Abstracts /Archives of Clinical Neuropsychology I5 (2000) 653-850 817

Cognitive reserve theory in closed head injury

Ropacki MT Elias m

Cognitive reserve theory (a.k.a., brain reserve capacity) generally proposes that previous neurologic
insult increases vulnerability to the future effects of neurologic problems such as dementing
illnesses, whereas higher education and larger head circumference serve as buffers to the
development of future neurologic problems. Support for cognitive reserve theory has been found
in Parkinson’s disease, Alzheimer’s disease, Schizophrenia, and HIV research. The purposes of the
present investigation were to provide support for cognitive reserve theory in closed head injury
(CHI) research, and demonstrate the appropriateness of using the Oklahoma Premorbid Intelligence
Estimate (OPIE) in research and clinical activities. Fifty-one consecutive patients (N = 5 1) under-
went neuropsychological assessment following brain injury. Participants were included if they had
exited PTA, demonstrated uncompromised upper extremity use, displayed adequate verbal com-
munication, and were judged capable of completing a ml1 neuropsychological evaluation. All
participants were divided into a closed head injury-clean (CHI-C) or closed head injury-not clean
(CHI-NC) group based upon pre-morbid history variables (e.g., history of alcoholism). In the
current investigation, there were less severe head injuries in the CHI-NC group, but greater pre-
post differences for PIQ [F (1, 2 1) = 4.56, p = 0.041 and a significantly larger VIQ/PIQ discrepancy
[F (1, 22)=4.90, p = 0.0381 for the CHI-NC group as compared to the CHI-C group. Furthermore,
the significant pre-post PIQ difference and VIQL’IQ discrepancy were found despite nearly
equivalent pre-injury education levels between the CHI-C and CHI-NC groups. Overall, it
appeared that the CHI-NC group was more sensitive to the effects of head injury supporting
cognitive reserve theory in head injury.

Persisting post-concussion syndrome following lighting injury: case and review

Santa Maria Me Donnelly KZ, Ferraro JS, Everhart DE.

Sensory and cognitive deficits following lightning and other electrical injuries have been well
documented. Research has suggested similarities between the postconcussion syndrome and the
symptoms of electrical injury. The current case illustrates persisting (32 months) postconcussion
symptomatology following 5 minutes loss of consciousness due to lightning injury. The patient was
neuropsychologically evaluated and symptoms were quantified with the Postconcussion Syndrome
Checklist, an objective measure of postconcussion symptomatology. The current case is integrated
with data in the literature supporting the often persisting nature of symptoms following electrical
injuries. The authors conclude that the postconcussion symptomatology which follows lightning injury
tends to persist for much longer periods of time than is typical of mild head injuries due to blunt
trauma, with comparable duration of loss of consciousness.

The Test of Memory Malingering 2 (TOMM-2)

Tombaugh TN, Rees L, Munson J, Gagnon M.

The Test of Memory Malingering-2 (TOMM-2) was developed as a supplementary test to the Test of
Memory Malingering (TOMM). The TOMM-2 was designed to appear to be a more difficult test than
the TOMM by using 24 abstract geometric figures rather than pictures of common objects. On each of
2 learning trials, the 24 abstract drawings are presented, after which 24 2-choice recognition panels are
818 Abstracts /Archives of Clinical Neuropsychology I5 (2000) 653-850

shown. The examinee is required to select the design previously seen. The same procedure is used on
the retention trial except the target designs are not re-administered.
Normative data from 83 healthy adults are presented. In addition, results from 2 different types of
malingering studies are presented. The first design employed students who were asked either to
simulate a head injury in order to achieve monetary compensation (n = 3 1) or to try their best (n = 3 1).
The second design used a ‘known-groups’ procedure where TBI patients (n = 112) were administered
both the TOMM and TOMM-2. Patients who fell below the cut-off score of 45 on Trial 2 or on the
retention trial on the TOMM were classified as ‘malingerers’ (n = 16). Using a cut-off score of 20 on
the TOMM-2, sensitive and specificity scores were then calculated for both experiments. In
Experiment I, 100 % of student stimulators and non-simulators were correctly identified. In the
TBI group, sensitivity was 81% and specificity was 85%. Overall, the results showed that the use of
geometric designs substantially increased the difficulty of the test. However, the TOMM-2 did not
discriminate between malingering and non-malingering subjects as well as did the original TOMM.
Although the TOMM-2 was judged to provide a useful clinical tool to provide convergent evidence of
malingering when used in conjunction with the TOMM, additional modification of the test stimuli is
required (particularly on the retention trial) before it can be recommended that it be used as a ‘stand-
alone’ test of memory malingering.

WAIS-R performance and discrepancy between predicted and obtained IQ scores in the
detection of insufficient effort
Demakis GJ, Sweet JJ, Sawyer Te Moulthrop M, Nies K, Clingerman S.

This study examines performance on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and
how well the discrepancy between predicted and obtained IQ scores discriminates between insufficient
effort (IE) and traumatic brain injury (TBI). Twenty-seven clinical referrals who evidenced insufficient
effort on measures other that the WAIS-R were compared to 48 patients with documented moderate to
severe TBI. IE patients performed significantly more poorly on the WAIS-R than TBIs and high levels
of sensitivity and specificity were obtained when VIQ, PIQ, and FSIQ were used to discriminate
between groups. To compute the discrepancy score, predicted premorbid IQS were calculated using
regression-based formulae that use either demographic data (Barona Index) or combinations of
demographic and WAIS-R subtest data (Best-3 and the Oklahoma Premorbid Intelligence Estimation).
IQ predictions for both groups were similar for the Barona, but IE patients’ predicted IQs were lower
than patients with TBI when measures with a performance component were computed. For most
discrepancy scores (i.e., predicted IQ - obtained IQ), the IE patients demonstrated a greater difference
than patients with TBI; high levels of sensitivity and specificity were obtained when cutoffs were
developed based on these discrepancy scores. Implications for using the WAIS-R in detecting
insufficient effort are discussed, as is the potential advantage of discrepancy scores.

“Is you is or is you ain’t” malingering: problems in assessing symptom validity in mild
traumatic brain injury
Macciocchi SN, Sharp B, Barisa M, Godsall R.

Mild brain injured persons typically present with a myriad of cognitive and somatic symptoms. The
duration of time between injury and formal assessment of neuropsychological functioning varies, but
examinations are commonly performed 1 or more years following injury. Chronological history of