasticity, as well as modest improvements in fatigue and depressive symptoms. Neuroimaging findings further suggested microstructural changes consistent with altered white matter properties. Potential mechanisms include modulation of cortical excitability, synaptic plasticity, interhemispheric balance, and neuroimmune processes. Despite these promising directional trends, small sample sizes, variability in stimulation protocols, and limited geographic representation limit the broader generalizability and robustness of these findings. Overall, rTMS appears generally well tolerated in small trials, with short-term symptomatic improvements reported in some domains. These preliminary findings highlight the need for longitudinal trials employing standardized stimulation protocols and multimodal outcome assessments to elucidate sustained efficacy and underlying mechanisms.
BACKGROUND:The Addenbrooke's Cognitive Examination III is a cognitive screen developed for early detection of dementia and is also used to detect mild cognitive impairments. METHODS:This service evaluation aimed to explore whether the ACE-III is associated with cognitive domains identified from more detailed assessment in acquired brain injury (ABI), and therefore a clinically useful screening tool, for service users in the Community Acquired Brain Injury Service (CABIS). A sample of 20 CABIS service users were deemed eligible for this service evaluation. Correlations and weighted linear regressions were conducted. RESULTS:Pearson and Spearman Rank correlations and weighted linear regressions identified significant associations between certain cognitive domains in the ACE-III and the WAIS-IV. A significant positive correlation of moderate strength was found for Attention × Working Memory, Spearman's ρ(16)=0.52, p=.028. Weighted linear regressions were found to be significant for Attention × Working Memory (F=4.60, p=.048, R2=0.22); Visuospatial × Perceptual Reasoning (F=27.17, p<.001, R2=0.66); and Total Score × Full Scale (F=5.76, p=.032, R2=0.31). CONCLUSIONS:This study reveals practical applications for the service in which the evaluation was conducted, in that the ACE-III may be considered a clinically useful tool to indicate trends of cognitive functioning for people with ABI. Future research should aim to replicate these findings in a larger sample, using true experimental designs.
Working memory capacity negatively correlates with Attention Deficit Hyperactivity Disorder. In this narrative review, we examine the strength of this correlation, alongside explanations for its existence. Some explanations cast working memory weaknesses as an artifact of testing, such that inattention during testing disrupts encoding. Other explanations link working memory weakness to poor executive control and selective attention, such that ADHD impedes mental manipulation central to all working memory tasks. We thereafter compare these extant explanations against the following alternative explanation: Correlations between ADHD and working memory are artifacts of contaminated samples employing imprecise inclusion and exclusion criteria that neither commonly control for intelligence nor rule out low intelligence as an alternative explanation for putative ADHD. This alternative explanation is relevant because intelligence positively correlates with working memory capacity; and at the same time, ADHD samples are often selected based on ratings that neither measure intelligence nor attention. This alternative explanation suggests that, though not spurious, the correlation between these constructs is exaggerated by including those with lower intelligence in ADHD samples. We systematically select a subset of ADHD studies, scrutinizing their methodology, discussion, and limitations sections so as to determine, where possible, whether working memory weaknesses remain after controlling for intelligence.
INTRODUCTION:It is thought that many behaviors that occur in daily life, especially during social communication, are influenced by ToM skills. OBJECTIVES:The aim of this study was to investigate the predictive role of executive function and verbal ability on theory of mind development in adults with visual impairment in Saudi Arabia context. METHOD:Participants volunteered for this study at a nonprofit organization for visually impaired in Saudi Arabia. A total of 110 subjects were selected to participate in the study. Participants ranged in age from 30-70, with a mean age of 50. Advanced ToM, Cognitive Spare Capacity Test and the vocabulary subtest in the Wechsler Adult Intelligence Scale were used. RESULTS:The findings indicated that executive function and verbal ability directly predicted theory of mind. The three variables were correlated positively and significantly. The indirect effects of executive function on theory of mind via verbal ability (standardized indirect effect = 0.40, p < 0.01, 95% BC CIs = 0.20-0.59) were significant. DISCUSSION/CONCLUSION:The current study provides evidence that executive function and verbal ability play a predictive role on theory of mind in adults with visual impairment. The findings provide direction for further research in this area.
BACKGROUND:The objective of this research is to study whether Theory of Mind (ToM) mediates the relationship between executive functions (EFs)and perceived academic self-efficacy (PASE) in Saudi young adults with intellectual giftedness. METHODS:Three hundred and twenty young adults participated in this study. They were 180 females (56.25%) and 140 (43.75%). All of them were identified as intellectually gifted. The mean age was 22.4 years old, (SD = 1.01). Descriptive statistics and correlation analysis were performed using SPSS 24.0 software, with missing values of variables replaced by serial means. The mediation model was tested using the SPSS macroprocess program. RESULTS:Positive correlations between EFs and PASE were revealed. Significant negative correlations between ToM and PASE were found. ToM played a mediating role in the relationship between EFs and PASE. CONCLUSION:The ability to use executive functions strengthens students' sense of self-efficacy and allows them to develop greater confidence in their academic abilities.
Emotion dysregulation (ED) is common in ADHD, and a source of greater clinical impairment. Current official diagnostic criteria for ADHD do not include ED symptoms, although some scholars have proposed revisions to address this issue. The present study examined how substituting elevated ED for elevated hyperactivity-impulsivity would change which postsecondary students meeting a combined-presentation symptom threshold. Archival data from 2,459 postsecondary students referred for a neuropsychological evaluation were analyzed. Participants completed a standard rating scale of ADHD symptoms as well as at least one ED measure. The proportions meeting the traditional and ED-inclusive symptom thresholds were similar: 22.1% met the traditional combined-presentation threshold, whereas 21.7% and 22.3% met two different ED-inclusive thresholds. Agreement between the traditional and ED-inclusive classifications was moderate (φ = .34-.37), and the ED-inclusive groups contained higher proportions of female participants (60-68%) than the traditional ADHD symptom group did (52%). Thus, substituting ED produced similarly sized but only partially overlapping symptom-threshold groups. These findings do not establish improved diagnostic accuracy or support a particular revision to ADHD criteria; rather, they demonstrate that substituting ED for traditional hyperactivity-impulsivity changes who meets the symptom threshold while leaving the overall proportion classified largely unchanged.
OBJECTIVES:Cancer-related cognitive impairment is a decline in cognitive functioning following cancer treatment that negatively affects survivors' quality of life. Self-report tools such as the Cognitive Failure Questionnaire (CFQ) offer a rapid and cost-effective method for early detection of subjective cognitive difficulties. This study aimed to develop and compare machine learning models using demographic variables to classify subjective cognitive impairment (SCI) severity into low, moderate, and high levels. METHODS:Data from 437 cancer survivors were analyzed. SCI severity was defined based on self-reported CFQ scores. Demographic predictors included age, gender, marital status, education, and occupation. Four supervised machine learning algorithms, Logistic Regression (LR), Support Vector Machine (SVM), Artificial Neural Network (ANN), and k-Nearest Neighbors (KNN), were applied for multiclass classification. Model performance was evaluated using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1-score and area under the ROC curve (AUC), with stratified 5-fold cross-validation. RESULTS:LR model demonstrated the best performance (accuracy = 0.89, AUC = 0.95), followed by SVM (accuracy = 0.86, AUC = 0.95), ANN (accuracy = 0.85, AUC = 0.93), and KNN (accuracy = 0.82, AUC = 0.91). CONCLUSION:Logistic Regression provided the most robust and interpretable results. These findings support the utility of simple demographic-based models as noninvasive tools that may support early supportive screening of subjective cognitive difficulties in cancer survivorship care. However, external validation using independent datasets is required.
Stroke affects not only motor abilities but also cognitive and social functioning, resulting in complex life changes. This study investigated the relationship between executive functions and activities of daily living (ADL), social problem-solving, and participation among stroke survivors. A total of 110 individuals with stroke and 28 healthy controls participated. The control group completed the Executive Function Performance Test (EFPT), and stroke participants were grouped based on EFPT scores. Pearson's correlation and linear regression analyses examined the relationships and predictive effects, while group differences were assessed using the Mann-Whitney U test. Stroke survivors with executive dysfunction showed significantly poorer ADL performance and social problem-solving skills than those without impairment, although no significant difference was observed in participation. Executive functions were significantly correlated with both basic and instrumental ADL and problem-solving styles. Executive functions accounted for 27% of the variance in ADL, 16% in instrumental ADL, and 37% in social problem-solving. The findings highlight the adverse impact of executive dysfunction on daily functioning and cognitive skills post-stroke. However, no significant association was found with participation. These results underscore the importance of targeted rehabilitation strategies to address executive function impairments in stroke recovery.
Assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) among adults is complicated by high psychiatric comorbidity and symptom overlap, increasing the risk of potential diagnostic misclassification. This study used a Three-Step Latent Profile Analysis (LPA) to identify distinct Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Restructured Clinical (RC) scale profiles in a mixed clinical sample seeking ADHD evaluation (n = 546). Three latent profiles emerged: a low-symptom profile, a somatic-depressed-threat sensitive profile, and a primarily demoralized profile. Profiles were not associated with ADHD diagnosis alone or most ADHD comorbidities. However, the profiles differed significantly in the probability of depression diagnoses, anxiety diagnoses, and combined ADHD/depression/anxiety diagnoses. Findings suggest MMPI-2-RF RC scale profiles are informative for identifying internalizing psychopathology and diagnostic complexity but lack specificity for ADHD. Results underscore the utility of MMPI-2-RF, RC scale-based latent profiles in disentangling diagnostic heterogeneity and the importance of multimethod assessment in adult ADHD evaluations.
The Halstead Category Test (HCT) is considered among the most sensitive measures for detecting global neurological impairment. Although its ability to localize neurological dysfunction or to assess executive function has been questioned, its demonstrated diagnostic sensitivity to overall cognitive dysfunction remains widely accepted. Nevertheless, its use has declined significantly over the years, owing to complaints regarding the original cumbersome equipment, labor-intensive administration, and overall length. These criticisms were addressed over 30 years ago with the introduction of convenient computer software and validated HCT short forms. This survey examined whether any version of the HCT was being taught in post-doctoral fellowships in adult clinical neuropsychology. Training directors reported that the majority of trainees (63%) were not taught any version of the HCT. A minority were provided only informal training. Several supervisors reported not having been trained on the HCT themselves. Some expressed interest in computer administration and using available HCT short forms, yet these were rarely employed. The findings suggest that concerted promotion of convenient versions of the HCT is required in order for the test not to fall into obsolescence.
BACKGROUND:Subjective cognitive decline (SCD) is a heterogeneous clinical condition; however, routine cognitive screening primarily relies on global scores, which may obscure meaningful cognitive variability. This study examined whether domain-level analysis of the Addenbrooke's Cognitive Examination III (ACE-III) could identify distinct cognitive profiles within clinically confirmed SCD, even when global cognitive performance is preserved. METHODS:This retrospective study included 370 help-seeking adults aged ≥60 years with clinically confirmed SCD, established through comprehensive neuropsychological assessment. Gaussian mixture modeling was applied to standardized ACE-III Memory, Fluency, and Visuospatial domain scores to identify latent cognitive profiles. RESULTS:Three cognitive profiles were identified: Reassurance (64%), Lower-efficiency (23%), and Visuospatial-low (13%). Visuospatial was the principal domain differentiating the profiles and the only one to distinguish all groups. The greatest between-profile differences were observed for Clock Drawing and other visuoconstructional tasks. Profile membership was not explained by age or educational attainment. CONCLUSIONS:Clinically confirmed SCD is characterized by meaningful cognitive heterogeneity, even when global cognitive performance is preserved. Qualitative interpretation of ACE-III domain scores may complement conventional total-score assessment and enhance the characterization of cognitive variability in individuals with SCD. Longitudinal studies incorporating biomarkers and neuroimaging are required to determine the prognostic significance of these profiles.
OBJECTIVE:As dementia diagnoses rise with population aging, understanding factors that influence neuropsychological performance become increasingly important. While research has established links between test anxiety and poorer test results in younger populations, its effects in older adults remain unclear. METHOD:A total of 342 cognitively unimpaired older adults from the National Alzheimer's Coordinating Center were included. Participants were categorized according to clinician-observed test anxiety using the Social Behavioral Observer Checklist into Anxious versus Non-anxious groups and Self-conscious versus Non-self-conscious groups. Measures of episodic memory, executive functions, language, and visuospatial abilities were administered. Analyses of covariance tested performance differences, adjusting for sex, education, and age. RESULTS:Anxious and self-conscious participants performed significantly worse than their counterparts on episodic memory (delayed recall), although effect sizes were small (η2 ≈ .02-.04). No significant group differences were observed on other cognitive measures. The association between being Self-conscious during testing and lower episodic memory remained significant when controlled for everyday anxiety and depression symptoms, whereas the association for being Anxious did not. CONCLUSIONS:Findings suggest that clinician-observed test anxiety may have minimal impact on cognitive results in aging. Nonetheless, the specific association between test anxiety and episodic memory performance underscores the need to minimize anxiety during assessments to support accurate diagnosis.
Efficient everyday communication depends on the ability to sustain, selectively allocate, and inhibit auditory attention, particularly in multi-talker environments. Despite its clinical importance, standardized tools that assess attention across multiple stimulus levels are limited, especially within the auditory domain and the Indian context. The study aimed to develop and validate a comprehensive auditory attention assessment tool (C-AAAT) in Malayalam using a Delphi-guided framework. In Phase I, expert consensus established the need for the tool and guided its conceptualization, resulting in five subsections: syllable, word, nonword, discourse, and nonverbal stimuli. Content validation demonstrated strong relevance and clarity, with all items exceeding accepted content validity index thresholds, and pilot testing confirmed feasibility and ease of administration. In Phase II, the C-AAAT was administered to 67 younger adults (18-25 years) and 57 older adults (55-70 years) with normal hearing and no cognitive impairment. Outcome measures included accuracy, impulsivity, inattention, and response time. Exploratory factor analysis confirmed the coherent internal structure. Mann-Whitney U, Friedman's test, logistic regression, and receiver operating characteristic analyses and intraclass-correlation demonstrated sensitivity to age-related and subsection-wise differences, along with good to excellent test-retest reliability. These findings provide preliminary evidence of tool's validity and potential utility in assessing auditory attention among Indian-context.
BACKGROUND:The diagnosis of attention deficit hyperactivity disorder (ADHD) has traditionally relied on subjective clinical interviews. Recent years have witnessed a paradigm shift toward objective, data-driven diagnostics powered by artificial intelligence (AI). OBJECTIVE:This study provides a comprehensive bibliometric review of AI and machine learning (ML) applications in ADHD prediction to map the field's evolution, current trends, and future directions. METHODS:A structured search of the Scopus database retrieved 722 publications from 2011 to 2024. Bibliometric indicators were analyzed using Python and VOSviewer to evaluate annual production, geographical distribution, and technological trends. RESULTS:The field has entered an exponential growth phase, with publication output peaking in 2023. A geopolitical analysis reveals a "research duopoly" between the United States (130 papers) and China (129 papers). Technologically, there is a distinct transition from traditional ML-support vector machines (SVM) to deep learning (DL) architectures. Crucially, electroencephalography (EEG) has emerged as the preferred neuroimaging modality over functional magnetic resonance imaging (fMRI) in recent AI studies, driven by its cost-effectiveness and high temporal resolution. CONCLUSION:AI-based ADHD diagnosis has matured from an exploratory niche to an evolving domain of computational psychiatry. Future research must prioritize explainable AI (XAI) and multimodal data fusion to translate high algorithmic accuracy into clinical utility.
This study evaluated the utility of the Controlled Oral Word Association Test (COWAT-FAS) and Animal Naming as embedded performance validity tests (PVTs) in a mixed clinical sample of 165 military veterans referred for neuropsychological evaluation. Participants had either a self-reported history of mild TBI or were referred for evaluation of possible ADHD. Participants were classified as credible (0 PVT failures; n = 92) or non-credible (≥2 PVT failures; n = 73). Classification accuracy was examined for COWAT and Animal Naming raw scores, demographically adjusted T-scores, and two previously published logistic regression models. Both verbal fluency measures significantly differentiated credible from non-credible groups. Optimal indices utilized COWAT raw scores, either alone or when embedded within the logistic regression formula. Findings support verbal fluency measures as efficient embedded, non-memory-based PVTs.
OBJECTIVE:Adult outcomes of childhood-diagnosed specific learning disorder (SLD) remain insufficiently characterized, particularly in non-Western clinical samples. We examined the neuropsychological and attentional profile of Turkish adults with documented childhood SLD. METHOD:In this exploratory case-control study, 20 adults with childhood-diagnosed SLD and 20 age- and sex-comparable healthy controls completed a multimodal assessment including the Stroop Test-TBAG form, Digit Span, Adult Attention Deficit Hyperactivity Disorder (ADHD) Self-Report Scale, Adult Reading History Questionnaire, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition-Clinician Version (SCID-5-CV) diagnostic interview. The prespecified primary outcome was Stroop total completion time. Four prespecified secondary outcomes-Stroop interference, Digit Span total, Digit Span forward, and Adult ADHD Self-Report Scale (ASRS) Part A positive-item count-were corrected using Benjamini-Hochberg false discovery rate. Adjusted analyses used HC3 robust standard errors. RESULTS:Adults with SLD showed substantially longer Stroop total completion time than controls, with a large adjusted group effect that remained robust after additional adjustment for education. All four secondary outcomes met the corrected significance threshold, indicating poorer interference control, lower verbal attention and working-memory performance, and higher adult ADHD symptom burden. Reading-history scores were also consistent with persistent self-reported difficulties. CONCLUSIONS:Adults with childhood-diagnosed SLD showed a measurable multidomain neuropsychological and attentional profile, supporting executive and attentional screening in adult SLD assessment.
