OBJECTIVE:This study examined the clinical utility of the long-term memory sign (LTMS), which is defined as self-reported long-term memory loss that is equal to or greater than self-reported short-term memory loss, and hypothesized to be a sign of functional cognitive disorders. METHOD:The LTMS was established using two standardized clinical interview prompts in 568 consecutive patients (MAGE = 64.25, SD = 13.03) referred for neuropsychological evaluation. Patients were categorized into five diagnostic groups: dementia (n = 140), mild neurocognitive disorder (n = 245), primary psychiatric diagnosis (n = 100), subjective cognitive complaints with no diagnosis (n = 42), and invalid cognitive presentations (n = 41). The LTMS was analyzed as a marker of functional cognitive disorders using diagnostic accuracy indices. RESULTS:The LTMS demonstrated high specificity (92.2%) but low sensitivity (28.3%) for functional cognitive disorders. It was reported by 82/568 patients (14.4%), with the highest frequency observed in those with invalid cognitive profiles (43.9%), primary psychiatric diagnoses (26.0%), and subjective cognitive complaints (19.0%), with progressively lower rates in mild neurocognitive disorder (9.8%) and dementia (4.3%). CONCLUSIONS:The LTMS is a quickly elicited interview-based clinical sign that may reflect a neurologically unlikely subjective complaint pattern associated with functional cognitive disorders.

Abstract Objective We investigated the clinical utility of the newly described long-term memory (LTM) sign in adults referred for neuropsychological evaluation. Individuals with dementia often report short-term episodic memory decline or no memory decline, but rarely report long-term episodic memory decline. The LTM sign refers to patient self-report of long-term episodic memory decline, that is equivalent to/or greater than, subjective short-term episodic memory decline. Method The LTM sign was endorsed on a pre-visit intake form and established during clinical interview in 568 patients (M age = 63, SD = 14.3) referred for neuropsychological evaluation at a large medical center in the Northwest United States. Results In our sample of 568 patients, 79 (14%) reported the LTM sign. In 79 patients with the LTM sign, 45 were diagnosed with a primary psychiatric disorder (57%), 23 were diagnosed with mild neurocognitive disorder (29%), seven had no cognitive or psychiatric diagnosis (9%), and four had dementia (5%). The LTM sign was most common in those with a history of trauma in childhood or adolescence (52/79, 66%) and substance use disorders (50/79, 63%). Conclusions The LTM sign was rare in dementia, but common in those with a current psychiatric diagnosis. These findings support the literature on episodic memory decline in dementia populations and suggests that encoding of early memories and/or retrieval of old memories is negatively impacted by a current psychiatric disorder, traumatic events in childhood and adolescence, and lifetime history of substance use disorder. The LTM sign is a valuable addition to the clinical interview of neuropsychological patients.

OBJECTIVE:This study was design to evaluate the potential of the recognition trials for the Logical Memory (LM), Visual Reproduction (VR), and Verbal Paired Associates (VPA) subtests of the Wechsler Memory Scales-Fourth Edition (WMS-IV) to serve as embedded performance validity tests (PVTs). METHOD:The classification accuracy of the three WMS-IV subtests was computed against three different criterion PVTs in a sample of 103 adults with traumatic brain injury (TBI). RESULTS:The optimal cutoffs (LM ≤ 20, VR ≤ 3, VPA ≤ 36) produced good combinations of sensitivity (.33-.87) and specificity (.92-.98). An age-corrected scaled score of ≤5 on either of the free recall trials on the VPA was specific (.91-.92) and relatively sensitive (.48-.57) to psychometrically defined invalid performance. A VR I ≤ 5 or VR II ≤ 4 had comparable specificity, but lower sensitivity (.25-.42). There was no difference in failure rate as a function of TBI severity. CONCLUSIONS:In addition to LM, VR, and VPA can also function as embedded PVTs. Failing validity cutoffs on these subtests signals an increased risk of non-credible presentation and is robust to genuine neurocognitive impairment. However, they should not be used in isolation to determine the validity of an overall neurocognitive profile.

Background: Delirium is a common neurologic manifestation of coronavirus disease 2019 (COVID–19) in older adults who present to the emergency department (ED). Objective: To investigate clinical characteristics associated with delirium as a presenting symptom of COVID–19 in older adults and develop a logistic regression to predict the likelihood of delirium. Method: We compared clinical characteristics in an age- and gender-matched sample of 68 delirious individuals with 68 nondelirious individuals (Mage = 78) who presented to the ED with COVID–19. Results: The delirious group was more likely to have neurologic, psychiatric, and cardiovascular comorbidities; a prior history of delirium; and deliriogenic medications in their medication list. They were less likely to present with respiratory symptoms and more likely to present with sepsis, hypoxia, higher heart rate, and higher sodium. The delirious group had higher mortality (51%) than the nondelirious group (32%). Delirium developed within an average of 2 days of initial COVID–19 symptom onset, with symptom onset to ED within an average of 4 days and symptom onset to death within an average of 11 days. Logistic regression based on five delirium predictors correctly predicted 80% of those with delirium (75% sensitivity at 86% specificity). Conclusion: Our results are largely consistent with prior studies and suggest that delirium is a common, early occurring, and lethal manifestation of COVID–19 in older adults presenting to the ED, in most cases causing acute on chronic neurocognitive dysfunction strongly influenced by inflammatory and hypoxic–ischemic mechanisms.

OBJECTIVE This study was designed to replicate previous research on critical item analysis within the Word Choice Test (WCT). METHOD Archival data were collected from a mixed clinical sample of 119 consecutively referred adults (Mage = 51.7, Meducation = 14.7). The classification accuracy of the WCT was calculated against psychometrically defined criterion groups. RESULTS Critical item analysis identified an additional 2%-5% of the sample that passed traditional cutoffs as noncredible. Passing critical items after failing traditional cutoffs was associated with weaker independent evidence of invalid performance, alerting the assessor to the elevated risk for false positives. Failing critical items in addition to failing select traditional cutoffs increased overall specificity. Non-White patients were 2.5 to 3.5 times more likely to Fail traditional WCT cutoffs, but select critical item cutoffs limited the risk to 1.5-2. CONCLUSIONS Results confirmed the clinical utility of critical item analysis. Although the improvement in sensitivity was modest, critical items were effective at containing false positive errors in general, and especially in racially diverse patients. Critical item analysis appears to be a cost-effective and equitable method to improve an instrument's classification accuracy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We investigated the diagnostic utility of the "motor perseveration sign" for the identification of mild neurocognitive disorder and dementia in patients referred for neuropsychological evaluation.

Describe clinical characteristics of COVID-19 in patients with Parkinson's disease (PD).

Background Medical comorbidities and neurological manifestations are commonly associated with COVID-19, though specific relationships remain unclear. Objective The aim of this study is to investigate the relationship between medical comorbidities and neurological manifestations in patients with COVID-19. Methods We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) manifestations in 484 consecutive patients with COVID-19. Results Neurological manifestations were seen in 345 (71%) of 484 COVID-19 patients. CNS manifestations included headaches (22%), altered mental status (19%), dizziness (8%), gait imbalance (5%), strokes (four patients, <1%), and seizures (two patients, <1%). PNS manifestations included myalgia (31%), hypogeusia (8%), hyposmia (6%), critical illness myopathy (nine patients, 2%), visual disturbance (six patients, 1%), rhabdomyolysis (four patients, <1%), and nerve pain (one patient, <1%). There were 153 (32%) patients with CNS manifestations, 98 (20%) patients with PNS manifestations, and 94 (19%) patients with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (22%), dementia (17%), hypertension (16%), and chronic obstructive pulmonary disease (COPD; 13%) were significantly associated with CNS manifestations. No comorbidities were associated with PNS manifestations. Conclusion Neurological manifestations were common in our sample of 484 COVID-19 patients, with headache and altered mental status being the most common CNS manifestations and myalgia being the most common PNS manifestation. Cardiac disease, dementia, hypertension, and COPD were more common in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.

Objective: Replicate previous research on Logical Memory Recognition (LMRecog) and perform a critical item analysis. Method: Performance validity was psychometrically operationalized in a mixed clinical sample of 213 adults. Classification of the LMRecog and nine critical items (CR-9) was computed. Results: LMRecog <= 20 produced a good combination of sensitivity (.30-.35) and specificity (.89-.90). CR-9 >= 5 and >= 6 had comparable classification accuracy. CR-9 >= 5 increased sensitivity by 4% over LMRecog <= 20; CR-9 >= 6 increased specificity by 6-8% over LMRecog <= 20; CR-9 >= 7 increased specificity by 8-15%. Conclusions: Critical item analysis enhances the classification accuracy of the optimal LMRecog cutoff (<= 20).

This study was designed to determine the clinical utility of embedded performance validity indicators (EVIs) in adults with intellectual disability (ID) during neuropsychological assessment. Based on previous research, unacceptably high (>16%) base rates of failure (BRFail) were predicted on EVIs using on the method of threshold, but not on EVIs based on alternative detection methods. A comprehensive battery of neuropsychological tests was administered to 23 adults with ID (M-Age = 37.7 years, M-FSIQ = 64.9). BRFail were computed at two levels of cut-offs for 32 EVIs. Patients produced very high BRFail on 22 EVIs (18.2%-100%), indicating unacceptable levels of false positive errors. However, on the remaining ten EVIs BRFail was <16%. Moreover, six of the EVIs had a zero BRFail, indicating perfect specificity. Consistent with previous research, individuals with ID failed the majority of EVIs at high BRFail. However, they produced BRFail similar to cognitively higher functioning patients on select EVIs based on recognition memory and unusual patterns of performance, suggesting that the high BRFail reported in the literature may reflect instrumentation artefacts. The implications of these findings for clinical and forensic assessment are discussed.

Objective: The present study was designed to investigate the relationship between medical comorbidities and neurological manifestations in a series of 484 consecutive patients with COVID-19. Background: Medical comorbidities and neurologic manifestations are associated with COVID- 19, though the specific relationships between comorbid conditions and neurologic manifestations of COVID-19 remain unclear. Design/Methods: We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) symptoms in 484 consecutive patients hospitalized with COVID-19. Results: Neurological manifestations were seen in 345 of 484 COVID-19 patients (71%). CNS manifestations included headaches (107 patients, 22%), altered mental status (92 patients, 19%), dizziness (40 patients, 8%), gait imbalance (23 patients, 5 %), strokes (4 patients, <1%), and seizures (2 patients, <1%). PNS manifestations included myalgia (151 patients, 31%), hypogeusia (38 patients, 8%), hyposmia (27 patients, 6%), critical illness myopathy (9 patients, 2%), visual disturbance (6 patients, 1%), rhabdomyolysis (4 patients, <1%) and nerve pain (1 patient, <1%). There were 153 patients (32%) with CNS symptoms, 98 patients with PNS symptoms (20%), and 94 patients (19%) with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (108 patients, 22%), dementia (83 patients, 17%), hypertension (76 patients, 16%), and COPD (61 patients, 13%) were significantly associated with CNS manifestations. No comorbidities were significantly associated with PNS manifestations. Conclusions: Neurological manifestations are common in COVID-19 patients. The most common CNS manifestations were headache and altered mental status and the most common PNS manifestation was myalgia. Comorbid conditions such as cardiac disease, dementia, hypertension, and COPD were more prevalent in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.

Rationale: Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions. Methods: Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T >= 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at alpha = 0.05, one-tailed, given our directional hypothesis. Results: At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores. Conclusions: A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood. (C) 2021 Elsevier Inc. All rights reserved.

Abstract Objective This project was designed to cross-validate existing performance validity cutoffs embedded within measures of verbal fluency (FAS and animals) and develop new ones for the Emotion Word Fluency Test (EWFT), a novel measure of category fluency. Method The classification accuracy of the verbal fluency tests was examined in two samples (70 cognitively healthy university students and 52 clinical patients) against psychometrically defined criterion measures. Results A demographically adjusted T-score of ≤31 on the FAS was specific (.88–.97) to noncredible responding in both samples. Animals T ≤ 29 achieved high specificity (.90–.93) among students at .27–.38 sensitivity. A more conservative cutoff (T ≤ 27) was needed in the patient sample for a similar combination of sensitivity (.24–.45) and specificity (.87–.93). An EWFT raw score ≤5 was highly specific (.94–.97) but insensitive (.10–.18) to invalid performance. Failing multiple cutoffs improved specificity (.90–1.00) at variable sensitivity (.19–.45). Conclusions Results help resolve the inconsistency in previous reports, and confirm the overall utility of existing verbal fluency tests as embedded validity indicators. Multivariate models of performance validity assessment are superior to single indicators. The clinical utility and limitations of the EWFT as a novel measure are discussed.