Differential discordance of informant‐ and self‐rated depression and apathy in Black, Hispanic, and White participants in the NACC dataset

Sex-based dyad differences on informant reports of participants' daily functioning

Functional assessment in neurocognitive evaluation is often provided via informant reports. These subjective reports can vary based on the characteristics of informants and their relationships with participants, such as informant sex. However, whether informant sex intersects with participant sex to impact subjective ratings of participants' daily functioning, and whether such effects mirror observed patterns in neuropsychological performance, has not been adequately examined with ethnoracially diverse samples. We examined differences among participant-informant sex-based dyads on subjective informant reports of participants' daily functioning (assessed via the Functional Activities Questionnaire [FAQ]), and whether any observed differences on reported functioning corresponded to differences in objective participant performance on neuropsychological performance, among middle-aged and older Hispanic/Latino (n = 543), non-Hispanic Black (NHB; n = 1030), and non-Hispanic White (NHW; n = 5356) adults in the National Alzheimer's Coordinating Center cohort (n = 6929). Analysis of covariance (ANCOVA) tests revealed significant dyad differences on FAQ scores in the NHB (p<.001) and NHW subsamples (p<.05), but not in the Hispanic/Latino subsample (p>.05). For the Hispanic/Latino and NHB subsamples, ANCOVA tests revealed no significant effects of dyad on neuropsychological performance (ps>.01), whereas for the NHW subsample, ANCOVA tests revealed significant dyad differences on performance in multiple cognitive domains (ps<.01). Nevertheless, the pattern of dyad differences on neuropsychological performance did not mirror the pattern of observed differences on FAQ scores in the NHW subsample. Findings and their implications, including potential contributions of other informant characteristics on observed dyad differences on reported functioning, are discussed.

Informant sex/gender moderates associations between reported functioning and memory performance in Mexican American adults

Objective: In neuropsychological evaluations, assessing cognitive functioning is often achieved using objective neuropsychological measures, whereas subjective informant reports are typically obtained to determine manifest daily functioning. Informant reports of participant functioning and their associations with objective participant performance on neuropsychological testing have been shown to vary based on informant characteristics. However, associations among informant characteristics, reported functioning, and neuropsychological performance have not been adequately examined with Mexican American or other Hispanic/Latino samples, despite these populations' disproportionately higher rates of dementia due to Alzheimer's disease and related disorders. Method: We examined associations of informant characteristics with informant reports of participant functioning (assessed via the Functional Activities Questionnaire [FAQ]), and potential moderating effects of these characteristics on associations between reported functioning and participant performance on neuropsychological testing, for Mexican American adult participants in the National Alzheimer's Coordinating Center cohort (n = 294). Results: Female informants reported significantly worse participant functioning compared to male informants (p = .035, r = .126). Moreover, significant associations between reported functioning and memory performance were observed for participants with female informants, but not for those with male informants (p = .024, r = .138). Higher levels of informant education were associated with significantly worse participant functioning (p = .011, r = .151). However, informant education did not moderate associations between reported functioning and neuropsychological performance (ps > .05). Conclusions: Compared to male informants, female informants may provide subjective reports of Mexican American participant functioning that more closely corroborate objective participant performance in memory.

Informant Characteristics Influence Reports of Participant Functioning and their Associations with Neuropsychological Performance in Non-Hispanic Black Adults

OBJECTIVE

Assessing one's functional capacity-in addition to neuropsychological performance-is essential for determining neurocognitive status, and functional assessment is often provided via informant report. Although informant characteristics have been shown to influence reports of participant functioning, the degree to which they moderate relationships between reported functioning and participant performance on neuropsychological testing is unclear. Moreover, associations among informant characteristics, reported functioning, and neuropsychological performance have not been adequately examined with non-Hispanic Black (NHB) samples, despite this population's disproportionately high risk of Alzheimer's disease and related dementias.

METHOD

In this cross-sectional observational study, we examined the influence of informant characteristics on informant reports of participant functioning (assessed via the Functional Activities Questionnaire [FAQ]) and associations between reported functioning and participant performance on neuropsychological testing, among NHB adult participants in the National Alzheimer's Coordinating Center cohort (n = 1024).

RESULTS

Informants who were younger, female, more educated, knew participants longer, or lived with participants reported poorer participant functioning (p < .001). However, younger (vs. older) informants provided reports of functioning that were more predictive of visuoconstructional ability and visual memory, and male (vs. female) informants provided reports of functioning that were more predictive of verbal memory, visuoconstructional ability and visual memory, and language (ps < .001).

CONCLUSIONS

Within the context of neurocognitive evaluations of NHB participants, informant characteristics may influence subjective reports of participants' functioning and the extent to which reported functioning corroborates objective participant performance on neuropsychological testing.

Distinguishing apathy and depression in older adults with mild cognitive impairment using text, audio, and video based on multiclass classification and shapely additive explanations

OBJECTIVES

This study aimed to develop a classification model to detect and distinguish apathy and depression based on text, audio, and video features and to make use of the shapely additive explanations (SHAP) toolkit to increase the model interpretability.

METHODS

Subjective scales and objective experiments were conducted on 319 mild cognitive impairment (MCI) patients to measure apathy and depression. The MCI patients were classified into four groups, depression only, apathy only, depressed-apathetic, and the normal group. Speech, facial and text features were extracted using the open-source data analysis toolkits. Multiclass classification and SHAP toolkits were used to develop a classification model and explain the contribution of specific features.

RESULTS

The macro-averaged f1 score and accuracy for overall model were 0.91 and 0.90, respectively. The accuracy for the apathetic, depressed, depressed-apathetic, and normal groups were 0.98, 0.88, 0.93, and 0.82, respectively. The SHAP toolkit identified speech features (Mel-frequency cepstral coefficient (MFCC) 4, spectral slopes, F0, F1), facial features (action unit (AU) 14, 26, 28, 45), and text feature (text 6 semantic) associated with apathy. Meanwhile, speech features (spectral slopes, shimmer, F0) and facial expression (AU 2, 6, 7, 10, 14, 26, 45) were associated with depression. Apart from the shared features mentioned above, new speech (MFCC 2, loudness) and facial (AU 9) features were observed in the depressive-apathetic group.

CONCLUSIONS

Apathy and depression shared some verbal and facial features while also exhibited distinct features. A combination of text, audio, and video could be used to improve the early detection and differential diagnosis of apathy and depression in MCI patients.