Scott R. Millis

Few validated measures that assess processing speed without requiring motor response are available. The Wechsler Adult Intelligence Scale, Fifth Edition (WAIS-5) introduced Naming Speed Quantity (NSQ), a new non-motor subtest within the Processing Speed domain. Considering the prevalence of motor limitations with age and the desire to expand access, the current retrospective study aimed to evaluate the NSQ within a multidisciplinary dementia clinic with a sample of 100 adults between the ages of 70 and 85. The NSQ was evaluated within a brief battery of commonly used neuropsychological measures to assess for dementia, including RBANS, Trail Making Test, COWAT, and Animals. The results demonstrate the strongest correlation with RBANS Coding (r = .46). Although expressive language performances were also correlated with the NSQ, processing speed measures accounted for the most variance. NSQ performances were significantly lower in individuals with functional impairment (N = 43) compared to those without functional impairment (N = 57, d = .50), although the effect was larger in TMT-A (d = .95) and RBANS Coding (d = 1.02). Although the NSQ demonstrated the strongest relationship to RBANS Coding, with the WAIS-5 normative transformation, the two tests show poor agreement (ρ_c = .28) and low scores were infrequent.

Objective: To evaluate latency to presentation among persons with epilepsy at an urban National Association of Epilepsy Centers Level IV epilepsy center and assess the impact of socioeconomic status and race on this latency. Less than 1% of persons with epilepsy are referred to specialized centers in the United States, often taking over twenty years to undergo surgery, significantly affecting quality of life and healthcare costs. Our primary objective was to assess latency to presentation at our Level IV epilepsy clinic in Detroit, Michigan. The secondary objective was to evaluate the impact of low socioeconomic status and Black race on latency to presentation.Methods: We retrospectively analyzed persons with epilepsy seen at our clinic in 2014, excluding those previously seen at an epilepsy center. Persons with epilepsy were divided into drug‐resistant epilepsy and non‐drug‐resistant epilepsy groups. We calculated latency to presentation for all patients and both groups and assessed drug resistance for the drug‐resistant epilepsy group. Regression models were fitted using latency to presentation as the outcome variable.Results: A total of 648 unique persons with epilepsy were seen, with 408 included in the analysis. Among these, 66.42% were Black, and 63.72% had low socioeconomic status. The drug‐resistant epilepsy group had more patients with known etiology and temporal lobe epilepsy (p < 0.05). The mean latency to presentation was 13.21 years for all patients and 16.04 years for the drug‐resistant epilepsy group; since drug resistance, it was 14.74 years. Persons with low socioeconomic status showed longer latency, but significance did not persist after regression. No differences were found between Black and White persons.Significance: Optimal epilepsy care in the United States remains delayed with first presentation to the epilepsy clinic taking more than 13 years. Future studies should explore reasons for these delays rather than focusing solely on epilepsy surgery referrals.

With greater survival rates after catastrophic injury, more women with traumatic brain injury (TBI) are living longer than ever. However, knowledge about this transition in these women is largely unexamined and there are no scales that have been developed to assess the experience of symptoms. To address this gap, we developed and tested a new scale of menopause symptoms in midlife women with TBI. We selected candidate items from two existing measures based on feedback from focus group discussions with seven women with TBI. Twenty candidate items were tested in cognitive interviews with six women with TBI/1 non-TBI. Then, these were field tested with 221 participants (TBI, n = 68; non-TBI, n = 153) recruited from registries. Rasch analysis and convergent validity testing were used to evaluate the new scale. Results of the Rasch analysis indicate that overall, the scale fits well the Rasch model with evidence for unidimensionality. Differential item functioning indicated that the scale performed equally well for women with and without TBI and distinguished pre- and post-menopausal states. Convergent validity was found in the expected directions. These findings support further development of the new scale to understand the experience of menopause symptoms among women with TBI.

Objective: The aim of the study was to determine what factors determine the quality of rehabilitation clinical practice guidelines. Design: Six databases were searched for articles that had applied the Appraisal of Guidelines for Research & Evaluation II quality assessment tool to rehabilitation clinical practice guidelines. The 573 deduplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for Appraisal of Guidelines for Research & Evaluation II application to rehabilitation clinical practice guidelines, resulting in a final selection of 40 reviews appraising 504 clinical practice guidelines. Data were extracted from these by one author and checked by a second. Data on each clinical practice guideline included the six Appraisal of Guidelines for Research & Evaluation II domain scores, as well as the two Appraisal of Guidelines for Research & Evaluation II global evaluations. Results: All six Appraisal of Guidelines for Research & Evaluation II domain scores were statistically significant predictors of overall clinical practice guideline quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest (overall model P < 0.001, R ² = 0.53). Five of the six domain scores were significant predictors of the clinical practice guideline use recommendation, with D3 the strongest predictor and D5 (applicability) the weakest (overall model P < 0.001, pseudo R ² = 0.53). Conclusions: Quality of rehabilitation clinical practice guidelines may be improved by addressing key domains such as rigor of development.

Purpose of the Study: To investigate the association among global and regional white matter fractional anisotropy (FA) values following traumatic brain injury (TBI) and cognitive functioning. Materials and Methods: This research was conducted in an urban rehabilitation hospital. Participants included adults who were healthy controls (n = 18) or who had a TBI (n = 27). Diffusion tensor imaging using a Siemens VERIO 3T scanner and calculation of global and regional FA values were undertaken. FA values were correlated with neuropsychological test scores and injury severity variables. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to investigate discriminative ability of the FA values. Neuropsychological measures, including the Symbol Digit Modalities Test (SDMT), Trail Making Test, Wechsler Test of Adult Reading, California Verbal Learning Test 2nd Edition, Digit Vigilance Test, and Wisconsin Card Sorting Test, comprised the cognitive measures. Results: Within the TBI group, regional FA values were significantly lower across regions compared with controls; global FA and five brain regions were associated with SDMT scores. The FA value within the body of the corpus callosum (CC) yielded excellent discrimination between groups. Conclusions: Convergent findings support the discriminability and potential clinical utility of the CC body FA value in the context of TBI.