B – 140 A hierarchical approach to neuropsychological factors in chronic pain.

Abstract Objective This study examined neuropsychological measures within a hierarchical framework in a chronic pain (CP) sample. Method 461 patients who were referred for a presurgical psychological evaluation as dorsal column spinal stimulator candidates (61.2% female, 86.7% white, Mage = 53.25, SD = 13.57, Meducation = 13.10, SD = 2.66), and completed the Trail Making Test (TMT) Parts A and B, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and Wechsler Abbreviated Scale of Intelligence (WASI). Results Iterative Principal Components Analyses (PCAs) were conducted using Goldberg’s (2006) “bass-ackwards” approach—a hierarchical approach commonly used to evaluate “stratum” in personality and psychopathology. A 4-stratum model was constructed, where the first unrotated principal component (FUPC) was related to two lower stratum factors of verbal tests (r=.76) and visual tests (r=.65). The third stratum was defined by verbal RBANS subtests, WASI fluid reasoning, and processing speed/attention tasks. On the final stratum, clusters were formed based on memory, visuospatial ability, intellectual functioning, and processing speed/attention tasks. Correlational pathways between factors ranged from .38 to .98, with cross-loadings showing moderate relations across third and fourth stratum. Conclusion Factors at lowest stratum generally aligned with functions for various domains of cognitive functioning. Stratum 4 was conceptualized as memory (factor 1), processing speed/attention (factor 2), intellectual functioning (factor 3), and visual perception (factor 4). However, interesting factors and associations were noted at higher strata that were not intuitive.