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The factor structure of the Wisconsin card sorting test in a stroke rehabilitation sample
76
Abstractsfrom the 18th Annual Meeting
Freshwater, S. F., Teichner, G., & Golden, C. J. Scoring Methodology: Demographic Corrections in Neuropsychological Assessment. The concept of neuropsychological disability presupposes some level of functioning against which a patient's cognitive performance may be evaluated. For many cognitive functions, demographic variables, such as age, education, gender, and ethnicity, may significantly affect neuropsychological test performance and interpretation. Multiple regression is particularly appropriate for determining whether these variables are useful in predicting an expected level of performance in a cognitive domain, and how much variance is accounted for in a cognitive measure by these subject demographics. The LuriaNebraska Neuropsychological Battery-Third edition (LNNB-III), a battery of neuropsychological tests designed to provide information useful in the diagnosis and treatment of brain dysfunction or damage was administered to a normal sample (n = 109). A hierarchical stepwise analysis was performed investigating curvilinear and linear relationships of demographic variables. Results indicated linear regression contributed to a greater amount of variance with the most powerful predictors age and education. Regression equations and standard errors of measurement were then generated from the normative sample for each clinical scale. Z-score transformations and T-score calculations were then derived for each of the LNNB-III 35 clinical scales. This paper presents the regression equations and standard errors of estimate generated for the LNNB-III clinical scales, an example of their application, and a discussion of the methodology and applicability of regression analysis with any neuropsychological test to produce age and education corrected scores while also allowing conversion of raw scores to T-scores for "cut off" methodology. Gouvier, W. D., Tucker, K. A., Baglio, C. S., Smith, J. M., Price, C. C., & Matson, J. L. Detection of Tardive Dyskinesia in Developmentally Disabled Individuals. Individuals with developmental disabilities who live in residential facilities are commonly prescribed neuroleptic medications for psychosis and behavioral problems such as aggression and self-injurious behavior. As a consequence of treatment with neuroleptics, these individuals may develop involuntary movements that are associated with tardive dyskinesia (TD). Since these movements may be quite debilitating and are potentially irreversible, early detection of TD is essential in this group of individuals who are frequently already neurologically compromised. Neuropsychologists working within this field are being called upon to assist in the identification of these symptoms. The purpose of this study was to determine whether the Dyskinesia Identification System: Condensed User Scale (DISCUS) effectively identifies clients who are exhibiting symptoms of TD among developmentally disabled individuals whose intellectual functioning is within the severe and profound ranges. The DISCUS correctly classified 68% of subjects into one of four groups: neuroleptic treated subjects with symptoms of TD, unmedicated subjects exhibiting symptoms of another movement disorder, subjects taking neuroleptics who did not exhibit symptoms of TD, and subjects who were not medicated and did not display involuntary movements. The interrater reliability, test-retest reliability, and concurrent validity were examined as well. Results indicate that the DISCUS is a reliable and valid instrument for the detection of TD within developmentally disabled samples. The ability of this measure to accurately classify these subjects may be diminished by the communication and physical deficits that limit their participation in the assessment. Suggestions are made regarding other possible symptoms of TD within this population that may help increase the classificatory power of the DISCUS. Greve, K. W., Hartley, S. M., Lindberg, R., Bianchini, K. J., & Adams, D. The Factor Structure of the Wisconsin Card Sorting Test in a Stroke Rehabilitation Sample. The factor structure and construct validity of the Wisconsin Card Sorting Test (WCST) have been the subject of considerable recent research. These studies have demonstrated
Abstracts from the 18th Annual Meeting
77
consistent structure in among WCST variables across varied normal and patient populations (Greve, Ingram, & Bianchini, in press). The present study was designed to determine if the three-factor structure reported by Greve et al. could be replicated in a relatively homogeneous sample of stroke patients. Further, the previous studies were extended in that the association of the observed WCST factors with functional indices of rehabilitation outcome and recovery was examined. This is particularly important given the increasing role of neuropsychological assessment in the rehabilitation of persons with brain injury. Participants were 83 patients suffering from recent CVA's being treated in a comprehensive hospital-based physical rehabilitation program. Eight WCST scores were submitted to a principal components analysis with an orthogonal (varimax) rotation: total correct (TC), total errors (TE), perseverative responses (PR), perseverative errors (PE), nonperseverative errors (NPE), percent conceptual level responses (CLR), categories completed (CAT), failure-to-maintain-set (FMS). A three factor solution accounting for 96.8% of the variance was produced. Factor 1 contained TE (-.96), CLR (.96), CAT (.95), PE (-.86), TC (.84), PR (-.83). Factor 2 contained only NPE ( - . 9 9 ) though both PE and PR loaded moderately (.46 and .50, respectively). FMS was the sole variable loading on Factor 3 though TC also loaded moderately (.42). A second principal components analysis to assess the construct validity of the WCST resulted in a five factor solution accounting for 74.4% of the observed variance. WCST Factor 1 was associated with measures of perceptual organization, planning, and construction. WCST Factor 2 was associated only with the WAIS-R verbal comprehension factor, while the WCST Factor 3 was the sole variable on the fifth factor. Finally, the WCST factor scores were related to the discharge scores from the Functional Independence Measure (FIM). The WCST scores alone accounted for only 7 to 18% of the variance in discharge FIMs. However, when admission FIMs were included in the analysis, between 40 and 74% of the variance was explained. The WCST factor scores' residual contribution was minimal. This study replicates the three factor structure for the WCST reported by Greve et al. (in press). This factor structure has been demonstrated in a range of normal and patient samples. Nonetheless, the construct validity of the factors remains less clear. In particular, Factor 3 (FMS) continues to defy association with other neuropsychological measures. Finally, while WCST performance is associated with functional status at discharge, its unique contribution to the relationship is minimal. It is possible that because of the difficulty of the WCST, its value in the stroke rehabilitation setting may be limited to higher functioning or younger individuals.
Griffin, S. L., & Rankin, E. J. Normative Data for a Copy Version of the Wechsler Memory Scale-Revised (WMS-R) Visual Reproduction Subtest. The present investigation obtained normative data for 195 subjects' performance on a copy version of the WMS-R Visual Reproduction (VR) Subtest. Subjects were administered selected subtests of the WMS-R as part of a larger neuropsychological battery. Following the delayed recall portion of the WMS-R VR Subtest, subjects were asked to copy each of the four designs presented. Subjects included 23 non-neurological controls, 35 chronic pain patients, 96 traumatic brain injury (TBI) patients, 15 patients with a history of cerebral vascular accident (CVA), and 16 subjects with degenerative dementia. Analysis of variance revealed no significant differences between the performance of non-neurological controls, chronic pain patients, and TBI patients. However, the performance of individuals with a history of C VA and individuals with a degenerative dementia was significantly poorer than that of each of the other groups. In non-neurological controls, performance on the WMS-R VR was significantly correlated with dominant
Abstractsfrom the 18th Annual Meeting
Freshwater, S. F., Teichner, G., & Golden, C. J. Scoring Methodology: Demographic Corrections in Neuropsychological Assessment. The concept of neuropsychological disability presupposes some level of functioning against which a patient's cognitive performance may be evaluated. For many cognitive functions, demographic variables, such as age, education, gender, and ethnicity, may significantly affect neuropsychological test performance and interpretation. Multiple regression is particularly appropriate for determining whether these variables are useful in predicting an expected level of performance in a cognitive domain, and how much variance is accounted for in a cognitive measure by these subject demographics. The LuriaNebraska Neuropsychological Battery-Third edition (LNNB-III), a battery of neuropsychological tests designed to provide information useful in the diagnosis and treatment of brain dysfunction or damage was administered to a normal sample (n = 109). A hierarchical stepwise analysis was performed investigating curvilinear and linear relationships of demographic variables. Results indicated linear regression contributed to a greater amount of variance with the most powerful predictors age and education. Regression equations and standard errors of measurement were then generated from the normative sample for each clinical scale. Z-score transformations and T-score calculations were then derived for each of the LNNB-III 35 clinical scales. This paper presents the regression equations and standard errors of estimate generated for the LNNB-III clinical scales, an example of their application, and a discussion of the methodology and applicability of regression analysis with any neuropsychological test to produce age and education corrected scores while also allowing conversion of raw scores to T-scores for "cut off" methodology. Gouvier, W. D., Tucker, K. A., Baglio, C. S., Smith, J. M., Price, C. C., & Matson, J. L. Detection of Tardive Dyskinesia in Developmentally Disabled Individuals. Individuals with developmental disabilities who live in residential facilities are commonly prescribed neuroleptic medications for psychosis and behavioral problems such as aggression and self-injurious behavior. As a consequence of treatment with neuroleptics, these individuals may develop involuntary movements that are associated with tardive dyskinesia (TD). Since these movements may be quite debilitating and are potentially irreversible, early detection of TD is essential in this group of individuals who are frequently already neurologically compromised. Neuropsychologists working within this field are being called upon to assist in the identification of these symptoms. The purpose of this study was to determine whether the Dyskinesia Identification System: Condensed User Scale (DISCUS) effectively identifies clients who are exhibiting symptoms of TD among developmentally disabled individuals whose intellectual functioning is within the severe and profound ranges. The DISCUS correctly classified 68% of subjects into one of four groups: neuroleptic treated subjects with symptoms of TD, unmedicated subjects exhibiting symptoms of another movement disorder, subjects taking neuroleptics who did not exhibit symptoms of TD, and subjects who were not medicated and did not display involuntary movements. The interrater reliability, test-retest reliability, and concurrent validity were examined as well. Results indicate that the DISCUS is a reliable and valid instrument for the detection of TD within developmentally disabled samples. The ability of this measure to accurately classify these subjects may be diminished by the communication and physical deficits that limit their participation in the assessment. Suggestions are made regarding other possible symptoms of TD within this population that may help increase the classificatory power of the DISCUS. Greve, K. W., Hartley, S. M., Lindberg, R., Bianchini, K. J., & Adams, D. The Factor Structure of the Wisconsin Card Sorting Test in a Stroke Rehabilitation Sample. The factor structure and construct validity of the Wisconsin Card Sorting Test (WCST) have been the subject of considerable recent research. These studies have demonstrated
Abstracts from the 18th Annual Meeting
77
consistent structure in among WCST variables across varied normal and patient populations (Greve, Ingram, & Bianchini, in press). The present study was designed to determine if the three-factor structure reported by Greve et al. could be replicated in a relatively homogeneous sample of stroke patients. Further, the previous studies were extended in that the association of the observed WCST factors with functional indices of rehabilitation outcome and recovery was examined. This is particularly important given the increasing role of neuropsychological assessment in the rehabilitation of persons with brain injury. Participants were 83 patients suffering from recent CVA's being treated in a comprehensive hospital-based physical rehabilitation program. Eight WCST scores were submitted to a principal components analysis with an orthogonal (varimax) rotation: total correct (TC), total errors (TE), perseverative responses (PR), perseverative errors (PE), nonperseverative errors (NPE), percent conceptual level responses (CLR), categories completed (CAT), failure-to-maintain-set (FMS). A three factor solution accounting for 96.8% of the variance was produced. Factor 1 contained TE (-.96), CLR (.96), CAT (.95), PE (-.86), TC (.84), PR (-.83). Factor 2 contained only NPE ( - . 9 9 ) though both PE and PR loaded moderately (.46 and .50, respectively). FMS was the sole variable loading on Factor 3 though TC also loaded moderately (.42). A second principal components analysis to assess the construct validity of the WCST resulted in a five factor solution accounting for 74.4% of the observed variance. WCST Factor 1 was associated with measures of perceptual organization, planning, and construction. WCST Factor 2 was associated only with the WAIS-R verbal comprehension factor, while the WCST Factor 3 was the sole variable on the fifth factor. Finally, the WCST factor scores were related to the discharge scores from the Functional Independence Measure (FIM). The WCST scores alone accounted for only 7 to 18% of the variance in discharge FIMs. However, when admission FIMs were included in the analysis, between 40 and 74% of the variance was explained. The WCST factor scores' residual contribution was minimal. This study replicates the three factor structure for the WCST reported by Greve et al. (in press). This factor structure has been demonstrated in a range of normal and patient samples. Nonetheless, the construct validity of the factors remains less clear. In particular, Factor 3 (FMS) continues to defy association with other neuropsychological measures. Finally, while WCST performance is associated with functional status at discharge, its unique contribution to the relationship is minimal. It is possible that because of the difficulty of the WCST, its value in the stroke rehabilitation setting may be limited to higher functioning or younger individuals.
Griffin, S. L., & Rankin, E. J. Normative Data for a Copy Version of the Wechsler Memory Scale-Revised (WMS-R) Visual Reproduction Subtest. The present investigation obtained normative data for 195 subjects' performance on a copy version of the WMS-R Visual Reproduction (VR) Subtest. Subjects were administered selected subtests of the WMS-R as part of a larger neuropsychological battery. Following the delayed recall portion of the WMS-R VR Subtest, subjects were asked to copy each of the four designs presented. Subjects included 23 non-neurological controls, 35 chronic pain patients, 96 traumatic brain injury (TBI) patients, 15 patients with a history of cerebral vascular accident (CVA), and 16 subjects with degenerative dementia. Analysis of variance revealed no significant differences between the performance of non-neurological controls, chronic pain patients, and TBI patients. However, the performance of individuals with a history of C VA and individuals with a degenerative dementia was significantly poorer than that of each of the other groups. In non-neurological controls, performance on the WMS-R VR was significantly correlated with dominant