Assessing financial competence in older adults with cognitive impairment

One common problem brought before Courts and Tribunals in Australia is whether or not someone is able to manage his or her own financial affairs. The problem is that currently in Australia there are no universally agreed upon standards for assessing financial competence. The aim of this study was to examine the reliability and validity of a new measure of financial competence, The Financial Competence Assessment Inventory (FCAI), in assessing financial competency of older adults with a cognitive impairment. The sample comprised 18 older adults with acquired brain injury, 10 adults with schizophrenia, 21 adults with dementia and 27 older adults without cognitive impairment. Ages ranged from 55 to 91. Each participant was individually interviewed using the FCAI. The findings revealed that the FCAI is a reliable and valid assessment tool for assessing financial competence of older adults with different types and levels of cognitive impairment. In particular, the FCAI was able to distinguish between older adults with global brain impairment and older adults with specific brain impairment; and older adults who had a legal administrator and older adults who did not. In addition, using the FCAI it was possible to obtain a profile of participants’ strengths and weaknesses across six domains of financial competence including; everyday financial abilities, financial judgment, estate management, cognitive based financial tasks, debt management, and support resources. The FCAI has the potential to assist clinicians and legal decision-makers regarding ‘least restrictive alternatives’ when financial competence is in question.

Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder

Objective: To identify neuropsychological predictors of treatment response to cognitive-behavioral therapy (CBT) and fluoxetine in treatment-naive adults with obsessive-compulsive disorder (OCD). Method: Thirty-eight adult outpatients with OCD underwent neuropsychological assessment, including tasks of intellectual function, executive functioning and visual and verbal memory, before randomization to a 12-week clinical trial of either CBT or fluoxetine. Neuropsychological measures were used to identify predictors of treatment response in OCD. Results: Neuropsychological measures that predicted a better treatment response to either CBT or fluoxetine were higher verbal IQ (Wechsler Abbreviated Scale of Intelligence) (p = 0.008); higher verbal memory on the California Verbal Learning Test (p = 0.710); shorter time to complete part D (Dots) (p<0.001), longer time to complete part W (Words) (p = 0.025) and less errors on part C (Colors) (p<0.001) in the Victoria Stroop Test (VST). Fewer perseverations on the California Verbal Learning Test, a measure of mental flexibility, predicted better response to CBT, but worse response to fluoxetine (p = 0.002). Conclusion: In general, OCD patients with better cognitive and executive abilities at baseline were more prone to respond to either CBT or fluoxetine. Our finding that neuropsychological measures of mental flexibility predicted response to treatment in opposite directions for CBT and fluoxetine suggests that OCD patients with different neuropsychological profiles may respond preferentially to one type of treatment versus the other. Further studies with larger samples of OCD patients are necessary to investigate the heuristic value of such findings in a clinical context. (C) 2012 Elsevier Inc. All rights reserved.

Opioid dependence: Brain structure and function : a magnetic resonance imaging, neuropsychological, and electromagnetic study

Background: Opiod dependence is a chronic severe brain disorder associated with enormous health and social problems. The relapse back to opioid abuse is very high especially in early abstinence, but neuropsychological and neurophysiological deficits during opioid abuse or soon after cessation of opioids are scarcely investigated. Also the structural brain changes and their correlations with the length of opioid abuse or abuse onset age are not known. In this study the cognitive functions, neural basis of cognitive dysfunction, and brain structural changes was studied in opioid-dependent patients and in age and sex matched healthy controls. Materials and methods: All subjects participating in the study, 23 opioid dependents of whom, 15 were also benzodiazepine and five cannabis co-dependent and 18 healthy age and sex matched controls went through Structured Clinical Interviews (SCID) to obtain DSM-IV axis I and II diagnosis and to exclude psychiatric illness not related to opioid dependence or personality disorders. Simultaneous magnetoencephalography (MEG) and electroencephalography (EEG) measurements were done on 21 opioid-dependent individuals on the day of hospitalization for withdrawal therapy. The neural basis of auditory processing was studied and pre-attentive attention and sensory memory were investigated. During the withdrawal 15 opioid-dependent patients participated in neuropsychological tests, measuring fluid intelligence, attention and working memory, verbal and visual memory, and executive functions. Fifteen healthy subjects served as controls for the MEG-EEG measurements and neuropsychological assessment. The brain magnetic resonance imaging (MRI) was obtained from 17 patients after approximately two weeks abstinence, and from 17 controls. The areas of different brain structures and the absolute and relative volumes of cerebrum, cerebral white and gray matter, and cerebrospinal fluid (CSF) spaces were measured and the Sylvian fissure ratio (SFR) and bifrontal ratio were calculated. Also correlation between the cerebral measures and neuropsychological performance was done. Results: MEG-EEG measurements showed that compared to controls the opioid-dependent patients had delayed mismatch negativity (MMN) response to novel sounds in the EEG and P3am on the contralateral hemisphere to the stimulated ear in MEG. The equivalent current dipole (ECD) of N1m response was stronger in patients with benzodiazepine co-dependence than those without benzodiazepine co-dependence or controls. In early abstinence the opioid dependents performed poorer than the controls in tests measuring attention and working memory, executive function and fluid intelligence. Test results of the Culture Fair Intelligence Test (CFIT), testing fluid intelligence, and Paced Auditory Serial Addition Test (PASAT), measuring attention and working memory correlated positively with the days of abstinence. MRI measurements showed that the relative volume of CSF was significantly larger in opioid dependents, which could also be seen in visual analysis. Also Sylvian fissures, expressed by SFR were wider in patients, which correlated negatively with the age of opioid abuse onset. In controls the relative gray matter volume had a positive correlation with composite cognitive performance, but this correlation was not found in opioid dependents in early abstinence. Conclusions: Opioid dependents had wide Sylvian fissures and CSF spaces indicating frontotemporal atrophy. Dilatation of Sylvian fissures correlated with the abuse onset age. During early withdrawal cognitive performance of opioid dependents was impaired. While intoxicated the pre-attentive attention to novel stimulus was delayed and benzodiazepine co-dependence impaired sound detection. All these changes point to disturbances on frontotemporal areas.

Adult Attachment Style on the MMPI-2: Does an Elevated Scale 4 Predict Dismissing Attachment?

This study examines some aspects of Caldwell's (200 I) hypotheses about the adaptations associated with elevations on the clinical scales of the Minnesota Multiphasic Personality Assessment-2 (MMPI-2). The argument is made that the adaptation to early rejection and neglect, which he attributes to Scale 4, parallels the adaptation represented by a dismissing attachment. Archival data of 72 individuals who completed assessment batteries that included both the MMPI-2 and that Adult Attachment Projective (AAP) were analyzed to determine if there was a relationship between elevations on Scale 4 and classification as dismissing attachment. No significant relationship was found for the primary hypothesis; however, some small effects were noted in related exploratory analyses. Possible reasons for the lack of a significant result are discussed a well as directions for future research.

Utility of the Mild Brain Injury Atypical Symptoms Scale to detect symptom exaggeration : an analogue simulation study

Brief self-report symptom checklists are often used to screen for postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD) and are highly susceptible to symptom exaggeration. This study examined the utility of the five-item Mild Brain Injury Atypical Symptoms Scale (mBIAS) designed for use with the Neurobehavioral Symptom Inventory (NSI) and the PTSD Checklist–Civilian (PCL–C). Participants were 85 Australian undergraduate students who completed a battery of self-report measures under one of three experimental conditions: control (i.e., honest responding, n = 24), feign PCD (n = 29), and feign PTSD (n = 32). Measures were the mBIAS, NSI, PCL–C, Minnesota Multiphasic Personality Inventory–2, Restructured Form (MMPI–2–RF), and the Structured Inventory of Malingered Symptomatology (SIMS). Participants instructed to feign PTSD and PCD had significantly higher scores on the mBIAS, NSI, PCL–C, and MMPI–2–RF than did controls. Few differences were found between the feign PCD and feign PTSD groups, with the exception of scores on the NSI (feign PCD > feign PTSD) and PCL–C (feign PTSD > feign PCD). Optimal cutoff scores on the mBIAS of ≥8 and ≥6 were found to reflect “probable exaggeration” (sensitivity = .34; specificity = 1.0; positive predictive power, PPP = 1.0; negative predictive power, NPP = .74) and “possible exaggeration” (sensitivity = .72; specificity = .88; PPP = .76; NPP = .85), respectively. Findings provide preliminary support for the use of the mBIAS as a tool to detect symptom exaggeration when administering the NSI and PCL–C.

Are Fast Responses More Random? Testing the Effect of Response Time on Scale in an Online Choice Experiment

Scepticism over stated preference surveys conducted online revolves around the concerns over “professional respondents” who might rush through the questionnaire without sufficiently considering the information provided. To gain insight on the validity of this phenomenon and test the effect of response time on choice randomness, this study makes use of a recently conducted choice experiment survey on ecological and amenity effects of an offshore windfarm in the UK. The positive relationship between self-rated and inferred attribute attendance and response time is taken as evidence for a link between response time and cognitive effort. Subsequently, the generalised multinomial logit model is employed to test the effect of response time on scale, which indicates the weight of the deterministic relative to the error component in the random utility model. Results show that longer response time increases scale, i.e. decreases choice randomness. This positive scale effect of response time is further found to be non-linear and wear off at some point beyond which extreme response time decreases scale. While response time does not systematically affect welfare estimates, higher response time increases the precision of such estimates. These effects persist when self-reported choice certainty is controlled for. Implications of the results for online stated preference surveys and further research are discussed.

Volumetric MRI changes, cognition and personality traits in old age depression.

BACKGROUND: The presence of cognitive and structural deficits in euthymic elderly depressed patients remains a matter of debate. Integrative aetiological models assessing concomitantly these parameters as well as markers of psychological vulnerability such as persistent personality traits, are still lacking for this age group. METHODS: Cross-sectional comparisons of 38 elderly remitted patients with early-onset depression (EOD) and 62 healthy controls included detailed neuropsychological assessment, estimates of brain volumes in limbic areas and white matter hyperintensities, as well as evaluation of the Five-Factor personality dimensions. RESULTS: Both cognitive performances and brain volumes were preserved in euthymic EOD patients. No significant group differences were observed in white matter hyperintensity scores between the two groups. In contrast, EOD was associated with significant increase of Neuroticism and decrease of Extraversion facet scores. LIMITATIONS: Results concern the restricted portion of EOD patients without psychiatric and physical comorbidities. Future longitudinal studies are necessary to determine the temporal relationship between the occurrence of depression and personality dimensions. CONCLUSIONS: After remission from acute depressive symptoms, cognitive performances remain intact in elderly patients with EOD. In contrast to previous observations, these patients display neither significant brain volume loss in limbic areas nor increased vascular burden compared to healthy controls. Further clinical investigations on EOD patterns of vulnerability in old age will gain from focusing on psychological features such as personality traits rather than neurocognitive clues.

Estudio de asociación entre genotipo de DAT1 y transtorno por déficit de atención / hiperactividad

Introducción: El TDAH tiene un componente genético importante; el gen de transportador de Dopamina (DAT1) se ha asociado con susceptibilidad al TDAH y con sus endofenotipos. El VNTR de 40pb en la región 3’UTR aumenta la expresión del DAT1. En Colombia no hay ningún estudio previo que indique evidencia de la asociación genética entre TDAH y el gen DAT1. Objetivo: Determinar asociación entre el VNTR del DAT1 y el fenotipo y/o endofenotipos del TDAH. Métodos: Se seleccionaron 73 pacientes con TDAH y 75 controles, se valoró en los casos inteligencia y funciones ejecutivas. Mediante (PCR) se amplificó el VNTR DAT1. Se establecieron estadísticos genético poblacionales, análisis de asociación y de regresión logística entre las pruebas neuropsicológicas y genotipo. Resultado: El polimorfismo del DAT1 no mostró asociación con TDAH, ni con alteraciones en las funciones ejecutivas. El genotipo 10/10 del VNTR DAT1 se encontró asociado con el índice de velocidad de procesamiento (p <0,05). En el subgrupo hiperactividad hubo asociación con algunas subpruebas de flexibilidad cognitiva, número de respuestas correctas, total de errores, número de respuestas perseverativas (p ≤ 0.01). En el subgrupo mixto se asoció con índice de comprensión verbal (p <0,05). Conclusiones: No hubo asociación entre el polimorfismo VNTR (DAT1) y el fenotipo de TDAH. Se encontraron asociaciones entre genotipo y algunos test de flexibilidad cognitiva e índice de comprensión verbal. Se establecieron los estadísticos genético poblacionales de este polimorfismo para la población analizada, el cual corresponde al primer reporte de una muestra de nuestro país.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Semantic Dementia Versus Nonfluent Progressive Aphasia Neuropsychological Characterization and Differentiation

Background: Early progressive nonfluent aphasia (PNFA) may be difficult to differentiate from semantic dementia (SD) in a nonspecialist setting. There are descriptions of the clinical and neuropsychological profiles of patients with PNFA and SD but few systematic comparisons. Method: We compared the performance of groups with SD (n = 27) and PNFA (n = 16) with comparable ages, education, disease duration, and severity of dementia as measured by the Clinical Dementia Rating Scale on a comprehensive neuropsychological battery. Principal components analysis and intergroup comparisons were used. Results: A 5-factor solution accounted for 78.4% of the total variance with good separation of neuropsychological variables. As expected, both groups were anomic with preserved visuospatial function and mental speed. Patients with SD had lower scores on comprehension-based semantic tests and better performance on verbal working memory and phonological processing tasks. The opposite pattern was found in the PNFA group. Conclusions: Neuropsychological tests that examine verbal and nonverbal semantic associations, verbal working memory, and phonological processing are the most helpful for distinguishing between PNFA and SD.

Neuropsychological impairments and the impact of dystrophin mutations on general cognitive functioning of patients with Duchenne muscular dystrophy

Mutations in the dystrophin gene have long been recognised as a cause of mental retardation. However, for reasons that are unclear, some boys with dystrophin mutations do not show general cognitive deficits. To investigate the relationship between dystrophin mutations and cognition, the general intellectual abilities of a group of 25 boys with genetically confirmed Duchenne muscular dystrophy were evaluated. Furthermore, a subgroup underwent additional detailed neuropsychological assessment. The results showed a mean full scale intelligence quotient (IQ) of 88 (standard deviation 24). Patients performed very poorly on various neuropsychological tests, including arithmetics, digit span tests and verbal fluency. No simple relationship between dystrophin mutations and cognitive functioning could be detected. However, our analysis revealed that patients who lack the dystrophin isoform Dp140 have significantly greater cognitive problems.

Exploring occasion specificity in the assessment of DSM-5 maladaptive personality traits: A latent state-trait theory analysis.

The alternative classification system for personality disorders in DSM-5 features a hierarchical model of maladaptive personality traits. This trait model comprises five broad trait domains and 25 specific trait facets that can be reliably assessed using the Personality Inventory for DSM-5 (PID-5). Although there is a steadily growing literature on the validity of the PID-5, issues of temporal stability and situational influences on test scores are currently unexplored. We addressed these issues using a sample of 611 research participants who completed the PID-5 three times, with time intervals of two months. Latent state-trait (LST) analyses for each of the 25 PID-5 trait facets showed that, on average, 79.5% of the variance was due to stable traits (i.e., consistency), and 7.7% of the variance was due to situational factors (i.e., occasion specificity). Our findings suggest that the PID-5 trait facets predominantly capture individual differences that are stable across time.

Primary personality trait correlates of religious practice and orientation

The aim of the study was to examine the relationships between Eysenck's primary personality factors and various aspects of religious orientation and practice. Some 400 UK undergraduates completed questionnaires constructed from the Batson and Schoenrade Religious Life Inventory (Batson & Schoenrade, 1991) and the Eysenck Personality Profiler (Eysenck, Barrett, Wilson, & Jackson, 1992). As is generally found, all the religious variables correlated negatively with the higher order personality factor of psychoticism. In contrast, among the primary factors, those associated with neuroticism appeared to be the strongest indicators of religiosity. In particular, all the primary traits classically linked to neuroticism correlate positively with the quest orientation. However, fewer primary traits predict religious behaviour in regression and of these, a sense of guilt is the greatest and a common predictor of extrinsic, intrinsic and quest religiosities. Upon factor analysis of the significant personality predictors together with the three religious orientations, the orientations formed a single discrete factor, which implies that extrinsic, intrinsic and quest religiosities have more in common with one another than with any of the personality traits included in the study. This suggests that religious awareness may itself be an important individual difference that is distinct from those generally associated with models of personality. (C) 2003 Elsevier Ltd. All rights reserved.

PERSONALIDADE, ESTILOS PARENTAIS E COGNIÇÃO EM MENINOS VÍTIMAS DE ABUSO SEXUAL

Há um consenso na literatura de que a vivência do abuso sexual na infância ocasiona uma série de consequências, tanto físicas quanto psicológicas, às vítimas. O cenário de violência contra crianças e adolescentes está cada vez mais frequente na sociedade contemporânea, tornando-se um problema de saúde pública, de modo a ser necessário um olhar mais atento dos profissionais e elaboração de políticas públicas tanto para a prevenção dos casos como para o tratamento dos problemas deles decorrentes. Nas crianças, há uma associação do aumento de problemas comportamentais e psicológicos, que podem se estender até o período da idade adulta. Outros estudos enfatizam alterações em áreas cerebrais e as relacionam com o surgimento de transtornos mentais na população de crianças vítimas de violência sexual, dentre outros tipos de violência. O objetivo deste trabalho foi verificar a presença de traços de personalidade, os estilos parentais desenvolvidos e o desempenho cognitivo, especificamente as funções executivas, em meninos com histórico de abuso sexual. Foram avaliadas 62 crianças e adolescentes (32 com histórico de abuso sexual e 30 sem), sendo que no grupo de abuso a idade média dos integrantes é de 11,7 anos de idade e seus genitores majoritariamente divorciados, diferentemente do grupo controle, no qual os genitores são, na maior parte, casados. O método constou de questionário sociodemográfico, testes neuropsicológicos que avaliam as funções executivas (Wisconsin Card Sortint Test, Figuras de Ray e Escala de Inteligência Wechsler para Crianças - Terceira Edição (WISC-III)- Semelhanças, Arranjo de Figuras, Compreensão, Cubos, Dígitos e Vocabulário), Questionário de Personalidade para Crianças e Adolescentes (EPQ-J) e Inventário de Estilos Parentais (IEP). Não houve resultados significativos entre o abuso e as funções executivas, tanto nos subtestes dos Escala de Inteligência Wechsler para Crianças - Terceira Edição (WISC-III) quanto no do Wisconsin; porém o grupo apresentou dados significativamente menores na memória do Figuras Complexas de Rey. Com relação ao EPQ-J, os resultados demonstraram maiores índices de neuroticismo, os quais podem ser associados com sintomas de depressão, e apresentaram menores índices em extroversão, trazendo possíveis dificuldades nas relações sociais. Com relação aos estilos parentais, o grupo apresentou dificuldades e prejuízos nas percepções sobre os genitores, especialmente com relação ao genitor, que é o maior abusador estatisticamente. Os dados mostraram uma correlação entre neuroticismo e vocabulário, estilos parentais e vocabulário, e neuroticismo e estilos parentais. Observou-se a importância de maiores estudos com o público masculino, para que possam ser elucidadas, de forma mais abrangente, as questões de abuso sexual e suas interferências nos aspectos neuropsicológicos, estilos parentais e traços de personalidade, visto que a maior parte dos estudos é relacionada ao público feminino. É necessário o desenvolvimento de políticas públicas para o atendimento específico do público masculino que sofre abuso, e que o profissional da saúde esteja preparado para ajudar, fortalecendo os aspectos psíquicos e emocionais.