1
|
Marier A, Dadar M, Bouhali F, Montembeault M. Irregular word reading as a marker of semantic decline in Alzheimer's disease: implications for premorbid intellectual ability measurement. Alzheimers Res Ther 2024; 16:96. [PMID: 38698406 PMCID: PMC11064305 DOI: 10.1186/s13195-024-01438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Irregular word reading has been used to estimate premorbid intelligence in Alzheimer's disease (AD) dementia. However, reading models highlight the core influence of semantic abilities on irregular word reading, which shows early decline in AD. The primary objective of this study is to ascertain whether irregular word reading serves as an indicator of cognitive and semantic decline in AD, potentially discouraging its use as a marker for premorbid intellectual abilities. METHOD Six hundred eighty-one healthy controls (HC), 104 subjective cognitive decline, 290 early and 589 late mild cognitive impairment (EMCI, LMCI) and 348 AD participants from the Alzheimer's Disease Neuroimaging Initiative were included. Irregular word reading was assessed with the American National Adult Reading Test (AmNART). Multiple linear regressions were conducted predicting AmNART score using diagnostic category, general cognitive impairment and semantic tests. A generalized logistic mixed-effects model predicted correct reading using extracted psycholinguistic characteristics of each AmNART words. Deformation-based morphometry was used to assess the relationship between AmNART scores and voxel-wise brain volumes, as well as with the volume of a region of interest placed in the left anterior temporal lobe (ATL), a region implicated in semantic memory. RESULTS EMCI, LMCI and AD patients made significantly more errors in reading irregular words compared to HC, and AD patients made more errors than all other groups. Across the AD continuum, as well as within each diagnostic group, irregular word reading was significantly correlated to measures of general cognitive impairment / dementia severity. Neuropsychological tests of lexicosemantics were moderately correlated to irregular word reading whilst executive functioning and episodic memory were respectively weakly and not correlated. Age of acquisition, a primarily semantic variable, had a strong effect on irregular word reading accuracy whilst none of the phonological variables significantly contributed. Neuroimaging analyses pointed to bilateral hippocampal and left ATL volume loss as the main contributors to decreased irregular word reading performances. CONCLUSIONS While the AmNART may be appropriate to measure premorbid intellectual abilities in cognitively unimpaired individuals, our results suggest that it captures current semantic decline in MCI and AD patients and may therefore underestimate premorbid intelligence. On the other hand, irregular word reading tests might be clinically useful to detect semantic impairments in individuals on the AD continuum.
Collapse
Affiliation(s)
- Anna Marier
- Douglas Research Centre & Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada
- Department of Psychology, Université de Montréal, Succursale Centre-Ville, Montréal, QC, C.P. 6128, H3C 3J7, Canada
| | - Mahsa Dadar
- Douglas Research Centre & Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada
| | | | - Maxime Montembeault
- Douglas Research Centre & Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada.
| |
Collapse
|
2
|
Marier A, Dadar M, Bouhali F, Montembeault M. Irregular word reading as a marker of cognitive and semantic decline in Alzheimer's disease rather than an estimate of premorbid intellectual abilities. RESEARCH SQUARE 2023:rs.3.rs-3381469. [PMID: 37841870 PMCID: PMC10571618 DOI: 10.21203/rs.3.rs-3381469/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Irregular word reading has been used to estimate premorbid intelligence in Alzheimer's disease (AD) dementia. However, reading models highlight the core influence of semantic abilities on irregular word reading, which shows early decline in AD. The general aim of this study is to determine whether irregular word reading is a valid estimate of premorbid intelligence, or a marker of cognitive and semantic decline in AD. Method 681 healthy controls (HC), 104 subjective cognitive decline, 290 early and 589 late mild cognitive impairment (EMCI, LMCI) and 348 AD participants from the Alzheimer's Disease Neuroimaging Initiative were included. Irregular word reading was assessed with the American National Adult Reading Test (AmNART). Multiple linear regressions were conducted predicting AmNART score using diagnostic category, general cognitive impairment and semantic tests. A generalized logistic mixed-effects model predicted correct reading using extracted psycholinguistic characteristics of each AmNART words. Deformation-based morphometry was used to assess the relationship between AmNART scores and voxel-wise brain volumes, as well as with the volume of a region of interest placed in the left anterior temporal lobe (ATL). Results EMCI, LMCI and AD patients made significantly more errors in reading irregular words compared to HC, and AD patients made more errors than all other groups. Across the AD continuum, as well as within each diagnostic group, irregular word reading was significantly correlated to measures of general cognitive impairment / dementia severity. Neuropsychological tests of lexicosemantics were moderately correlated to irregular word reading whilst executive functioning and episodic memory were respectively weakly and not correlated. Age of acquisition, a primarily semantic variable, had a strong effect on irregular word reading accuracy whilst none of the phonological variables significantly contributed. Neuroimaging analyses pointed to bilateral hippocampal and left ATL volume loss as the main contributors to decreased irregular word reading performances. Conclusions Irregular word reading performances decline throughout the AD continuum, and therefore, premorbid intelligence estimates based on the AmNART should not be considered accurate in MCI or AD. Results are consistent with the theory of irregular word reading impairments as an indicator of disease severity and semantic decline.
Collapse
Affiliation(s)
- Anna Marier
- Department of Psychology, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montréal, QC, Canada, H3C 3J7
| | - Mahsa Dadar
- Douglas Research Centre & Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montréal, QC, Canada, H4H 1R3
| | | | - Maxime Montembeault
- Douglas Research Centre & Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montréal, QC, Canada, H4H 1R3
| |
Collapse
|
3
|
Pelak VS, Hills W. Vision in Alzheimer's disease: a focus on the anterior afferent pathway. Neurodegener Dis Manag 2018; 8:49-67. [PMID: 29359625 DOI: 10.2217/nmt-2017-0030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Visual dysfunction has long been recognized as a manifestation of Alzheimer's disease (AD), particularly in the form of visuospatial impairment during all stages of disease. However, investigations have revealed findings within the anterior (i.e., pregeniculate) afferent visual pathways that rely on retinal imaging and electrophysiologic methodologies for detection. Here we focus on the anterior afferent visual pathways in AD and the measures used for assessment, including optical coherence tomography, electrophysiology, color vision testing and threshold visual field perimetry. A brief summary of higher order visual dysfunction is also included to allow the reader to keep in context the broader findings of afferent visual dysfunction in AD.
Collapse
Affiliation(s)
- Victoria S Pelak
- Departments of Neurology & Ophthalmology, The Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - William Hills
- Departments of Ophthalmology & Neurology, Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
4
|
Sierra Sanjurjo N, Montañes P, Sierra Matamoros FA, Burin D. Estimating Intelligence in Spanish: Regression Equations With the Word Accentuation Test and Demographic Variables in Latin America. APPLIED NEUROPSYCHOLOGY-ADULT 2014; 22:252-61. [DOI: 10.1080/23279095.2014.918543] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Patricia Montañes
- Facultad de Psicología, Universidad Nacional de Colombia, Bogota, Colombia
| | | | - Debora Burin
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| |
Collapse
|
5
|
Vocabulary is an appropriate measure of premorbid intelligence in a sample with heterogeneous educational level in Brazil. Behav Neurol 2014; 2014:875960. [PMID: 24803737 PMCID: PMC4006600 DOI: 10.1155/2014/875960] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/13/2014] [Accepted: 03/03/2014] [Indexed: 11/18/2022] Open
Abstract
Crystallized intelligence refers to one's knowledge base and can be measured by vocabulary tests. Fluid intelligence is related to nonverbal aspects of intelligence, depends very little on previously acquired knowledge, and can be measured by tests such as Block Design (BD) and Raven Colored Matrices (RCM). Premorbid intelligence quotient (IQ) refers to one's intellectual ability level previous to the onset of disorders like mild cognitive impairment (MCI) and Alzheimer's disease (AD) and it is important to estimate disease severity. The objective was to compare performance in tests that measure crystallized and fluid intelligence in healthy subjects and patients with amnestic MCI (aMCI) and AD. One hundred forty-four participants (aMCI (n = 38), AD (n = 45), and healthy controls (n = 61)) were submitted to neuropsychological tests (WAIS-III vocabulary, BD, and RCM). There were significant among groups, except for vocabulary, indicating a relative stability of crystallized intelligence in the continuum from normal to pathological cognitive decline. Vocabulary seems to be stable during the progression of the disease and useful as a measure of premorbid intelligence, that is, to estimate previous function in relation to the level of education and, as a collateral measure of cognition in people with low education.
Collapse
|
6
|
de Oliveira MO, Nitrini R, Brucki SMD. The S-TOFHLA as a measure of functional literacy in patients with mild Alzheimer's disease or mild cognitive impairment. Arch Clin Neuropsychol 2014; 29:269-77. [PMID: 24503948 DOI: 10.1093/arclin/act120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In developing countries, education levels vary dramatically, and the number of years of schooling does not always correlate with the true level of educational competency. This study was designed to verify the accuracy of the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) in individuals with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), when compared with healthy controls (HCs), in order to assess its utility as a measure of functional literacy. One hundred forty-eight subjects were divided into three groups: HC (n = 61), MCI patients (n = 42), and AD patients (n = 45). The S-TOFHLA does not seem to be suitable as an instrument to measure functional literacy for patients with advanced cognitive impairment, but proved to be appropriate in both the HC group and MCI patients in numeracy and prove to be useful as an adjuvant to estimate IQ, reading ability, and premorbid IQ, as an indicator of cognitive reserve.
Collapse
Affiliation(s)
- Maira Okada de Oliveira
- Behavioral and Cognitive Neurology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | | |
Collapse
|
7
|
Quality, and not just quantity, of education accounts for differences in psychometric performance between african americans and white non-hispanics with Alzheimer's disease. J Int Neuropsychol Soc 2012; 18:277-85. [PMID: 22300593 PMCID: PMC3685288 DOI: 10.1017/s1355617711001688] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effect of race on cognitive test performance in the evaluation of Alzheimer's disease (AD) remains controversial. One factor that may contribute substantially to differences in cognitive test performance in diverse populations is education. The current study examined the extent to which quality of education, even after controlling for formal years of education, accounts for differences in cognitive performance between African Americans and White Non-Hispanics (WNHs). The retrospective cohort included 244 patients diagnosed with AD who self-identified as African Americans (n = 51) or WNHs (n = 193). The Wechsler Test of Adult Reading (WTAR) was used as an estimate of quality of education. In an analysis that controlled for traditional demographics, including age, sex, and years of formal education, African Americans scored significantly lower than WNHs on the Mini-Mental State Examination, as well as on neuropsychological tests of memory, attention, and language. However, after also adjusting for reading level, all previously observed differences were significantly attenuated. The attenuating effect remained even after controlling for disease severity, indicating that reading scores are not confounded by severity of dementia. These findings suggest that quality, and not just quantity, of education needs to be taken into account when assessing cognitive performance in African Americans with AD.
Collapse
|
8
|
Carlozzi NE, Stout JC, Mills JA, Duff K, Beglinger LJ, Aylward EH, Whitlock KB, Solomon AC, Queller S, Langbehn DR, Johnson SA, Paulsen JS. Estimating premorbid IQ in the prodromal phase of a neurodegenerative disease. Clin Neuropsychol 2011; 25:757-77. [PMID: 21660882 PMCID: PMC3159182 DOI: 10.1080/13854046.2011.577811] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Estimates of premorbid intellect are often used in neuropsychological assessment to make inferences about cognitive decline. To optimize the method of controlling for premorbid intellect in assessments of prodromal neurodegenerative disease, we examined performance on the American National Adult Reading Test (ANART; administered during Years 1 and 3) and the two-subtest version of the Wechsler Abbreviated Scale of Intelligence (WASI; administered in Years 2 and 4) in an ongoing prospective longitudinal study of 371 participants with prodromal Huntington disease and 51 participants with normal CAG repeats. Although both measures performed similarly, the ANART demonstrated slightly lower variability in performance over a 2-year period and had slightly higher test-retest reliability than the WASI.
Collapse
Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| | - Julie C. Stout
- Department of Psychological and Brain Sciences, Indiana University, United States
- School of Psychology and Psychiatry, Monash University, Australia
| | - James A. Mills
- Department of Psychiatry, University of Iowa, United States
- Department of Biostatistics, University of Iowa, United States
| | - Kevin Duff
- Department of Neurology, University of Utah
| | | | | | - Kathryn B. Whitlock
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Andrea C. Solomon
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Sarah Queller
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Douglas R. Langbehn
- Department of Psychiatry, University of Iowa, United States
- Department of Biostatistics, University of Iowa, United States
| | | | - Jane S. Paulsen
- Department of Psychiatry, University of Iowa, United States
- Department of Neurology, University of Iowa, United States
| | | |
Collapse
|
9
|
Abstract
BACKGROUND Basic lexical skills are hypothesised to be relatively preserved in mild dementia, but clinical studies have reported inconsistent results. METHODS More than 400 older Catholic nuns, priests and brothers recruited from groups across the USA completed annual evaluations for up to 15 years, died and underwent brain autopsy. Each clinical evaluation included administration of a 20-item word reading test and a 15-item vocabulary test, which were combined to form a composite measure of word knowledge. In a uniform neuropathological examination, Alzheimer's disease pathology was quantified with a composite index of plaques and tangles, and the presence of gross and microscopic cerebral infarctions and Lewy bodies was recorded. RESULTS The post-mortem level of Alzheimer's disease neuropathology was linearly related to rate of decline in word knowledge. Decline was nearly fourfold faster at a relatively high level of pathology (75th percentile) compared with a relatively low level (25th percentile). Neocortical (but not nigral or limbic) Lewy bodies and gross (but not microscopic) cerebral infarction were also associated with a more rapid decline in word knowledge. Effects for word reading and vocabulary were similar, except that gross cerebral infarction was associated with accelerated decline in vocabulary, but not in word reading. CONCLUSION Common neuropathological changes associated with late-life dementia impair word knowledge in old age, calling into question the use of word knowledge tests to estimate premorbid cognitive ability.
Collapse
Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 South Paulina Ave, Suite 1038, Chicago, IL 60612, USA.
| | | | | | | |
Collapse
|
10
|
ROLSTAD SINDRE, NORDLUND ARTO, GUSTAVSSON MARIEHELENE, ECKERSTRÖM CARL, KLANG OLA, HANSEN STEFAN, WALLIN ANDERS. The Swedish National Adult Reading Test (NART-SWE): A test of premorbid IQ. Scand J Psychol 2008; 49:577-82. [DOI: 10.1111/j.1467-9450.2008.00677.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Matsuoka K, Uno M, Kasai K, Koyama K, Kim Y. Estimation of premorbid IQ in individuals with Alzheimer's disease using Japanese ideographic script (Kanji) compound words: Japanese version of National Adult Reading Test. Psychiatry Clin Neurosci 2006; 60:332-9. [PMID: 16732750 DOI: 10.1111/j.1440-1819.2006.01510.x] [Citation(s) in RCA: 359] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of the English-speaking patients with dementia. The purpose of the present study was to develop a Japanese version of the NART (JART), using 50 Japanese irregular words, all of which are Kanji (ideographic script) compound words. Reading performance based on JART and IQ as measured by the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was examined in a sample of 100 normal elderly (NE) persons and in 70 age-, sex-, and education-matched patients with Alzheimer's disease (AD). The NE group was randomly divided into the NE calculation group (n=50) and the NE validation group (n=50). Using the NE calculation group, a linear regression equation was obtained in which the observed full-scale IQ (FSIQ) was regressed on the reading errors of the JART. When the regressed equation computed from the NE calculation group was applied to the NE validation group, the predicted FSIQ adequately fit the observed FSIQ (R2=0.78). Further, independent t-tests showed that the JART-predicted IQs were not significantly different between the NE and AD groups, whereas the AD group performed worse in the observed IQs. The reading ability of Kanji compound words is well-preserved in Japanese patients with AD. The JART is a valid scale for evaluating premorbid IQ in patients with AD.
Collapse
|
12
|
Lebowitz BK, Shear PK, Steed MA, Strakowski SM. Stability of estimated IQ across mood state in patients with bipolar disorder. Bipolar Disord 2006; 8:81-4. [PMID: 16411984 DOI: 10.1111/j.1399-5618.2006.00245.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The goal of this study was to assess the impact of mania symptoms on the stability of the American version of the National Adult Reading Test (ANART), a measure that provides a putative estimate of premorbid intellectual functioning. METHODS The ANART was administered to a sample of 10 inpatients with bipolar disorder who were experiencing an acute episode of mania. During a subsequent follow-up visit during which these individuals exhibited at most minimal mood symptoms, the ANART was re-administered. RESULTS ANART estimated intelligence quotient (IQ) scores during mania and affective stability were assessed in the 10 patients using a paired sample t-test. Within-subject performance across the two mood states did not significantly differ [t(9) = -1.24, p = 0.25]. Additionally, the greatest individual difference across mood states was only 3.68 points, and the average estimated IQ difference across mood states was 1.66. CONCLUSIONS While the results are preliminary and based on a small sample, the highly consistent scores achieved across mood states in this study suggest that the ANART is a reliable indicator of premorbid IQ.
Collapse
Affiliation(s)
- Brian K Lebowitz
- Center for Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45221-0376, USA
| | | | | | | |
Collapse
|
13
|
Cuetos F, Martinez T, Martinez C, Izura C, Ellis AW. Lexical processing in Spanish patients with probable Alzheimer’s disease. ACTA ACUST UNITED AC 2003; 17:549-61. [PMID: 14561444 DOI: 10.1016/s0926-6410(03)00169-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Twenty Spanish patients with probable Alzheimer's disease (AD) and 20 matched controls were given a battery of 17 tasks involving object recognition and the spoken and written perception and production of words and non-words. The AD patients were significantly impaired on nine of the tasks. Prominent among these were tasks that involve semantic processing, though non-word reading was also impaired. Performance on a category fluency task best discriminated AD patients from controls. It is proposed that impairment to semantic processing underlies most of the observed deficits on lexical processing tasks in patients with early AD, but that non-word reading may be sensitive to additional, mild impairments to phonological representations caused by extension of the degenerative process from anterior to posterior temporal regions.
Collapse
Affiliation(s)
- Fernando Cuetos
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | | | | | | | | |
Collapse
|
14
|
Baker DW, Gazmararian JA, Sudano J, Patterson M, Parker RM, Williams MV. Health literacy and performance on the Mini-Mental State Examination. Aging Ment Health 2002; 6:22-9. [PMID: 11827619 DOI: 10.1080/13607860120101121] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objectives of the study were to determine the relationship between functional health literacy and performance on the Mini-Mental State Examination (MMSE). New Medicare managed-care enrollees aged 65 years and older, living independently in the community in four US cities (Cleveland, Houston, Tampa, and Fort Lauderdale/Miami), were eligible to participate. In-home interviews were conducted to determine demographics and health status, and interviewers then administered the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the MMSE. We then determined the relationship between functional health literacy and the MMSE, including total scores, subscale scores (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction), and individual items. Functional health literacy was linearly related to the total MMSE score across the entire range of S-TOFHLA scores (R(2) = 0.39, p < 0.001). This relationship between health literacy and MMSE was consistent across all MMSE subscales and individual items. Adjustment for chronic conditions and self-reported overall health did not change the relationship between health literacy and MMSE score. Health literacy was related to MMSE performance even for subscales of the MMSE that were not postulated to be directly dependent on reading ability or education (e.g. delayed recall). These results suggest that the lower MMSE scores for patients with low health literacy are only partly due to 'test bias' and also result from true differences in cognitive functioning. 'Adjusting' MMSE scores for an individual's functional health literacy may be inappropriate because it may mask true differences in cognitive functioning.
Collapse
Affiliation(s)
- D W Baker
- Center for Health Care Research and Policy and the Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Baker DW, Gazmararian JA, Sudano J, Patterson M. The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci 2000; 55:S368-74. [PMID: 11078114 DOI: 10.1093/geronb/55.6.s368] [Citation(s) in RCA: 282] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine why older age groups have worse functional health literacy. METHODS Home interviews were conducted with community-dwelling elderly persons (n = 2,774) to determine demographics, years of school completed, newspaper reading frequency, chronic diseases, and health status. Participants completed the Short Test of Functional Health Literacy in Adults (S-TOFHLA, range 0-100) and the Mini Mental State Examination (MMSE). RESULTS Mean S-TOFHLA scores declined 1.4 points (95% CI 1.3-1.5) for every year increase in age (p < .001). After adjusting for sex, race, ethnicity, and education, the S-TOFHLA score declined 1.3 points (95% CI 1.2-1.4) for every year increase in age. Even after adjustment for performance on the MMSE, the S-TOFHLA score declined 0.9 points (95% CI 0.8-1.0) for every year increase in age (p < .001). Differences in newspaper reading frequency, visual acuity, chronic medical conditions, and health status, did not explain the lower literacy of older participants. DISCUSSION Functional health literacy was markedly lower among older age groups even after adjusting for differences in MMSE performance, newspaper reading frequency, health status, and visual acuity. Future studies should prospectively examine whether functional literacy declines with age and whether this is explained by declines in cognitive function.
Collapse
Affiliation(s)
- D W Baker
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio USA.
| | | | | | | |
Collapse
|
16
|
Camp SJ, Stevenson VL, Thompson AJ, Miller DH, Borras C, Auriacombe S, Brochet B, Falautano M, Filippi M, Hérissé-Dulo L, Montalban X, Parrcira E, Polman CH, De Sa J, Langdon DW. Cognitive function in primary progressive and transitional progressive multiple sclerosis: a controlled study with MRI correlates. Brain 1999; 122 ( Pt 7):1341-8. [PMID: 10388799 DOI: 10.1093/brain/122.7.1341] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The relative rarity of primary progressive (PP) and transitional progressive (TP) multiple sclerosis has meant that little documentation of cognitive function in such patients is currently available. The aim of this study was to investigate the cognitive skills of patients with PP and TP multiple sclerosis relative to matched healthy controls, and to examine the relationship of this impairment to MRI parameters. Sixty-three patients (43 PP, 20 TP) were individually matched with healthy controls, who undertook the same cognitive tasks as the patient group. The neuropsychological assessment comprised Rao's brief repeatable battery, a reasoning test, and a measure of depression. Patients also underwent T1- and T2-weighted brain MRI. These patients were taken from a larger cohort (158 PP, 33 TP) in whom it had been demonstrated that the re were no significant differences between the mean scores of the PP and TP groups on any of the cognitive variables. The 63 patients were therefore taken as one group for comparison with the healthy controls. These patients performed significantly worse than the controls in tests of verbal memory, attention, verbal fluency and spatial reasoning. An impairment index was constructed and applied to the patient data. This correlated modestly with T2-lesion load (r = 0.45, P = 0.01), T1-hypointensity load (r = 0.45, P = 0.01) and cerebral volume (r = -0.35, P = 0.01). Thus, PP and TP multiple sclerosis patients demonstrate significant cognitive dysfunction when compared with matched healthy controls. The relationship between this impairment and MRI parameters is moderate, suggesting that cognitive dysfunction in PP and TP multiple sclerosis has a complex and multifactorial aetiology, which is not adequately explained by pathology as demonstrated on conventional MRI.
Collapse
Affiliation(s)
- S J Camp
- Department of Clinical Neurology, Institute of Neurology, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Langdon DW, Thompson AJ. Multiple sclerosis: a preliminary study of selected variables affecting rehabilitation outcome. Mult Scler 1999; 5:94-100. [PMID: 10335517 DOI: 10.1177/135245859900500205] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PROBLEM The diversity of physical and cognitive impairments seen in progressive multiple sclerosis (MS), make it difficult to identify the factors that influence neurorehabilitation outcome. Improvements in a motor disability scale must be considered in the context of the patient's physical and cognitive starting points, if the process of neurorehabilitation is to be properly understood. METHOD Data was collected from 38 patients (mean age 41 years, 16 men and 22 women) with clinically definite MS (of whom all but one were in the progressive phase of the disease), who were consecutively admitted to a neurorehabilitation unit. Patients' physical disability was assessed on the motor scale of the Functional Independence Measure (FIM) on admission and discharge. Cognitive and neurological assessments were completed on admission. The cognitive battery comprised the WAIS-R, NART, RMT, CVLT CMT, GNT, GDA, and VOSP (some in short form). Emotional measures were the STAI, STAXI and BDI. RESULTS The mean improvement on the FIM was 6 points. A multiple regression analysis was performed to determine which cognitive and neurological variables related to reduced disability after neurorehabilitation. To take account of each patient's starting point, the model included their FIM admission score. This variable, together with vocabulary skills and cerebellar function accounted for 57% of the variance in the patients' improvements. These results suggest that verbal intelligence and cerebellar function are influential in determining rehabilitation outcome. Although these findings will be unsurprising to clinicians, this is the first quantitative demonstration of these effects.
Collapse
|
18
|
Strain E, Patterson K, Graham N, Hodges JR. Word reading in Alzheimer's disease: cross-sectional and longitudinal analyses of response time and accuracy data. Neuropsychologia 1998; 36:155-71. [PMID: 9539236 DOI: 10.1016/s0028-3932(97)00092-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Using a list of high- and low-frequency regular and exception words, we measured the reading performance of three groups of subjects: patients with mild dementia of the Alzheimer's type (DAT) at presentation (Stage 1) and 2-3 years later (Stage 2); moderately severe DAT patients; and control subjects. In the longitudinally studied patients, there was a dramatic increase in response times (RTs) from Stage 1 to Stage 2, but little change in either error rate or pattern. By contrast, a comparison of the Stage 2 with the Moderate patients revealed similar RTs but a significant increase in error rate for the Moderate group, particularly on low-frequency exception words. These two results for word naming were almost exactly mirrored by effects in picture naming. We conclude that correct word reading, especially for less common words with atypical spelling-sound correspondences, is compromised in DAT only when the disease produces a significant deterioration of semantic memory. These results are relevant to current theories about normal and impaired reading processes.
Collapse
Affiliation(s)
- E Strain
- MRC Applied Psychology Unit, Cambridge, UK
| | | | | | | |
Collapse
|
19
|
Maddrey AM, Cullum CM, Weiner MF, Filley CM. Premorbid intelligence estimation and level of dementia in Alzheimer's disease. J Int Neuropsychol Soc 1996; 2:551-5. [PMID: 9375159 DOI: 10.1017/s1355617700001727] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Simple sight-word reading tasks have demonstrated utility in the estimation of premorbid intelligence, although the effects of progressive dementia on such tasks has not been thoroughly examined. The present investigation sought to examine estimated IQ scores from the National Adult Reading Test-Revised (NART-R; Blair & Spreen, 1989) in relation to a WAIS-R-based (Wechsler, 1981) estimate of IQ in a series of patients with probable Alzheimer's disease across varying levels of dementia. Results suggest that while NART-R scores do show a decrement with dementia severity, this decline is mild, in contrast to traditionally based IQ scores and other measures of cognitive function, which show more marked declines. Similarly, compared with other tasks, the NART-R showed the strongest correlation with education across the sample as a whole, while the other indices were more related to level of dementia. These findings support the use of measures such as the NART-R in estimating premorbid intellectual functioning in patients at various levels of dementia severity, including those with more advanced cognitive deterioration.
Collapse
Affiliation(s)
- A M Maddrey
- University of Texas Southwestern Medical Center, Dallas 75235, USA
| | | | | | | |
Collapse
|