Yoram Braw

Objective: Neuropsychological assessments commonly include word list learning tasks to assess verbal memory and learning. The California Verbal Learning Test (CVLT) provides multiple outcome measures and information regarding strategies used to enhance the coding and retrieval of information. Despite its popularity, the CVLT has not yet been formally translated into Hebrew and adapted to the Israeli population. Methods: The CVLT-III was adapted to Hebrew (CVLT-III _Hebrew ), and normative data of healthy Hebrew-speaking adults living in Israel (age range: 20 – 65, education range: 9 – 20) were collected ( N = 235). Results: CVLT-III _Hebrew core scores were influenced by age, education level, and, to a lesser extent, sex. Normative data for the Hebrew-speaking Israeli population were generated using an overlapping interval strategy, and regression models were used to evaluate the necessity of adjusting core scale scores for sociodemographic variables. Internal reliability was very high. Clinicians can employ an easy-to-use calculator for adjusting CVLT-III _Hebrew core scores. Conclusions: The adapted CVLT-III _Hebrew provides a valuable tool for evaluating the verbal memory of Hebrew speakers. Caution, however, is warranted when assessing individuals with lower education levels, as the normative sample was relatively highly educated. This highlights the importance of expanding the normative sample to include a broader spectrum of educational levels and ages. Moreover, the inclusion of Israeli minority groups, currently unrepresented in this normative sample, is of importance.

The Numerical Pain Rating Scale (NPRS) is routinely used to assess pain severity. A recently developed NPRS integrated the pain scale with an eye tracker (NPRS_ETI). As part of this study, we explored the NPRS_ETI's utility to detect feigned pain, an ongoing challenge facing clinicians. To achieve this aim, chronic pain outpatients were randomly assigned to a simulation (i.e., requested to exaggerate their pain; n = 34) or a control condition (i.e., requested to genuinely report their pain severity; n = 35). They then rated their pain using the NPRS_ETI. Eye movement analyses indicated that simulators spent more time gazing at the higher NPRS_ETI pain ratings before providing their pain ratings and less time at the leftward (“No pain”) anchor afterward. The discrimination capacities of these measures, however, were poor. In contrast, pain ratings using the NPRS_ETI showed excellent discriminative capacity, with a pain rating of 10 associated with 94.3% specificity and 26.5% sensitivity. Overall, the study's findings further indicate the feasibility of incorporating an eye tracker to evaluate the severity of pain. Though the findings at present do not support the utility of NPRS_ETI‐based eye movement measures as validity indicators, pain ratings showed promise as a simple screen of feigned pain. The preliminary nature of the findings, however, calls for further research. Such research may aid in further developing effective indicators of feigned pain and hopefully clarify cognitive processes (e.g., experienced cognitive load) involved in pain deception.Perspective: The NPRS_ETI enables pain ratings by patients with severe motor and speech impairments. While eye movements were not adequate in detecting feigned pain, participants' pain ratings showed initial promise. As this is a preliminary study, further research is recommended.

Noncredible cognitive performance among chronic pain patients garners increased clinical attention. The Word Memory Test (WMT)—a well-established stand-alone validity indicator—was recently integrated with an eye tracker, and its utility was assessed using healthy simulators. The current study expands on this earlier work by assessing the utility of the eye-tracker integrated WMT to detect noncredible cognitive performance in the context of chronic pain. Chronic pain outpatients were randomly assigned to either a simulation (i.e., patients simulating cognitive impairment; n = 22) or honest control (i.e., patients performing to the best of their ability; n = 23) conditions. They then completed the WMT’s immediate recognition (IR) subtest while their eye movements were recorded. Simulators gazed less at relevant stimuli and gazed more at irrelevant stimuli than controls. Sensitivity levels tended to be low to moderate when maintaining specificities ≥ 90%, as customary in the field. While a previously developed scale that integrates eye movement measures using a logistic regression did not adequately differentiate the groups, conjunctive rules (i.e., the participant was required to fail both the WMT's classification scheme and the eye movement measure with the strongest discriminative capacity) were associated with higher specificities than those of the WMT’s conventional classification scheme. Overall, the eye-tracker integrated WMT shows initial clinical utility for detecting noncredible cognitive performance. Decreasing costs of eye trackers and enhanced usability will hopefully encourage further research of their utility for detecting noncredible cognitive performance and integration of this novel technology with other stand-alone validity indicators.

This chapter details the integration of a Numerical Rating Scale (NPRSETI) with a portable eye tracker, enabling the assessment of pain in conditions in which verbal communication and use of hands are limited (e.g., advanced Amyotrophic lateral sclerosis, ALS). After detailing the construction of the NPRSETI, we describe its validation in an outpatient pain clinic. More specifically, thirty chronic pain patients performed the NPRSETI and filled a conventional NPRS (order was pseudo-randomized). Eye movements, including gaze direction and additional eye movement measures (e.g., saccade rate), were recorded, while participants rated their pain using the NPRSETI. The study’s findings indicated no significant differences in pain severity ratings of the NPRSETI and conventional NPRS. Notably, ratings using the two scales were highly correlated (r = 0.99). NPRSETI’s ratings were also strongly associated with participants’ currently experienced pain rating using the Brief Pain Inventory (BPI). The findings provide initial proof of concept for integrating conventional pain rating scales with an eye tracker and validate the NPRSETI compared with the well-validated and commonly used NPRS. Enhanced usability and decreasing costs of eye trackers will ease the additional research mandated to validate these preliminary findings and hopefully advance their integration into clinical practice.

Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and- at times- reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.

Stress impacts prefrontal cortex (PFC) activity and modulates working memory performance. In a recent study, stimulating the dorsolateral PFC (dlPFC) using transcranial direct current stimulation (tDCS) interacted with social stress in modulating participants’ working memory. More specifically, stress disrupted the enhancing effects of dlPFC tDCS on working memory performance. The current study aimed to further explore these initial findings by randomizing healthy females to four experimental conditions (N = 130); stimulation (right dlPFC tDCS vs. sham) and stress manipulation (social stress vs. control). Participants performed cognitive tasks (i.e., visual working memory task and a visual declarative memory task) at baseline and post-stimulation. They also completed self-report measures of stress and anxiety. A significant stimulation × stress interaction was evident in the declarative memory (One-Card Learning, OCL) task, while working memory performance was unaffected. Though tDCS stimulation and stress did not interact to affect working memory, further research is warranted as these initial findings suggest that immediate visual-memory learning may be affected by these factors. The limited number of earlier studies, as well as the variability in their designs, provides additional impetus for studying the interactive effects of stress and tDCS on human visual learning.

The availability of information regarding neuropsychological tests threatens their confidentiality. This concern may be particularly relevant to Attention-Deficit/Hyperactivity Disorder (ADHD) cons...