Time-to-completion cutoffs are valuable additions to both tests. They can function as independent validity indicators or enhance the sensitivity of accuracy scores without requiring additional measures or extending standard administration time.

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A link between noncredible responding and low scores on the Grooved Pegboard Test (GPB) is well documented in the clinical literature. However, no specific validity cutoffs have emerged in previous research. This study was designed to examine the classification accuracy of various demographically adjusted cutoffs on the GPB against established measures of performance validity. Analyses were based on a mixed clinical sample of 190 patients (52.1% female) medically referred for neuropsychological assessment. Mean age of participants was 44.1 years, with a mean education of 13.9 years. Criterion measures were the Recognition Memory Test and 3 composites based on several embedded validity indicators. A T score Յ29 for either hand or Յ31 on both hands were reliable markers of invalid performance (sensitivity ϭ .29 -.63; specificity ϭ .85-.91). Ipsative analyses revealed that these T score-based cutoffs have zero false positive rates. Failing these cutoffs had no consistent relationship with overall cognitive functioning. A moderate relationship between GPB failure and self-reported anxiety and depression emerged on face-valid screening measures. There was also a moderate relationship between GPB failure and Personality Assessment Inventory scales measuring somatic complaints, borderline traits, antisocial features, and substance use. The newly introduced GPB validity cutoffs were effective at separating credible and noncredible performance on neuropsychological testing. The complex relationship between failing the GPB and emotional problems is consistent with the psychogenic interference hypothesis. It may provide insight into the mechanism behind invalid responding and thus warrants further investigation.

BACKGROUND: Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy. PURPOSE: Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used.DATA SOURCES: We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. STUDY SELECTION:We chose studies that compared using balloon guide catheters with not using them.DATA ANALYSIS: Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes.DATA SYNTHESIS: Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (

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Background: Delirium is a common neurologic manifestation of coronavirus disease 2019 (COVID–19) in older adults who present to the emergency department (ED). Objective: To investigate clinical characteristics associated with delirium as a presenting symptom of COVID–19 in older adults and develop a logistic regression to predict the likelihood of delirium. Method: We compared clinical characteristics in an age- and gender-matched sample of 68 delirious individuals with 68 nondelirious individuals (Mage = 78) who presented to the ED with COVID–19. Results: The delirious group was more likely to have neurologic, psychiatric, and cardiovascular comorbidities; a prior history of delirium; and deliriogenic medications in their medication list. They were less likely to present with respiratory symptoms and more likely to present with sepsis, hypoxia, higher heart rate, and higher sodium. The delirious group had higher mortality (51%) than the nondelirious group (32%). Delirium developed within an average of 2 days of initial COVID–19 symptom onset, with symptom onset to ED within an average of 4 days and symptom onset to death within an average of 11 days. Logistic regression based on five delirium predictors correctly predicted 80% of those with delirium (75% sensitivity at 86% specificity). Conclusion: Our results are largely consistent with prior studies and suggest that delirium is a common, early occurring, and lethal manifestation of COVID–19 in older adults presenting to the ED, in most cases causing acute on chronic neurocognitive dysfunction strongly influenced by inflammatory and hypoxic–ischemic mechanisms.

Objective: This study was designed to compare different versions of the letter fluency test (FAS/CFL), evaluate the effect of repeat administration and the classification accuracy of traditional and novel cutoffs as performance validity tests (PVTs). Method: Archival data were collected from a mixed clinical sample (n = 64) of patients physician-referred for neuropsychological assessment (M Age = 43.2; M Education = 14.1). Sensitivity and specificity of various letter fluency cutoffs were calculated against various psychometric definitions of invalid performance. Results: There was no difference between the FAS and CFL on total score and phonemic clusters. Learning effects were small and limited to the CFL. A T score of ≤33 on the FAS and ≤35 on CFL was specific (.89-.98), but relatively insensitive (.27-.45). Likewise, ≤4 phonemic clusters were associated with high specificity (.88-.94) but variable sensitivity (.22-.60) and were orthogonal to self-reported anxiety and depression. A raw score of ≤7 (FAS) or ≤8 (CFL) on the trial F had comparable classification accuracy (.18-.44 sensitivity at .91-.98 specificity). Failure on multiple validity cutoffs had near-ceiling specificity (.92-1.00). Declining output was similar in valid and invalid response sets. Conclusions: FAS and CFL are psychometrically equivalent versions of the letter fluency test and are relatively robust to learning effects on serial testing. Both can function as effective embedded PVTs, although they are limited by low and variable sensitivity. Process variables had mixed results as predictors of performance validity. Public Significance StatementDifferent versions of the same test are expected to produce similar outcomes and repeat administrations often result in higher performance. However, these assumptions are rarely verified empirically. This study found that two versions of the letter fluency test (FAS and CFL) produce converging results, learning effects in clinical patients are small, and both versions function well as performance validity indicators.