Biomedical subjects

C Thomas Gualtieri

Publications and source records attributed to C Thomas Gualtieri.

7 recordsLinked to original sources

PubMed2006

Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs.

CNS Vital Signs (CNSVS) is a computerized neurocognitive test battery that was developed as a routine clinical screening instrument. It is comprised of seven tests: verbal and visual memory, finger tapping, symbol digit coding, the Stroop Test, a test of shifting attention and the continuous performance test. Because CNSVS is a battery of well-known neuropsychological tests, one should expect its psychometric properties to resemble those of the conventional tests upon which it is based. 1069 subjects age 7-90 participated in the normative database for CNSVS. Test-retest reliability (TRT) was evaluated in 99 Ss who took the battery on two separate occasions, separated, on the average, by 62 days; the results were comparable to those achieved by equivalent conventional and computerized tests. Concurrent validity studies in 180 subjects, normals and neuropsychiatric patients, indicate correlations that are comparable to the concurrent validity of similar tests. Discriminant validity is supported by studies of patients with mild cognitive impairment and dementia, post-concussion syndrome and severe traumatic brain injury, ADHD (treated and untreated) and depression (treated and untreated). The tests in CNSVS are also sensitive to malingerers and patients with conversion disorders. The psychometric characteristics of the tests in the CNSVS battery are very similar to the characteristics of the conventional neuropsychological tests upon which they are based. CNSVS is suitable for use as a screening instrument, or as a serial assessment measure. But it is not a substitute for formal neuropsychological testing, it is not diagnostic, and it will have only a limited role in the medical setting, absent the active participation of consulting neuropsychologists.

Adolescent↗

PubMed2006

Neurocognition in depression: patients on and off medication versus healthy comparison subjects.

Patients with depression have neuropsychological deficits in attention, memory, psychomotor speed, processing speed, and executive function. It is not clear, however, whether neurocognition in depression is impaired in a global or nonspecific way or if specific cognitive domains are selectively impaired. This naturalistic cross-sectional study employed a computerized neurocognitive screening battery to evaluate 38 depressed, drug-free patients, compared to 31 patients who responded to antidepressant monotherapy and to 69 healthy comparison subjects. There was evidence for global neuropsychological impairment in untreated depressed patients. In patients who had been successfully treated, performance was improved but not normalized. There was also evidence for specific depression-related deficits in executive function and processing speed but not in memory, psychomotor speed, or reaction time. Although depressed patients have global neurocognitive impairments, deficits in certain cognitive domains are more important than in others. In particular, impairments are noted in tests of executive control and in tests that demand effortful attention. Information processing speed is also impaired but not reaction time. Computerized testing in the clinic setting demonstrates a range of neurocognitive problems in patients with depression. These problems may have a bearing on treatment and outcome.

Adolescent↗

PubMed2006

Efficient allocation of attentional resources in patients with ADHD: maturational changes from age 10 to 29.

BACKGROUND: It has been proposed that ADHD is an executive control disorder. Little is known however about the maturation of executive control in ADHD. METHOD: A cross-sectional study of ADHD patients compared to normal controls tested on a computerized neurocognitive test battery. PARTICIPANTS: 175 patients with ADHD, age 10 to 29, compared to 175 age-matched normal controls. RESULTS: In every age group, ADHD patients were impaired in measures of psychomotor speed, reaction time, cognitive flexibility, and attention. Participants in both groups improved with age. In tests of executive control, normals improved their performance with shorter reaction times. ADHD patients improved their performance but by adopting a less efficient strategy: Their reaction times increased with age. CONCLUSIONS: These data support executive control as a "core deficit" in ADHD. In the Stroop and the shifting attention tests, ADHD patients proved to be inefficient in allocating their attentional resources.

Adolescent↗

PubMed2004

Dementia screening using computerized tests.

The preclinical phase of dementia usually precedes the clinical diagnosis by many years. Early detection of dementing conditions during this preclinical phase may provide opportunities for treatments that may slow or mitigate progression. Conventional assessment tools usually can only detect dementia when the symptoms are overt and the disease is well-established. Computerized neurocognitive screening tools hold promise for diagnosing dementia in its early phase. The use, performance and development of several computerized screening tools to diagnose and monitor patients with pre-dementias and dementia are reviewed. The ability to accurately assess the presence of dementia clearly has direct relevance to insurance risk assessment and risk management. As new treatments appear, their role in clinical management of dementia patients will increase as well. In a future issue, the differential diagnosis of dementias related to the findings on these screening tools will be reviewed.

Aging↗

PubMed2004

Dementia screening in light of the diversity of the condition.

Dementia is a general term, not a specific diagnosis. There are many different causes of dementia, and the different etiologies are associated with different neuropsychological profiles. This complicates the problem of dementia screening. Detection of dementing conditions at the earliest possible stage requires batteries of tests, rather than a single test. The cognitive domains that must be addressed include the following: visual and verbal memory, sustained attention and complex attention, working memory, processing speed, reaction time, psychomotor speed and executive function.

Cognition↗

PubMedDate not supplied

Antidepressant side effects in children and adolescents.

The association between antidepressant treatment and suicidality in children and adolescents has been the subject of a great deal of recent discussion and controversy. Appropriate warnings have been attached to these drugs by governing bodies in the United Kingdom and the United States. However, the data upon which these deliberations have been based derive almost exclusively from clinical trials supported by the manufacturers of the respective drugs; data that are rigorous, in some respects, but which may not capture the clinical realities of antidepressant treatment in real-world settings. Data are presented from a neuropsychiatry clinic where 128 children and adolescents were treated with modern antidepressants over the past 14 months. Behavioral side effects, including suicidal ideation and self-injurious behavior, were not an uncommon accompaniment of antidepressant treatment. The problems, however, were mild and decidedly nonlethal and easily managed in the clinic setting. Ironically, 34 of 36 patients who had developed behavioral side effects to antidepressants were subsequently managed, without further incident, either on an alternative antidepressant or on lower doses of the offending agent.

Adolescent↗

PubMedDate not supplied

Neurocognitive testing supports a broader concept of mild cognitive impairment.

The narrow concept of mild cognitive impairment (MCI) as an early form of Alzheimer s disease has been broadened by research that established the existence of alternative forms of the condition that may presage other forms of dementia. The research presented here was a naturalistic, cross-sectional study of patients in a community referral clinic-patients with MCI and mild dementia-compared to normal controls. A comprehensive, computerized neurocognitive screening battery developed by one of the authors (CNS Vital Signs) was administered to all of the subjects. Participants consisted of 36 patients with MCI and 53 patients with mild dementia, diagnosed by standard criteria, and 89 matched normal controls. Multivariate analysis indicated significant differences among the three groups for all 15 primary test variables and for all five of the domain scores. Tests of memory, processing speed, and cognitive flexibility were the most cogent discriminators between normal controls and MCI patients, and between MCI patients and patients with mild dementia. The same three tests also had the greatest sensitivity and specificity. The results of this study indicate that computerized testing can differentiate among normal controls, MCI patients, and patients with mild dementia. Also, in a diverse group of MCI and mild dementia patients, impairments in memory, processing speed, and cognitive flexibility were the most prominent observed deficits.

Aged↗