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Development of the multimodal medical memory measure
Abstracts from the 19th Annual Meeting
739
BIP condition showed strong differences among the ages (F-Correct = 3.96, DFH/ DFE = 5/722, p < .022, F-Errors = 8.84, DFH/DFE = 5/722, p < .001). A similar, but weaker, pattern was found for the NBIP Condition (F-Correct = 2.25, DFH/DFE = 5/302, p < .049; F-Errors = 1.92, 5/302, p < .091). These results suggested that the use of the BIP could contribute to improving the sensitivity of the BVRT in clinical and research settings. In particular, a comparison of the discrepancy from expected level during the BIP and NBIP condition may contribute to identifying those individuals who sensitivity to distraction may reflect the effects of acquired neuropsychological impairment.
Sewick, B. G., Leveque, S., Clark, S., & Staszkow, R. Halstead-Reitan Battery Recognition Memory Procedures: A Validity Study. In this paper, we present a 48-item two alternative forced choice recognition memory procedure utilizing stimuli from six tests routinely administered in the Halstead-Reitan (H-R) Battery. These recognition memory procedures can be completed in less than 5 minutes and provide information regarding test-taking behavior and motivation directly related to the neuropsychological tests. Four groups of 15 subjects were tested including normal controls (NC), simulated malingerers (SM), confirmed organics (CO) and mild traumatic brain injury patients involved in litigation (MT). The groups did not differ in age or education. Subjects were typically in their 30s, had 12 to 13 years of education and were Caucasian, Black, Hispanic, and male and female. All CO subjects had evidence of acquired neuropathology demonstrated via CT or MRI and were primarily of traumatic etiology. MT subjects met criteria established by the American Congress of Rehabilitation Medicine. All subjects were administered the 6 H-R tests utilized for the recognition memory procedures, the Rey 15 Item Memory Test and the Portland Digit Recognition Test (PDRT). The Validity Index (VI) from the Category Test was also calculated. The data were analyzed via analyses of variance and subsequent post-hoc tests when appropriate. Results indicated that the SM group performed more poorly than the NC, CO, and MI groups on all 6 H-R recognition procedures (p < .001). There were no significant differences between the NC, CO, and MT groups. An optimal total H-R recognition cut-off score was determined and resulted in 93% classification of SM subjects as malingerers (true positives). This compared to true positive classification rates of 40% for the Rey 15 Test, 66% for the PDRT and 86% for the VI utilizing recommended cut-off scores. Finally, the H-R recognition procedures resulted in 97% classification of NC and CO subjects as non-malingerers (true negatives) compared to rates of 93% for the Rey 15 Test, 97% for the PDRT and 93% for the VI. Results of this preliminary validity study suggest that the H-R recognition memory procedures appear to be of use in differentiating between malingering subjects versus normal and organic subjects. The procedures appeared to be at least as accurate as three popular and well researched contemporary methods. These results require cross-validation and the procedures will need to be studied with different organic and psychiatric groups. Yu, J. T.-C., & Wanlass, R. L. Development of the Multimodal Medical Memory Measure. This presentation describes the development of the Multimodal Medical Memory Measure (M4). This instrument assesses the ability to comprehend and recall health-related information presented in spoken, written, and pictorial modalities. In addition to assessing free and forced-choice recall, M4 provides a measure of prospective memory and a measure of the ability to utilize note taking as a memory compensation strategy. Normal
740
Abstracts from the 19th Annual Meeting
controls (N = 107) scored significantly higher than persons with neurological diagnoses (N = 33). Both groups learned better when information was repeated and presented in multiple modalities. This instrument has potential applicability in health settings as a means of assessing patients' ability to understand and recall health information and follow through on health care instructions.
FORENSIC NEUROPSYCHOLOGY Baker, W., Senior, G., & Douglas, L. Difficulty in Classifying Medico-Legal Groups with the MMPI-2. The Minnesota Multiphasic Personality Inventory-Revised (MMPI-2) is one of the most frequently used psychological measures in the medico-legal arena. Perhaps because of the MMPI's long history and the nature of clinicians' biases, there has been little to no research conducted into developing more effective methods of analysis and interpretation. The method proposed in this study utilizes the cluster analysis of clinical scales to characterize performance, and a method of comparison which accounts for measures of central tendency, variance, and scale intercorrelations. MMPI-2 protocols were analyzed from 197 chronic pain (CP), and 200 traumatic brain injury (TBI) patients. A hierarchical clustering procedure was performed on K-corrected T scores of the MMPI-2 using the 10 clinical scales. Three relatively homogeneous, and almost identical subgroups (High Distress-High Disturbance; High Distress-Low Disturbance; Within Normal Limits) were identified for both TBI and CP groups. In general, CP profiles replicated the MMPI and MMPI-2 findings of previous researchers. The patterns of cluster types found in this study support the view that the clusters represent a continuum of generalized distress or pathology rather than specific patterns of problems. While this is certainly an endorsement of the ability of the MMPI-2 to reflect such difficulties, the utility of the MMPI-2 as a screening measure to differentiate various clinical groups, in a medico-legal setting, appears limited.
Senior, G., Lothrop, P., & Deacon, S. TBI(f): An MMPI-2 Scale for Assessing Traumatic Brain Injury in a Forensic Setting. The MMPI-2 is, perhaps, the most commonly utilized measure for personality assessment in medicolegal settings. Although much research has been done examining the potential impact of traumatic brain injury (TBI) upon MMPI-2 Basic scales, few attempts have been made to develop a scale specific to this type of injury and clinical setting. The TBI(f) scale was developed to directly measure those MMPI-2 items that have a high base rate of endorsement in TBI patients. Initial item content was selected using the protocols of 100 individuals who had sustained a traumatic brain injury and were being assessed as part of ongoing litigation. Endorsement rates of all 567 items were contrasted with the published rates for the restandardization sample to ensure that all selected items had a substantially higher base rate of endorsement in TBI than unimpaired individuals. Factor analysis was utilized to derive three subscales with moderately high alpha coefficients (0.75-0.82) that differentially reflect cognitive, emotional, and physical concerns. Cross-validation was conducted using a second sample 100 TBI subjects, and test specificity was examined using medicolegal protocols of chronic pain and posttraumatic stress disorder patients. Incremental validity was also examined by comparing the test operating characteristics of the TBI(f) scale with the MMPI-2 Cerebral Impairment Index and the Gass Items.
739
BIP condition showed strong differences among the ages (F-Correct = 3.96, DFH/ DFE = 5/722, p < .022, F-Errors = 8.84, DFH/DFE = 5/722, p < .001). A similar, but weaker, pattern was found for the NBIP Condition (F-Correct = 2.25, DFH/DFE = 5/302, p < .049; F-Errors = 1.92, 5/302, p < .091). These results suggested that the use of the BIP could contribute to improving the sensitivity of the BVRT in clinical and research settings. In particular, a comparison of the discrepancy from expected level during the BIP and NBIP condition may contribute to identifying those individuals who sensitivity to distraction may reflect the effects of acquired neuropsychological impairment.
Sewick, B. G., Leveque, S., Clark, S., & Staszkow, R. Halstead-Reitan Battery Recognition Memory Procedures: A Validity Study. In this paper, we present a 48-item two alternative forced choice recognition memory procedure utilizing stimuli from six tests routinely administered in the Halstead-Reitan (H-R) Battery. These recognition memory procedures can be completed in less than 5 minutes and provide information regarding test-taking behavior and motivation directly related to the neuropsychological tests. Four groups of 15 subjects were tested including normal controls (NC), simulated malingerers (SM), confirmed organics (CO) and mild traumatic brain injury patients involved in litigation (MT). The groups did not differ in age or education. Subjects were typically in their 30s, had 12 to 13 years of education and were Caucasian, Black, Hispanic, and male and female. All CO subjects had evidence of acquired neuropathology demonstrated via CT or MRI and were primarily of traumatic etiology. MT subjects met criteria established by the American Congress of Rehabilitation Medicine. All subjects were administered the 6 H-R tests utilized for the recognition memory procedures, the Rey 15 Item Memory Test and the Portland Digit Recognition Test (PDRT). The Validity Index (VI) from the Category Test was also calculated. The data were analyzed via analyses of variance and subsequent post-hoc tests when appropriate. Results indicated that the SM group performed more poorly than the NC, CO, and MI groups on all 6 H-R recognition procedures (p < .001). There were no significant differences between the NC, CO, and MT groups. An optimal total H-R recognition cut-off score was determined and resulted in 93% classification of SM subjects as malingerers (true positives). This compared to true positive classification rates of 40% for the Rey 15 Test, 66% for the PDRT and 86% for the VI utilizing recommended cut-off scores. Finally, the H-R recognition procedures resulted in 97% classification of NC and CO subjects as non-malingerers (true negatives) compared to rates of 93% for the Rey 15 Test, 97% for the PDRT and 93% for the VI. Results of this preliminary validity study suggest that the H-R recognition memory procedures appear to be of use in differentiating between malingering subjects versus normal and organic subjects. The procedures appeared to be at least as accurate as three popular and well researched contemporary methods. These results require cross-validation and the procedures will need to be studied with different organic and psychiatric groups. Yu, J. T.-C., & Wanlass, R. L. Development of the Multimodal Medical Memory Measure. This presentation describes the development of the Multimodal Medical Memory Measure (M4). This instrument assesses the ability to comprehend and recall health-related information presented in spoken, written, and pictorial modalities. In addition to assessing free and forced-choice recall, M4 provides a measure of prospective memory and a measure of the ability to utilize note taking as a memory compensation strategy. Normal
740
Abstracts from the 19th Annual Meeting
controls (N = 107) scored significantly higher than persons with neurological diagnoses (N = 33). Both groups learned better when information was repeated and presented in multiple modalities. This instrument has potential applicability in health settings as a means of assessing patients' ability to understand and recall health information and follow through on health care instructions.
FORENSIC NEUROPSYCHOLOGY Baker, W., Senior, G., & Douglas, L. Difficulty in Classifying Medico-Legal Groups with the MMPI-2. The Minnesota Multiphasic Personality Inventory-Revised (MMPI-2) is one of the most frequently used psychological measures in the medico-legal arena. Perhaps because of the MMPI's long history and the nature of clinicians' biases, there has been little to no research conducted into developing more effective methods of analysis and interpretation. The method proposed in this study utilizes the cluster analysis of clinical scales to characterize performance, and a method of comparison which accounts for measures of central tendency, variance, and scale intercorrelations. MMPI-2 protocols were analyzed from 197 chronic pain (CP), and 200 traumatic brain injury (TBI) patients. A hierarchical clustering procedure was performed on K-corrected T scores of the MMPI-2 using the 10 clinical scales. Three relatively homogeneous, and almost identical subgroups (High Distress-High Disturbance; High Distress-Low Disturbance; Within Normal Limits) were identified for both TBI and CP groups. In general, CP profiles replicated the MMPI and MMPI-2 findings of previous researchers. The patterns of cluster types found in this study support the view that the clusters represent a continuum of generalized distress or pathology rather than specific patterns of problems. While this is certainly an endorsement of the ability of the MMPI-2 to reflect such difficulties, the utility of the MMPI-2 as a screening measure to differentiate various clinical groups, in a medico-legal setting, appears limited.
Senior, G., Lothrop, P., & Deacon, S. TBI(f): An MMPI-2 Scale for Assessing Traumatic Brain Injury in a Forensic Setting. The MMPI-2 is, perhaps, the most commonly utilized measure for personality assessment in medicolegal settings. Although much research has been done examining the potential impact of traumatic brain injury (TBI) upon MMPI-2 Basic scales, few attempts have been made to develop a scale specific to this type of injury and clinical setting. The TBI(f) scale was developed to directly measure those MMPI-2 items that have a high base rate of endorsement in TBI patients. Initial item content was selected using the protocols of 100 individuals who had sustained a traumatic brain injury and were being assessed as part of ongoing litigation. Endorsement rates of all 567 items were contrasted with the published rates for the restandardization sample to ensure that all selected items had a substantially higher base rate of endorsement in TBI than unimpaired individuals. Factor analysis was utilized to derive three subscales with moderately high alpha coefficients (0.75-0.82) that differentially reflect cognitive, emotional, and physical concerns. Cross-validation was conducted using a second sample 100 TBI subjects, and test specificity was examined using medicolegal protocols of chronic pain and posttraumatic stress disorder patients. Incremental validity was also examined by comparing the test operating characteristics of the TBI(f) scale with the MMPI-2 Cerebral Impairment Index and the Gass Items.