Reading is a complex cognitive process requiring the integration of orthographic, phonological, and semantic information. The visual word form area, located in the ventral occipitotemporal cortex, is critically involved in orthographic decoding, and damage to this region is known to cause alexia. In contrast, the contributions of white matter pathways supporting reading are less well understood. We present a unique neurosurgical case undergoing awake brain surgery for resection of a metastasis in the left occipitotemporal cortex. A tubular retractor was used to access the lesion and during the insertion of the retractor the patient underwent careful, continuous neuropsychological testing, including evaluation of reading. fMRI language mapping and diffusion MRI were performed preoperatively. Postoperative neuropsychological testing was completed two weeks after surgery to assess cognitive outcome. The patient developed an alexia with letter-by-letter reading in real time during insertion of the tubular retractor. Stealth imaging enabled localization of the tubular retractor at the exact onset of the alexia and, by correlating this with tractography, showed that the tubular retractor was in the vertical occipital fasciculus (VOF). We present the first detailed case report linking the VOF to the acute onset of alexia observed intraoperatively during awake brain surgery. We discuss the connectomics of reading and possible contributions of the VOF in reading.
Within resource-limited health care, it is important to demonstrate the value and impact of neuropsychological assessment (NPA) services. However, the most suitable methods for capturing these outcomes are yet to be established. We aimed to identify key potential outcomes of NPA, existing measures of these outcomes, and issues and challenges associated with outcome measurement. Focus groups of experienced Australian neuropsychologists discussed possible NPA outcomes, existing measures, and challenges of outcome measurement, analyzed using thematic analysis. The Delphi method of expert consensus was then used to identify the most important set of NPA outcomes, using iterative survey rounds with expert panelists. Panelists also rated the top three outcomes most likely to demonstrate the impact of NPA in trials. There were 50 potential NPA outcomes generated by the focus groups, spanning proximal and distal patient, caregiver, health service, and societal domains. Numerous issues and challenges were identified associated with meaningfully measuring NPA outcomes. After three Delphi survey rounds (n = 46), a total of 16 outcomes achieved consensus agreement. Few existing validated measures were identified. The top three rated outcomes were 1) better patient and/or caregiver understanding of presenting problems, 2) better patient and/or caregiver understanding of how to manage and cope with cognitive symptoms, and 3) diagnostic clarification. Psychoeducational benefits of NPA were considered by Australian experts as key outcomes relevant across contexts; however, there are no existing measures of these outcomes. Future research should develop valid outcome measures to be used in clinical trials evaluating NPA impacts.
In 2020, the American Academy of Clinical Neuropsychology (AACN) published consensus labels for the uniform description of normally distributed test results in the field of clinical neuropsychology. These consensus labels were developed in a North American context, but other countries have also struggled with the challenges of harmonizing verbal descriptive labels in neuropsychological reports. A recent effort in Norway has demonstrated that literal translations of the AACN labels do not always work in a different language and culture. Also, verbal labels may not be unequivocally understandable for patients, their significant others, and other healthcare professionals who refer patients for neuropsychological services. In this Commentary, we illustrate the process of coming to uniform descriptions for normally distributed test results for the Dutch language, spoken primarily in the Netherlands, the Flanders part of Belgium, the Dutch Caribbean, and Suriname. We also highlight the hurdles that need to be overcome to establish a global consensus.
To review the historical, conceptual, and ethical foundations of intelligence testing in neuropsychology and to consider whether alternative cognitive performance labels offer greater conceptual precision while reducing stigma. We conducted a narrative review of early twentieth century cognitive assessments, tracing the evolution of intelligence testing and its intersections with eugenic ideology. Key examples include the Army Alpha and Beta tests administered during World War I and Ellis Island immigration assessments, which were frequently interpreted without consideration of cultural or educational influences. We examine how these practices informed early interpretations of neuropsychological performance, particularly in individuals with epilepsy, and shaped initial characterizations of neurologically based cognitive abilities. Early intelligence testing was grounded in the belief that intelligence was a fixed and directly genetically determined trait. Test performance was interpreted as an index of biological superiority, lending scientific legitimacy to eugenic ideologies and reinforcing stigma toward individuals with epilepsy. Although modern frameworks emphasize multidimensional cognitive abilities, intelligence-based characterization persists and continues to be frequently reported as a primary outcome of neuropsychological testing. In contexts that require a single summary indicator of cognitive performance, labels such as Total Cognitive Composite are recommended since they avoid implying a fixed or unitary capacity. Continued reliance on the construct of "intelligence" is inconsistent with contemporary models of cognition, reflects outdated theoretical assumptions, and carries enduring psychosocial stigma. Moreover, its circular and internally inconsistent definitions substantially limit its validity and appropriateness within contemporary adult clinical neuropsychological practice.
This study aimed to make a head-to-head comparison of the diagnostic accuracy and cross-cultural applicability of abbreviated 20-item versions of the Copenhagen Cross-Linguistic Naming Test (C-CLNT20) and Naming Assessment in Multicultural Europe (NAME20). The present study was conducted in a multicultural and multilingual patient sample from memory clinics across five European countries. Receiver operating characteristic curve analysis was used to assess the diagnostic accuracy of C-CLNT20 and NAME20 in classifying dementia and mild cognitive impairment (MCI). Binary logistic regression analysis was performed to evaluate the influence of demographic and cultural factors on diagnostic accuracy. C-CLNT20 and NAME20 showed acceptable diagnostic accuracy for dementia with areas under the curve (AUC) of .75 and .82, respectively, but had low accuracy for MCI (AUC of .64 and .62, respectively). Compared to C-CLNT20, NAME20 had slightly higher, but statistically non-significant, AUCs for dementia in both in the full sample and in participants with immigrant background. The diagnostic accuracy of the C-CLNT20 and NAME20 was not significantly influenced by education and immigrant status in the full sample, or by acculturation and use of an interpreter in participants with immigrant background. Both C-CLNT20 and NAME20 are promising brief alternatives to the full versions of the naming tests when time is limited. They also present a promising alternative to other established naming tests by maintaining diagnostic accuracy while showing minimal cross-cultural and cross-linguistic bias.
The International Neuropsychological Society (INS) Justice and Equity Subcommittee initiated a survey of neuropsychological academic training programs, clinical practices, and research across Africa, examining respondents' interest in collaboration and their views on resources needed to advance the field. This quantitative, cross-sectional study employed chain-referral sampling at higher education institutions identified via uniRank. Of the 1,244 institutions screened, 241 offered psychology or psychiatry coursework. A multilingual cover letter and survey link (English, Swahili, Arabic, French, Portuguese, Spanish) were distributed, yielding 42 respondents from 17 of 54 countries (≈31.5% country response rate). Most respondents were clinical psychologists or neuropsychologists and reported 1-5 neuropsychologists per country. Neuropsychologists' roles included cognitive assessment, research, teaching, and assisting in neurological diagnoses, primarily using tests developed outside Africa. Current research centered on the neuropsychological effects of psychiatric disorders, infectious diseases (e.g., HIV, cerebral malaria), and neurodevelopmental disorders, with future focus areas identified as traumatic brain injury and epilepsy. Educational and training opportunities remain limited. Key barriers to program development included insufficient numbers of trained neuropsychologists, clinical training sites, and employment prospects. Despite this, there is strong interest in collaboration to accelerate the development of neuropsychology and neurosciences, given the heavy burden of neurological disease. To foster growth, efforts must target the creation of academic and clinical training pathways and the adaptation, standardization, and norming of assessment tools tailored to African populations. There exist ample impactful avenues for individual and organizational collaboration or support to further the global development of neuropsychology.
The quest for non-invasive and cost-effective biomarkers for mild cognitive impairment (MCI) and Alzheimer's disease (AD) has led to growing interest in resting-state functional magnetic resonance imaging (MRI). This study examined associations between whole-brain functional connectivity measures and cognitive performance across a spectrum of cognitive aging. A total of 108 older adults (mean age 74.1 ± 5.7 years), comprised of cognitively intact individuals, participants with amnestic MCI, and those with mild dementia due to probable AD, underwent high-resolution structural MRI and resting-state functional MRI scans and cognitive testing with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Functional connectivity values were derived from a 17-network brain parcellation. Correlations were established between network connectivity values and RBANS Index scores. Analyses revealed that lower RBANS Attention Index and Total Scale scores were significantly associated with increased connectivity between the ventral attention, central executive network, and limbic and default mode networks. Lower RBANS total scores were also associated with functional connectivity strength between the dorsal default mode networks and lateral frontoparietal regions of the central executive network, with increased connectivity observed across the dementia spectrum (Intact-MCI-AD). These findings suggest that aberrant and potentially compensatory increases in functional connectivity may be linked to cognitive decline, supporting the utility of resting-state functional MRI as a promising biomarker for MCI and AD.
Mathematical computation skills are a common vulnerability in those born very preterm (VP), but the underlying cognitive mechanisms have not been established. Using causal mediation methods, we aimed to investigate whether working memory, processing speed, and selective attention at 7 years of age could mediate the relationship between VP birth and mathematics computation performance at 13 and 20 years of age. Participants completed standardized measures of working memory, processing speed, and selective attention at 7 years. At 13 and 20 years, participants completed a standardized measure of mathematical computation. Using an interventional effects approach, we estimated the extent to which differences in mathematic performance could be reduced by hypothetically intervening on working memory, processing speed, and selective attention in childhood. The VP group performed lower than the FT group on mathematic computation at 13 and 20 years. Improving working memory, processing speed, and selective attention separately in the VP group to the level of the FT group reduced the difference in mathematics performance at both 13 and 20 years. If all cognitive domains were to be simultaneously intervened on so that the VP group matched the FT group, there would be a reduction in difference in mathematic performance by 68.7% at 13 years and 44.1% reduction at 20 years. Findings from our causal mediation analyses suggest that interventions targeting working memory, processing speed, and selective attention in childhood for those born VP have potential for improving mathematical outcomes in adolescence born VP, especially if implemented concurrently.
The Rey-Osterrieth complex figure (ROCF) test is widely used to assess constructional praxis. Qualitative scoring methods, such as the Boston Qualitative Scoring System (BQSS), enable the detection of alterations in spatial organization, planning, and executive control during copying performance. While alterations in constructional abilities have been previously reported in Parkinson's disease (PD), the possible presence of subtle qualitative modifications in PD patients without cognitive impairment (PD-CU) and their relationship with the cognitive functioning is still to be elucidated. This study evaluates differences in copying strategies and error patterns in PD patients with (PD-MCI) or without (PD-CU) mild cognitive impairment, assessing the link with the cognitive profile. Seventy PD patients and 56 healthy controls (HC) were recruited. All participants underwent a neuropsychological assessment, including the ROCF. Their performance was assessed by standard quantitative scoring and qualitative rating scales (BQSS). Statistical analyses compared BQSS performance between groups and examined associations between qualitative visuo-constructional features and other cognitive domains. Both PD-MCI and PD-CU groups showed qualitative alterations compared to HC, associated with executive dysfunctions. Qualitatively, PD-CU patients showed lower scores in neatness and planning measures compared to HC, the latter particularly associated with executive alterations. Notably, patients reporting a left or right asymmetric copy were characterized by different cognitive profiles. The here-presented results support the importance of qualitative assessment in identifying early cognitive impairments in PD patients and suggest that BQSS parameters (i.e., planning) may offer complementary insights to standard quantitative assessments in detecting subthreshold executive impairments not yet captured by conventional tests.
Language deficits are frequently described by patients with multiple sclerosis (MS); however, objective characterization remains somewhat limited due to its omission from standard MS cognitive evaluation and the inconsistent findings that arise from current language measures. To establish alternative approaches to characterizing single-word level language in MS, this study (i) validates the Sydney Language Battery (SYDBAT) visual confrontation naming subtest and (ii) examines the insights provided by examining naming errors and latencies. 40 MS patients from Royal Melbourne Hospital's Cognitive Neuroimmunology Clinic and 40 matched controls completed a series of neuropsychological tests, including the SYDBAT and 'gold standard' confrontation naming task, the Boston Naming Test (BNT). Error types and latencies on the SYDBAT were extracted from assessment audio recordings. SYDBAT and BNT scores were highly correlated (r = 0.81, p < .001) and these tasks reported comparable receiver operating characteristic curves (p = .091). Latency analysis captured lexical retrieval difficulties, with patients displaying significantly longer mean latencies than controls on the SYDBAT (p = .012, β = 0.54). These findings support the validity of the SYDBAT and value of the latency analysis in characterizing language impairment in MS. Use of the SYDBAT and latency considerations contribute to a broader assessment with a briefer administration time compared to gold-standard evaluation. The study thereby offers clinicians an enhanced toolkit to more effectively and appropriately evaluate language functioning and supplement standard cognitive evaluation in this population.
The goal of the present study is to understand whether youth with Noonan Syndrome Spectrum Disorder (NSSD) are at increased risk of neurocognitive difficulties when living in resource depleted communities. Youth (5-17 years; Mage = 9.48 years) with NSSD (n = 140) and unaffected youth (4-15 years; Mage = 9.63 years; n = 85) were included. We ascertained the Child Opportunity Index Health and Environment Index (COI H/E) national-level Z-scores and assessed academic achievement and executive function. Multiple regressions were run to analyze the effects of diagnosis (whether the child had NSSD), COI H/E Z-scores, and diagnosis × COI H/E Z-score interaction on academic achievement (i.e., word reading, math, spelling, and sentence comprehension) and executive skills (i.e., performance-based working memory and processing speed and parent-rated measure of daily executive skills). Diagnosis was a significant predictor in each model. COI H/E Z-score was a significant predictor of spelling and a marginally significant predictor of sentence comprehension scores. There was a significant diagnosis × COI H/E Z-score interaction for working memory, and marginally significant interactions for spelling and sentence comprehension scores. Higher H/E Z-scores were associated with better working memory in the NSSD group and better academic achievement in the unaffected group. While the effects of NSSD are large on all assessed domains, there is an additional burden of resource depletion on working memory abilities of youth with NSSD. Academic achievement in the NSSD group was lower than the unaffected group across resource-depleted/enriched environments, demonstrating the profound effects of NSSD on academic functioning.
Neuropsychological (NP) tests are multi-domain in execution. Reliance on a single score representing specific domains obscures the detection of subtle cognitive changes and increases risk of inaccurate assessment. Rooted in the Boston Process Approach (BPA), the Framingham Heart Study (FHS) captures multi-dimensional errors and process features within and across NP tests. We examined these BPA variables in community-dwelling older adults. We analyzed data from 2363 dementia-free participants aged 60 and above. Exploratory and confirmatory factor analyses used Kemeny covariance structures. Measurement invariance was estimated across age, sex, and education groups. We assessed the impact of demographics on latent factors, and the ability of these factors to predict future conversion to all-cause dementia. We trained machine learning (ML) models to compare NP and BPA data. Participants were older adults (mean age 71.5 ± 8.7 years), primarily female (54.2%), and non-Hispanic White (96.5%). The bifactor model was the only model with adequate fit (CFI = 0.96, RMSEA = 0.03). General and specific factors captured ability for accurate and strategic responses, test-specific variance, and nuanced executive and semantic processes distributed across tests. Higher general ability and stronger verbatim story recall were associated with a reduced likelihood of developing all-cause dementia (general: OR = 0.15, 95% CI [0.12-0.86]; recall: OR = 0.24, 95% CI [0.23-0.90]) over a median of 5.2 years. With NP/BPA data, ML models identified >99% of 222 converters. This study highlights the strengths of NP/BPA data. Multidimensional cognitive features may enhance sensitivity to early changes predictive of incipient dementia.
In Part I, we adapted the Test d'Identification des Émotions Faciales (TIE-93), an emotion recognition test, from French into Dutch, Moroccan-Arabic, and Turkish. In Part II, the translated versions were piloted. The procedures and challenges encountered during the translation and adaptation process are reported qualitatively. The translated versions were piloted, with performance on the TIE-93 compared across Dutch (n = 13), Surinamese (n = 15), Moroccan (n = 14), and Turkish (n = 16) healthy control groups. Second, we compared Surinamese, Moroccan, and Turkish healthy controls to matched patients (n = 20) with subjective cognitive decline, mild cognitive impairment, or dementia. Third, we compared Moroccan healthy controls from the Netherlands and France (n = 20). The challenges encountered during the translation process highlighted the difficulty of translating tests of social cognition, as emotional concepts are intricately linked to culture. As a result, literal translations often failed to maintain meaning equivalence; therefore, adaptations were necessary. Seventy-eight participants were included for piloting, and exploratory analyses were conducted. Healthy controls significantly outperformed patients, and Moroccan healthy controls from the Netherlands, who tested in their native language, significantly performed better than those from France. Results highlight challenges in cross-cultural test adaptation in social cognition, as achieving conceptual equivalence was complicated by cultural and linguistic nuances in emotion-related terms. Nevertheless, the TIE-93 shows clinical potential; this should be examined in larger samples.
The National Institutes of Health (NIH) Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) is a validated laptop-based battery of executive functioning tests. A modified tablet version of the EXAMINER was developed on the UCSF Tablet-based Cognitive Assessment Tool (TabCAT-EXAMINER). Here we describe the battery and investigate the reliability and validity of a composite score. A diagnostically heterogeneous sample of 2135 individuals (mean age = 65.58, SD = 16.07), including controls and participants with a variety of neurodegenerative syndromes, completed the TabCAT-EXAMINER. A composite score was developed using confirmatory factor analysis and item response theory. Validity was evaluated via linear regressions that tested associations with neuropsychological tests, demographics, clinical diagnosis, and disease severity. Replicability of cross-sectional results was tested in a separate sample of participants (n = 342) recruited from a frontotemporal dementia study. As this separate sample also collected longitudinal TabCAT-EXAMINER measures, we additionally assessed test-retest reliability and associations between baseline disease severity and changes in TabCAT-EXAMINER scores. The TabCAT-EXAMINER score was normally distributed, demonstrated high test-retest reliability, and was associated in the expected directions with independent tests of executive functioning, demographics, disease severity, and diagnosis. Greater baseline disease severity was associated with more rapid longitudinal TabCAT-EXAMINER decline. The TabCAT-EXAMINER is a tablet-based executive functioning battery developed for observational research and clinical trials. Performance can be summarized as a single composite score, and results of this study support its reliability and validity in cognitive aging and neurodegenerative disease cohorts.
The cognitive-behavioral model of body dysmorphic disorder (BDD) implicates impaired cognition; yet existing evidence of cognitive impairment in the disorder is often inconsistent. To date, cognitive performance in BDD has not been measured utilizing the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), a gold standard cognitive assessment in clinical settings. Accordingly, this study compared WAIS-IV performance between individuals with BDD and healthy controls. Participants included 59 BDD patients and 56 controls. Cognitive performance was evaluated via the WAIS-IV, and clinical characteristics of the BDD group were examined via multiple clinician and self-report questionnaires. The BDD group demonstrated significantly poorer performance compared to the control group in the WAIS-IV index and subtests that reflect processing speed abilities (Processing Speed Index: d = -0.55, 95% CI [-0.92, -0.18], Symbol Search: d = -0.70, 95% CI [-1.07, -0.32], Coding: d = -0.79, 95% CI [-1.17, -0.41]), yet other indices were not significantly different. These impairments were not correlated with anxiety or BDD-YBOCS symptom severity. Reduced overall cognitive performance was primarily driven by impairments in processing speed. The study suggests that in BDD, processing speed is notably lower than other index scores, falling in the low average range. This may reflect difficulties with rapid visual processing, attention to detail, or motor speed. Performance in domains reflective of reasoning and verbal functioning were unimpaired relative to controls. This selective cognitive pattern in BDD may be driven by increased cognitive load associated with perfectionistic traits. This has clinical implications for cognitive-behavioral treatment.
Few studies have examined the relationship between racial identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance. This study examined racial differences in baseline assessment performance before and after controlling for performance on a word-reading task as a proxy for education quality. We hypothesized that there would be racial differences in baseline performance but that controlling for education quality would reduce these differences. For this observational cross-sectional study, 875 collegiate athletes were grouped based on racial identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Education quality was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial differences in these cognitive domains before and after controlling for WTAR scores. There were significant racial differences in both composite scores and in attention/processing speed IIV, p's < .001, f = 0.13-0.21. However, there were no significant racial differences in memory IIV, p = .97. After controlling for WTAR scores, there were no significant racial differences in the attention/processing (p = .530, f = 0.03) or memory (p = .183, f = 0.06) composite scores, and the relationship between racial identity and attention/processing speed IIV was less prominent (p = .014, f = 0.10). Results suggest that racial differences at baseline assessment can be largely accounted for by education quality as assessed by the WTAR, which underscores the importance of considering sociocultural context when assessing racially diverse athletes.
Psychologists are increasingly asked to assess intellectual functions in adults from diverse cultural and linguistic backgrounds. This study investigated the impact of acculturation and bilingualism on Wechsler Adult Intelligence Scale (WAIS)-IV performance among Arabic-Danish bilingual university students. Forty-eight academically high-achieving participants (69% female), fluent in Danish and educated entirely in Denmark, were recruited in Greater Copenhagen and completed a demographic questionnaire, the Danish version of the WAIS-IV, and self-report measures of acculturation and bilingualism. Several WAIS-IV indexes and subtests were significantly associated with degree of bilingualism and acculturation, even after controlling for educational variables. Despite being academically high-achieving university students, participants scored below the national mean on most indexes and subtests. In fact, only performances on the Processing Speed Index, and the Coding and Symbol Search subtests were at the expected level. Notably, the lowest scores were observed on Block Design, which showed a strong correlation with Arabic acculturation scores. Finally, participants had index profiles that were more uneven than predicted based on the norms. These findings underscore the influence of cultural and linguistic factors on WAIS-IV performance and suggest that WAIS-IV may not fully capture the intellectual abilities of bilingual individuals, even when they are fluent in the test language and have the same educational experience as the norm population.
The primary aim of this study was to evaluate whether military occupations with repetitive exposure to low-level blast (i.e., breachers and snipers) display poorer neurocognitive status compared to military controls without prior occupational engagement as breachers and/or snipers, and whether that effect is mediated by self-reported mental health symptoms. With data collected from Canadian Armed Forces (CAF) breachers and snipers and sex- and age-matched CAF controls (n = 112), mental health was assessed using the PCL-5 (PTSD) and the Brief Symptoms Inventory, and neurocognitive function based on a set of computerized tasks (i.e., four-choice reaction time task, delayed matching-to-sample, n-back, Stroop). Directed Acyclic Graphs (DAGs) were created to establish a causal framework describing the potential effect of occupation on neurocognitive function while considering mental health. Factor analysis modeling was used to establish the latent construct of neurocognitive function, which was then incorporated into student-t models for effect estimation, following assumptions derived from causal inference principles. Our results demonstrated that it is snipers specifically who displayed lower neurocognitive performance compared to breachers and controls. Critically, this effect was not mediated by mental health status. In fact, mental health was generally better in both breachers and snipers when compared to controls. When the focus is on occupations with repetitive exposure to low-level blast, the snipers in particular are impacted most in terms of neurocognitive function. We speculate that this might be due to additional impact of recoil forces exacerbating the effect of blast overpressure on the nervous system.
Neurocognitive assessment is an essential research instrument for autism spectrum disorder (ASD), as the clinical manifestations are rooted in diverse neurocognitive processes that cause variation in clinical presentation. Few instruments comprehensively capture relevant neurocognitive domains, and most require professional assessors. The Penn Computerized Neurocognitive Battery (CNB) is widely used in child and adolescent psychiatry research across cultures. This study adapted and validated the CNB for a clinical ASD cohort in Hong Kong. In this Hong Kong version of the CNB (CNB-HK), thirteen cognitive tasks were translated and adapted, with one task for sensorimotor speed and twelve belonging to four specific domains (episodic memory, social cognition, complex cognition, and executive function). The CNB-HK was administered to 636 normal-IQ children with ASD (mean age: 8.4 years, 87.1% male) and 412 children without ASD (mean age: 8.6 years, 55.1% male). Factor structure was examined using factor analyses. The CNB-HK had high feasibility for children with ASD, with <7% invalid data across all tasks. The original four-factor and bi-factor structures were replicated with good model fit, and partial scalar invariance was achieved between children with and without ASD. The factor scores correlated positively with estimated IQ in the ASD group. The ASD group had worse performance across all four cognitive domains and the g factor compared to the group without ASD. The CNB-HK is a valid, multi-domain cognitive assessment tool for children with ASD in Hong Kong, offering a feasible and reliable approach for research and clinical settings.
This study aimed to explore the correlates of zero, one, and multiple performance validity test (PVT) failures on cognitive test performance in patients with various degrees of severity of traumatic brain injury. 306 participants completed the Trail Making Test as part of a neuropsychological evaluation within 1-36 months post-injury. They were assigned to zero, one, or ≥ two fail groups on the basis of at least two independent PVTs. Group differences in Trail Making Test performance were analyzed with analysis of variance, with post hoc contrasts with the Bonferroni correction for multiple comparisons. Groups were also compared on various background characteristics. Participants who passed all PVTs had statistically significantly better performance on both parts of the Trail Making Test as compared to those who failed either one or multiple PVTs, with the latter two groups not differing statistically significantly from each other. PVT failure was relatively more common in participants who were female, had an uncomplicated mild TBI, were involved in financial compensation-seeking, and were seen at a longer time point since injury. Failure of even only one PVT is associated with lower neuropsychological test performance in patients with traumatic brain injury, especially when empirically validated criteria are used that are stratified by injury severity. Such failure does not always reflect malingering but must be interpreted and addressed in the context of patient background characteristics.