Comparison of methods for estimating premorbid intelligence

To evaluate impact of neurological injury on cognitive performance it is typically necessary to derive a baseline (or ‘premorbid’) estimate of a patient’s general cognitive ability prior to the onset of impairment. In this paper, we consider a range of common methods for producing this estimate, including those based on current best performance, embedded ‘hold/no hold’ tests, demographic information, and word reading ability. Ninety-two neurologically healthy adult participants were assessed on the full Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV; Wechsler, 2008) and on two widely used word reading tests: National Adult Reading Test (NART; Nelson, 1982; Nelson & Willison, 1991) and Wechsler Test of Adult Reading (WTAR; Wechsler, 2001). Our findings indicate that reading tests provide the most reliable and precise estimates of WAIS-IV full-scale IQ, although the addition of demographic data provides modest improvement. Nevertheless, we observed considerable variability in correlations between NART/WTAR scores and individual WAIS-IV indices, which indicated particular usefulness in estimating more crystallised premorbid abilities (as represented by the verbal comprehension and general ability indices) relative to fluid abilities (working memory and perceptual reasoning indices). We discuss and encourage the development of new methods for improving premorbid estimates of cognitive abilities in neurological patients

A genetic algorithm to find optimal reading test word subsets for estimating full-scale IQ

In clinical neuropsychology the cognitive abilities of neurological patients are commonly estimated using well-established paper-based tests. Typically, scores on some tests remain relatively well preserved, whilst others exhibit a significant and disproportionate decline. Scores on those tests that measure preserved cognitive functions (so-called ‘hold’ tests) may be used to estimate premorbid abilities, including scores in non-hold tests that would have been expected prior to the onset of cognitive impairment. Many hold tests entail word reading, with each word being graded as correctly or incorrectly pronounced. Inevitably, such tests are likely to contain words that provide little or no diagnostic power (i.e., can be eliminated without negatively affecting prediction accuracy). In this paper, a genetic algorithm is developed and demonstrated, using n=92 neurologically healthy participants, to identify optimal word subsets from the National Adult Reading Test that minimize the mean error in predicting the most widely used clinical measure of IQ and cognitive ability, the Wechsler Adult Intelligence Scale Fourth Edition IQ. In addition to requiring only 17-20 of the original 50 words (suggesting that this test could be revised to be up to 66% shorter) and minimizing mean prediction error, the algorithm increases the proportion of the variance in the predicted variable explained in comparison to using all words (from r^2 = 0.46 to r^2 = 0.61). In a clinical setting this would improve estimates of premorbid cognitive function and, if an abbreviated revision to this test were to be adopted, reduce the arduousness of the test for patients. The proposed method is evaluated with jackknifing and leave one out cross validation. The general approach may be used to optimize the relationship between any two psychological tests by finding the question subset in one test that minimizes the prediction error in a second test by training the genetic algorithm using data collected from participants upon whom both tests have been administered. This approach may also be used to develop new predictive tests, since it provides a method to identify an optimal subset of a set of candidate questions (for which empirical data have been collected) that maximizes prediction accuracy and the proportion of variance in the predicted variable that can be explained

Change detection in visual short-term memory: the relative impact of pairwise switches and identity substitutions

Numerous kinds of visual events challenge our ability to keep track of objects that populate our visual environment from moment to moment. These include blinks, occlusion, shifting visual attention and changes to object’s visual and spatial properties over time. These visual events may lead to objects falling out of our visual awareness but can also lead to unnoticed changes, such as undetected object replacements and positional exchanges. Current visual memory models do not predict which visual changes are likely to be the most difficult to detect. We examined the accuracy with which switches (where two objects exchange locations) and substitutions (where one or two objects are replaced) are detected. Inferior performance for one-object substitutions vs. two-objects switches, along with superior performance for two-object substitutions vs. two-object switches was found. Our results are interpreted in terms of object file theory, trade-offs between diffused and localized attention, and net visual change

The National Adult Reading Test: restandardisation against the Wechsler Adult Intelligence Scale—Fourth edition

Since publication in 1982, the 50-item National Adult Reading Test (NART; Nelson, 1982; NART–R; Nelson & Willison, 1991) has remained a widely adopted method for estimating premorbid intelligence both for clinical and research purposes. However, the NART has not been standardised against the most recent revisions of the Wechsler Adult Intelligence Scale (WAIS-III (1997) and WAIS-IV (2008)). Our objective, therefore, was to produce reliable standardised estimates of WAIS-IV IQ from the NART. Ninety-two neurologically healthy British adults were assessed and regression equations calculated to produce population estimates of WAIS-IV full-scale IQ (FSIQ) and constituent index scores. Results showed strong NART/WAIS-IV FSIQ correlations with more moderate correlations observed between NART error and constituent index scores. FSIQ estimates were closely similar to the published WAIS and WAIS-R estimates at the high end of the distribution, but at the lower end were approximately equidistant from the highly discrepant WAIS (low) and WAIS-R (high) values. We conclude that the NART is likely to remain an important tool for estimating the impact of neurological damage on general cognitive ability. We advise caution in the use of older published WAIS and/or WAIS-R estimates for estimating premorbid WAIS-IV FSIQ, particularly for those with low NART scores

Patients with mild cognitive impairment show lower visual short-term memory performance for feature binding tasks

Background: Early cognitive changes in people at risk of developing dementia may be detected using behavioral tests that examine the performance of typically affected brain areas, such as the hippocampi. An important cognitive function supported by the hippocampi is memory binding, in which object features are associated to create a unified percept. Aim: To compare visual short-term memory (VSTM) binding performance for object names, locations, and identities between a participant group known to be at higher risk of developing dementia (mild cognitive impairment [MCI]) and healthily aging controls. Methods: Ten MCI and 10 control participants completed five VSTM tests that differed in their requirement of remembering bound or unbound object names, locations, and identities, along with a standard neuropsychological test (Addenbrooke’s Cognitive Examination [ACE]-III). Results: The performance of the MCI participants was selectively and significantly lower than that of the healthily aging controls for memory tasks that required object-location or name-location binding. Conclusion: Tasks that measure unimodal (object-location) and crossmodal (name-location) binding performance appear to be particularly effective for the detection of early cognitive changes in those at higher risk of developing dementia due to Alzheimer’s disease

The validity of abbreviated forms of the National Adult Reading Test and Spot-the-Word 2 for estimating full-scale IQ

In this study, we validate an earlier proposal for an abridged 17-item National Adult Reading Test (NART) by comparing its performance in estimating full-scale IQ against both the full test and the Spot-the-Word 2 (STW-2) test in a new cohort. We also compare the performance of the 17-item NART to two previous attempts to shorten this test, the Mini-NART and the Short NART. Findings include that NART 17 is numerically stronger and statistically equivalent to the other short variants, the full 50-word NART, and STW-2. Unlike the Short NART, the 17-item NART is usable for participants of all ability levels rather than only those with low reading ability, while offering equally precise premorbid estimates. We also compute that two-thirds of STW-2 is ostensibly redundant for full-scale IQ estimation and we, therefore, propose that, subject to additional verification in an independent sample, an abridged version of this test may also benefit clinical practice

Preference for Lighting Chromaticity in Migraine With Aura

Objective: We studied the color of lighting chosen as comfortable for reading by individuals with migraine and controls. We explored the effects of the chosen color on visual performance. Background: It has been reported that individuals who experience migraine with aura (MWA) choose, as comfortable for reading, light that is more strongly saturated in color than that chosen by individuals without migraine. Methods: A convenience sample of 18 individuals who experienced MWA, 18 without aura, and 18 controls without migraine participated in a cross‐sectional laboratory study at Anglia Ruskin University. We used an Intuitive Colorimeter that illuminated text with colored light and permitted the separate control of hue (color) and saturation (strength of color) without a change in luminance. We selected individuals with migraine and healthy controls from the general population. They were headache‐free in the 48 hours prior to testing. We used a routine that permitted the selection of the most comfortable hue from 12 alternatives and then alternately optimized the saturation and hue using small changes, thereby allowing for color adaptation. Visual performance at a word search task was measured under white light and under light of a color chosen as comfortable, using colored lenses. Results: Healthy individuals chose light with chromaticity close to the Planckian locus, which approximates the chromaticities of daylight and most electric lighting. The distance from the locus averaged 0.029 (SD 0.021). Individuals who experienced MWA chose strongly saturated colors well away from the Planckian locus (average distance 0.056, SD 0.022). Individuals who experienced migraine without aura chose intermediate chromaticities (average distance 0.034, SD 0.022). Overall there was a large statistically significant difference between participant groups that explained 24% variance. Visual search time of individuals with migraine aura decreased from 22.5 to 16.8 s when light of the chosen color was provided using tinted lenses (the average increase in search speed was 45.7%). The lenses had no statistically significant effect on the performance of individuals without migraine aura. Conclusions: Individuals who experienced MWA selected as comfortable colors that deviated from the lighting typically experienced in everyday life. Possibly, individuals who experience MWA may be more susceptible to photophobia under typical lighting. Visual performance was improved using lenses that provided light of the chosen comfortable color. The spectral power of that choice showed no evident relationship to melanopic energy (energy captured by the intrinsically photosensitive retinal ganglion cells)

How does aging influence object-location and name-location binding during a visual short-term memory task?

Objective: Age-related impairments in human visual short-term memory (VSTM) may reflect a reduced ability to retain bound object representations, viz., object form, name, spatial, and temporal location (so called ‘memory sources’). Our objective is to examine how healthy aging affects VSTM in a battery of memory recognition tasks in which sequentially presented objects, locations, and names (as auditory stimuli) were learned, with one component cued at test. Methods: Thirty-six young healthy adults (18-30 years) and 36 normally aging older adults (>60 years with no underlying health and vision issues) completed five VSTM tasks: 1. Object recognition for two or four objects; 2. Spatial location recognition for two or four objects; 3. Bound object-location recognition for two or four objects; 4. Object recognition with location priming for two or four objects; 5. Bound name (auditory)-location (cross-modal) recognition for four objects. Results: Significantly lower performance for older adults was found in spatial location recognition [task 2, p=0.03, 2 (memory loads) × 2 (age groups) ANOVA], bound object-location recognition [task 3, p˂0.001, 2 (memory loads) × 2 (age groups) ANOVA], object recognition with location priming [task 4, p=0.02, 2 (memory loads) × 2 (age groups) ANOVA], and bound name-location recognition [task 5, p=0.001, independent samples t-test] tasks. A significant age group-task interaction was found (p =0.02) Conclusion: Performance for all tests except test 1 was impaired in older adults. Lower performance for older adults was most significant in VSTM tasks requiring object-location (visual only) or name-location (auditory and visual) binding. The findings are compatible with the ‘memory source’ model, demonstrating that age-related binding performance is influenced by spatial coding and location priming deficits

The impact of stimulus configuration on visual short‐term memory decline in normal aging and mild cognitive impairment

When we memorize simultaneous items, we not only store information about specific items and/or their locations but also how items are related to each other. Such relational information can be parsed into spatial (spatial configuration) and identity (object configuration) components. Both these configurations are found to support performance during a visual short-term memory (VSTM) task in young adults. How the VSTM performance of older adults is influenced by object/spatial configuration is less understood, which this study investigated

More than 50% of players sustained a time-loss injury (>1 day of lost training or playing time) during the 2012 Super Rugby Union Tournament : a prospective cohort study of 17 340 player-hours

BACKGROUND : Professional rugby union is a contact sport with a high risk of injury. OBJECTIVE : To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament. DESIGN : Prospective cohort study SETTING : 2012 Super Rugby tournament (Australia, New Zealand, South Africa) PARTICIPANTS : 152 players from 5 South African teams METHODS : Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost). RESULTS : The proportion (%) of players sustaining a time-loss injury during the tournament (IPP) was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR per 1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the commonest mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations > 6 hours time difference). CONCLUSION : 55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries / match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for > 1 week.Clinical Sport and Exercise Medicine Research Fund (partial funding) International Olympic Committee (IOC) Research Center (Cape Town) (partial funding) South African Rugby Football Union (partial funding)http://bjsm.bmj.com/hb201