Validity assessment of early retirement claimants: Symptom overreporting on the Beck Depression Inventory - II

ObjectivesThe Beck Depression Inventory-II (BDI-II) is a commonly used clinical measure; however, it contains no method to assess validity of self-report. The primary objective of this research was to examine the possibility of cut scores on the BDI-II indicating possible invalid symptom report in forensic neuropsychological evaluations. Secondary objectives were to explore the utility of education specific cut scores and the effects of the criterion for invalid symptom report.MethodsTwo hundred and seventeen early retirement claimants (age range 19-64 years) presenting for forensic neuropsychological examination were considered for this study. Invalid symptom report was determined based on two independent self-report symptom validity tests. Further, all individuals completed the BDI-II as part of their routine assessment battery.ResultsIndividuals with invalid symptom report (30.9%) showed significantly higher BDI-II scores compared to individuals passing symptom validity assessment. ROC analysis supports the utility of the BDI-II to differentiate valid from invalid symptom report, AUC = 0.822, SE = 0.032, p < .001, 95%-CI = 0.760-0.884. A BDI-II cut score of 38 points reached a desired level of 0.90 specificity with 0.58 sensitivity. Secondary analysis indicated that the recommended cut score may vary depending on the educational level of the examinee. Further, results seem to be largely robust against the chosen criterion for invalid symptom report.ConclusionThe BDI-II appears to be a useful adjunct embedded validity indicator in forensic neuropsychological evaluations

Differences regarding the five-factor personality model in patients with subjective cognitive decline and mild cognitive impairment

Persönlichkeitsveränderung und Demenz sind miteinander assoziiert. Wissen über Persönlichkeitsveränderungen bei prodromalen Stadien der Demenz könnte hilfreich sein, um Demenz früher zu erkennen. Anhand einer Querschnittsstudie wurden Persönlichkeitsunterschiede zwischen drei kognitiv beeinträchtigten Gruppen anhand der Selbsteinschätzung von Persönlichkeitsmerkmalen untersucht. Des Weiteren wurden Zusammenhänge zwischen Persönlichkeit und kognitiver Funktion untersucht. Die Stichprobe bestand aus kognitiv beeinträchtigten Patienten (N=133) im Alter von 50 Jahren und älter, die aufgrund kognitiver Beschwerden eine Gedächtnisklinik aufsuchten. Die Untersuchung umfasste ein kognitives Screening, die Neuropsychologische Testbatterie Wien (NTBV) und das Big Five Plus One Persönlichkeitsinventar (B5PO). Während sich Patienten mit subjektivem kognitivem Abbau (SCD) nicht von denen mit nicht-amnestischer leichter kognitiver Beeinträchtigung (naMCI) bezüglich der verschiedenen Persönlichkeitsmerkmale unterschieden, zeigten Patienten mit amnestischer leichter kognitiver Beeinträchtigung (aMCI) signifikant niedrigere Werte für Extraversion (p<0,05), Offenheit (p<0,001) und Empathie (p<0,001) als Patienten mit SCD sowie Patienten mit naMCI. Kognitiv beeinträchtigte Gruppen unterschieden sich hinsichtlich Persönlichkeitseigenschaften in Abhängigkeit davon, ob Gedächtnisbeeinträchtigungen vorlagen oder nicht.Personality and dementia are connected in different ways. A broad knowledge about personality and prodromal stages of dementia might be helpful to identify dementia as early as possible. Hence, personality differences between three cognitively impaired groups on the basis of patients self-assessments of personality traits and connections between personality and cognitive functioning were examined via a cross-sectional study. The sample consisted of cognitively impaired patients (N=133), aged 50 and older, who came to a memory clinic due to cognitive complaints. The test procedure encompassed a cognitive screening, the Neuropsychological Test Battery Vienna (NTBV), and self-assessment questionnaires such as the Big Five Plus One Persönlichkeitsinventar (B5PO). While patients with subjective cognitive decline (SCD) did not differ from those with non-amnestic mild cognitive impairment (naMCI) concerning the different personality traits, patients with amnestic mild cognitive impairment (aMCI) showed significantly lower scores for extraversion (p<0.05), openness (p<0.001), and empathy (p<0.001) than patients with SCD as well as patients with naMCI. Thus, cognitively impaired groups mainly differ concerning personality traits depending on whether they do show memory decline or not.(VLID)365859

Does modification of olfacto-gustatory stimulation diminish sensory-specific satiety in humans?

8ppAlimentary sensory pleasure is an important factor in ingestive behavior. Renewal of olfacto-gustatory pleasure by introducing new foods or through seasoning of previously consumed food might increase intake. Objectives: To explore whether sensory-specific satiety (SSS) for a food could be modulated, either by introducing a novel food or by a modification of sensory stimulation via seasoning the food just eaten. Methods: 180 out of 242 subjects were distributed over 3 experiments involving ad libitum intake of one of 6 fresh foods (cucumber, tomato, pineapple, banana, peanut, pistachio). Blindfolded subjects reported their sensations for the foods on 3 parameters before and after intake of an olfactorily chosen food: Olfactory pleasure (OP), Specific appetite (SA) and Stimulus-Induced Salivation (SIS). EXP. 1: One chosen food was repeatedly presented orthonasally and rated before and after it was eaten. EXP. 2: A second food was olfactorily chosen and ingested after the first one. EXP. 3: The same food was offered again after seasoning. Results: 2 min after ingestion, food intake was limited by SSS. OP, SA, SIS correlated with each other for eaten and non-eaten foods. OP for noneaten foods increased (pb0.01) after ingestion of the chosen food to specific satiety. When the food just eaten was seasoned, OP increased (pb0.01) and led to additional intake (80% of first intake). Conclusion: A reduction in SSS after introduction of a new flavor or after seasoning an ingested food was observed. Such a reduction has not previously been reported. This could hint at how food sensory variation leads to over-consumptio

Wiener klinische Wochenschrift / Assessment of individual cognitive changes after deep brain stimulation surgery in Parkinsons disease using the Neuropsychological Test Battery Vienna short version

Long-term therapy of Parkinsons disease with LDOPA is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinsons patients, 24 patients with mild cognitive impairment (MCI) and 12 healthy controls using the Neuropsychological Test Battery Vienna short version (NTBV-short) for cognitive outcome 12 months after the first examination. Reliable change index methodology was used. Roughly 10% of DBS patients showed cognitive decline mainly affecting the domains attention and executive functioning (phonemic fluency). Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.(VLID)355129

Early dysfunctions of fronto-parietal praxis networks in Parkinsons disease

In Parkinsons disease (PD) the prevalence of apraxia increases with disease severity implying that patients in early stages may already have subclinical deficits. The aim of this exploratory fMRI study was to investigate if subclinical aberrations of the praxis network are already present in patients with early PD. In previous functional imaging literature only data on basal motor functions in PD exists. Thirteen patients with mild parkinsonian symptoms and without clinically diagnosed apraxia and 14 healthy controls entered this study. During fMRI participants performed a pantomime task in which they imitated the use of visually presented objects. Patients were measured ON and OFF dopaminergic therapy to evaluate a potential medication effect on praxis abilities and related brain functions. Although none of the patients was apraxic according to De Renzi ideomotor scores (range 6272), patients OFF showed significantly lower praxis scores than controls. Patients exhibited significant hyperactivation in left fronto-parietal core areas of the praxis network. Frontal activations were clearly dominant in patients and were correlated with lower individual praxis scores. We conclude that early PD patients already show characteristic signs of praxis network dysfunctions and rely on specific hyperactivations to avoid clinically evident apraxic symptoms. Subclinical apraxic deficits were shown to correlate with an activation shift from left parietal to left frontal areas implying a prospective individual imaging marker for incipient apraxia.(VLID)353391

Self-reported and informant-reported memory functioning and awareness in patients with mild cognitive impairment and Alzheimers disease

Grundlagen Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist ein wichtiger Faktor für eine angemessene Behandlung von Patienten mit leichter kognitiver Beeinträchtigung (MCI) und Alzheimer-Krankheit (AD). Ziel der vorliegenden Studie war herauszufinden (i) ob subjektive Gedächtnisleistung und objektive Gedächtnisleistung assoziiert sind, (ii) ob sich die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung mit der Zeit verändert und (iii) ob die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ein Prädiktor für die Entwicklung einer Demenz ist. Methodik Vierunddreißig Patienten mit MCI, die Hilfe in einer universitären Gedächtnisambulanz suchten, wurden in die Studie eingeschlossen. Alle Teilnehmer wurden einer ausführlichen neuropsychologischen Untersuchung unterzogen. Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung wurde durch Berechnung der Differenzwerte zwischen Patient und Informant Bewertung auf einem 16-Punkt-Fragebogen hinsichtlich Gedächtnisbeschwerden im täglichen Leben erhalten. Eine Kontrolluntersuchung wurde nach einer mittleren Nachbeobachtungszeit von 24 Monaten durchgeführt. Ergebnisse Die Analyse zeigte, dass die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung relativ stabil über die Zeit blieb. Selbst berichtete Gedächtnisbeschwerden korrelierten mit der episodischen Gedächtnisleistung zu Beginn der Studie und mit der Leistung bei einer Sprachaufgabe bei der Nachuntersuchung. Wiederholungsprüfungen angezeigt Rückgang des Bewusstseins. Der prädiktive Wert der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung in Bezug auf die Demenzentwicklung war gering. Schlussfolgerungen Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist mit episodischer Gedächtnis-Funktion verknüpft und nimmt mit Abnahme der kognitiven Fähigkeiten ab. Weitere Studien zur Vorhersagekraft der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung sollten eine größere Patientenstichprobe umfassen.Awareness of subjective memory is an important factor for adequate treatment of patients with mild cognitive impairment (MCI) and Alzheimers disease (AD). This study served to find out whether awareness of subjective memory complies with objective performance, if differences in awareness are observed longitudinally and whether decrease of awareness can serve as a predictor of AD in MCI patients. Methods Thirty-four patients with MCI seeking help in a memory outpatient clinic were included. All participants underwent thorough neuropsychological examination. Awareness of subjective memory was obtained by calculating difference scores between patient and informant ratings on a 16-item questionnaire concerning complaints about loss of memory in every-day life. Retesting was performed after a mean follow-up period of 24 months. Results Whole group analyses showed that awareness remained relatively stable across time. Self-reported memory complaints correlated with episodic memory at baseline and with performance on a language task at follow-up. Retests displayed decrease of awareness. At group level differences in awareness between both times of assessment were not significant for MCI and MCI patients converting to mild AD at follow-up. The predictive value of awareness was low. Conclusions Awareness of subjective memory deficit is linked to episodic memory function and decreases with decline of cognitive ability. Further studies evaluating predictive power of awareness of subjective memory should include a larger patient sample.(VLID)347208

Finger dexterity deficits in Parkinson's disease and somatosensory cortical dysfunction

INTRODUCTION The patho-physiological basis for finger dexterity deficits in Parkinson's disease (PD) is controversial. Previously, bradykinesia was regarded as the major mechanism. However, recent research suggested limb-kinetic apraxia as an important component of impaired fine motor skills in PD. In contrast to bradykinesia, limb-kinetic apraxia only marginally responds to dopaminergic treatment. Here we investigate the novel hypothesis that the dexterity deficits are related to an intrinsic dysfunction of primary somatosensory cortex (S1), which is not reversible by dopaminergic medication. METHODS Applying a standard and approved dexterity task (coin rotation), brain activation networks were investigated using functional magnetic resonance imaging in PD patients both ON and OFF medication and matched healthy controls. RESULTS PD patients both ON and OFF medication showed impaired S1 activation relative to controls (p < 0.05; region of interest based analysis). The impaired S1 activation remained unchanged by dopaminergic medication. Despite the considerable clinical deficit, no other brain area showed impaired activation. In contrast, structures of the basal ganglia--motor cortex loop responded to dopaminergic medication. Behaviorally, dexterity performance both ON and OFF was significantly (p < 0.05) reduced relative to controls. CONCLUSIONS Our results provide first evidence that dexterity deficits in PD are related to an S1 dysfunction which is insensitive to dopaminergic treatment

Best logistic regression models for the sleep status for each subgroup.

<p>aMCI = amnestic MCI, naMCI = non-amnestic MCI, SCD = subjective cognitive decline, MMSE = Mini Mental State Examination, BDI-II = Beck Depression Inventory</p><p>Best logistic regression models for the sleep status for each subgroup.</p