Identifying Appropriate Neuropsychological Tests for Uneducated/Illiterate Older Individuals

Feasibility and Clinical Effectiveness of Computer-Based Cognitive Rehabilitation in Illiterate and Low-Educated Individuals with Mild Cognitive Impairment: Preliminary Data

OBJECTIVE

We investigated the feasibility of the RehaCom cognitive rehabilitation software in illiterate and low-educated individuals with mild cognitive impairment (MCI) and its clinical effectiveness in improving cognitive functions.

METHODS

Twenty illiterate or low-educated individuals with MCI were randomly assigned to an intervention (IG; n = 10) and control group (CG; n = 10). The IG participated in the cognitive enhancement program for 6 weeks, twice a week and a duration of 50-60 min for each session, while the CG did not receive any kind of intervention.

RESULTS

The two groups were demographically matched. The IG successfully completed all sessions of the cognitive enhancement program. A within-subject comparison between baseline and post-intervention assessment of cognitive functions indicated that the IG improved significantly on all administered neuropsychological tests, in contrast to the CG, whose performance remained stable between baseline and final assessment. A between-group comparison found statistically significant differences between the IG and CG groups on the Hindi Mental State Examination, Mini-Mental State Examination, and on delayed memory and recognition tasks, in favor of the IG.

CONCLUSIONS

The findings of the present study support the feasibility of applying computerized cognitive enhancement programs to illiterate and low-educated individuals. Moreover, these programs appear to contribute positively to improving the cognitive functions of this population group. In order to generalize and confirm similar findings in a broader population of illiterate and low-educated individuals, future studies should include larger samples, possibly with longer duration of treatment and control groups that will receive non-targeted interventions as placebo interventions.

TMA-93 (binding by images): Cutoffs optimization based on Alzheimer's disease biomarkers

BackgroundWith the arrival of new disease-modifying treatments for Alzheimer's disease (AD), feasible cognitive tests, also for illiterate patients, are needed to screen those requiring deeper evaluation among individuals presenting with memory complaints. The TMA-93, a brief binding memory test, has proven useful for diagnosing early AD, and is supported by normative data that accounts for age and cognitive reserve.ObjectiveTo compare the sensitivity of different TMA-93 cutoffs in detecting AD pathology.MethodsA retrospective analysis was performed on a biobank sample of patients with confirmed AD pathology via amyloid PET or cerebrospinal fluid (CSF) biomarkers. The sensitivity of six TMA-93 cutoffs was evaluated: the 10th, 15th, and 20th percentiles based on traditional norming (TN) and regression-based norming (RBN). False negatives (FN) characteristics were also analyzed.ResultsA total of 270 AD-positive patients (96 by amyloid-PET, 174 by CSF biomarkers) were included, comprising 224 with mild cognitive impairment and 46 with mild dementia. The 15th percentile using RBN demonstrated substantial sensitivity (80.4%), higher than that of the 10th percentile, and also provided a more uniform distribution across normative groups compared to the TN approach. Higher global cognition (Mini-Mental State Examination score) and, in patients over 70, lower cognitive reserve (Cognitive Reserve Questionnaire), were linked to a greater likelihood of FN results.ConclusionsThe 15th percentile cutoff based on RBN, accounting for age and cognitive reserve, improves sensitivity for detecting AD pathology, making it a valuable screening tool for memory complaints. Future normative data from biomarker-negative subjects may enhance the sensitivity of cognitive tests.

Normative data for the CERAD verbal episodic memory tests in a sample of older illiterate Korean women

Background

Verbal episodic memory tests in the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery require literacy. While modified administrations are provided for illiterate individuals, there are no norms for evaluating the performance of illiterate subjects.

Objective

Assessing the performance of illiterate individuals has limitations, since existing norms were developed on data from literate populations. The purpose of this study is to provide normative data for illiterate Korean older women.

Methods

The participants analyzed in this study were all illiterate. Among a sample of 109 non-demented older adults recruited from community centers for dementia, only 9 were men. Thus, the current analysis developed norms for women. Descriptive statistics were used to summarize participants' characteristics and test scores. Linear regressions were conducted to examine the effect of age on verbal episodic memory tests.

Results

Age was found to be significantly associated with performance on all word list tests. Age was divided into two groups based on the average value for sufficient sample size and showed a significant difference in test performance: 60-75, ≥76 years.

Conclusions

Evaluating illiterate women using existing standards has the limitation of underestimating their performance relative to their actual skills. The present normative data are expected to enable researchers and clinicians to more accurately evaluate the results of the three verbal episodic memory tests, including the Word List Memory, Word List Recall, and Word List Recognition in older illiterate Korean women.

Association between possible sarcopenia and domain-specific cognitive impairment in middle-aged and older adults: Insights from the Gan-Dau Healthy Longevity Plan

BACKGROUND

Given the established association between sarcopenia and cognitive impairment was mainly in the older and oldest-old population or people with relatively limited education, this study extends the investigation to community-dwelling middle-to-old age adults in urban communities, emphasizing the need for preventive intervention for muscle health and healthy longevity.

METHODS

Data of 712 participants from the Gan-Dau Healthy Longevity Plan were retrieved for analysis, and all participants were stratified by age (50-64, 65-74 and 75+ years old). Possible sarcopenia was defined by 2019 consensus report of the Asian Working Group for Sarcopenia (AWGS). This study used four neuropsychological tests for analysis, i.e., Mini-Mental Status Examination (MMSE), California Verbal Learning Test II (CVLT-SF), Digital Symbol Substitution Test (DSST) and Verbal fluency (VF) for global and domain-specific cognitive function. Multivariate generalized linear models (GLMs) were employed to investigate the associations between possible sarcopenia and cognitive function in each age-specific groups.

RESULTS

The prevalence of possible sarcopenia increased with age, with 31.8 %, 37.7 %, and 55.6 % in participants aged 5064, 65-74 and, 75+ years, respectively. On the other hand, cognitive performance declined with age. In particular, among participants aged 75+ years with possible sarcopenia, their cognitive performance were poorer than robust counterparts, including MMSE (26.6 [3.4] vs. 27.4 [2.6]), CVTL-SF (total score: 21.5 [5.4] vs. 23.8 [5.5]; 30-second delayed recall: 6.0 [1.7] vs. 6.5 [1.6]), DSST (32.8 [14.3] vs. 41.3 [18.7]), and VF (12.8 [5.1] vs. 14.8 [4.9]). Multivariate generalized linear model indicated that possible sarcopenia was associated with lower MMSE (β: -0.70, p = 0.014) and lower DSST (β: -7.00, p = 0.010) in those aged 50-64 years. Moreover, possible sarcopenia was associated with lower CVLT-SF (total score β:-1.90, p = 0.028), lower DSST (β: -6.45, p < 0.001), and lower VF (β: -1.64, p=0.026) in 75+ years group.

CONCLUSIONS

An association exists between possible sarcopenia and cognitive impairment, encompassing global cognition, delayed memory, verbal fluency, and executive function, among community-dwelling adults of mid-to-old age. Future research is warranted to explore the temporal alterations in this association and the potential effects of interventions aimed at fostering healthy longevity.

Development of robust normative data for the neuropsychological assessment of Greek older adults

OBJECTIVE

Normative data for older adults may be tainted by inadvertent inclusion of undiagnosed individuals at the very early stage of a neurodegenerative process. To avoid this pitfall, we developed norms for a cohort of older adults without MCI/dementia at 3-year follow-up.

METHODS

A randomly selected sample of 1041 community-dwelling individuals (age ≥ 65) received a full neurological and neuropsychological examination on two occasions [mean interval = 3.1 (SD = 0.9) years].

RESULTS

Of these, 492 participants (Group 1; 65-87 years old) were without dementia on both evaluations (CDR=0 and MMSE ≥ 26); their baseline data were used for norms development. Group 2 (n = 202) met the aforementioned criteria only at baseline, but not at follow-up. Multiple linear regressions included demographic predictors for regression-based normative formulae and raw test scores as dependent variables for each test variable separately. Standardized scaled scores and stratified discrete norms were also calculated. Group 2 performed worse than Group 1 on most tests (p-values < .001-.021). Education was associated with all test scores, age with most, and sex effects were consistent with the literature.

CONCLUSIONS

We provide a model for developing sound normative data for widely used neuropsychological tests among older adults, untainted by potential early, undiagnosed cognitive impairment, reporting regression-based, scaled, and discrete norms for use in clinical settings to identify cognitive decline in older adults. Additionally, our co-norming of a variety of tests may enable intra-individual comparisons for diagnostic purposes. The present work addresses the challenge of developing robust normative data for neuropsychological tests in older adults.

Longitudinal episodic memory trajectories in older adults with normal cognition

OBJECTIVE

To determine the longitudinal trajectories and normative standards of episodic memory in older adults.

METHODS

Participants were drawn from the cognitively normal(CN) subgroup of the population-based HELIAD cohort, a fairly representative cohort of the older Greek population. Verbal and non-verbal memory were assessed using the Greek Verbal Learning Test and Medical College of Georgia-Complex Figure Test. Baseline and longitudinal associations of memory performance with age, sex and formal education were explored with linear regression analysis and generalized estimated equations.

RESULTS

A total of 1607 predominantly female (60%) individuals (73.82 ± 5.43 years), with a mean educational attainment of 8.17(±4.86) years were CN at baseline. Baseline analysis revealed a continuum of memory decline with aging and lower educational attainment. Women performed better in composite and verbal memory measures, while men performed better in non-verbal memory tasks. A subgroup of 761 participants with available assessments after 3.07(±0.82) years remained CN at follow-up. Composite memory scores yearly diminished by an additional 0.007 of a SD for each additional year of age at baseline. Regarding verbal learning, immediate free verbal recall, delayed free verbal recall and delayed cued verbal recall, an additional yearly decrease of 0.107, 0.043, 0.036 and 0.026 words were respectively recorded at follow-up, for each additional year of age at baseline. Women underwent steeper yearly decreases of 0.227 words in delayed cued verbal recall. No significant longitudinal associations emerged for immediate non-verbal memory, delayed non-verbal memory and immediate cued verbal recall.

CONCLUSIONS

In the present study, aging (but not educational attainment) was consistently associated with steeper verbal memory decline.

Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2022.2059011 .

Illiteracy, Neuropsychological Assessment, and Cognitive Rehabilitation: A Narrative Review

OBJECT

Νeuropsychological assessment is particularly important for the accurate discrimination of cognitive abilities and weaknesses of patients in order to determine the appropriate therapeutic intervention. However, the reliability and validity of neuropsychological assessment appears to be influenced by a wide range of factors, including literacy and educational level.

AIM

This systematic review evaluates neuropsychological tests appropriate for the valid assessment of illiterate individuals and the effectiveness of cognitive rehabilitation programs for illiterate and/or low-educated individuals according to the results of English language studies that have been published in the PubMed/Medline electronic database until August 2022 (no initiation date).

RESULTS

49 studies were included for neuropsychological assessment and 4 studies for cognitive rehabilitation. In terms of investigating the validity and reliability of neuropsychological tests for the assessment of healthy illiterate individuals, most studies concluded that for the majority of neuropsychological tests there is a significant difference in performance between healthy illiterate and literate individuals. However, there was consensus among studies that the performance of illiterate subjects was equivalent to the performance of literate subjects on tasks depicting colored and real objects. Regarding cognitive rehabilitation programs, all four studies concluded that they are effective in improving the cognitive functions of illiterate and/or low-literate patients with mild cognitive impairment and/or mild dementia.

CONCLUSIONS

For the assessment of illiterate individuals, it is imperative that neuropsychological tests with high ecological validity (i.e., tests related to activities of daily living) be administered so as not to underestimate their cognitive functioning. At the same time, cognitive enhancement/stimulation programs seem to be effective in this population group; however, this area needs further investigation.