Utility of digit recall tasks for assessing memory in the aged

Regression-based normative data for Corsi Span and Supraspan learning and recall among Italian adults

INTRODUCTION

The Corsi Block Tapping Test, or Corsi Span (CS), is a widely used task to measure visuospatial short-term and working memory. The same setup can be used to administer the Corsi SupraSpan Learning (CSSL) and Recall (CSSR), tests assessing visuospatial long-term memory. While the CS has relatively recent normative data, those of the CSSL are outdated For CSSR, no normative data are available. Given this critical lack, our study aimed to provide updated norms for CS, CSSL, and specifically for the recall delayed phase (CSSR).

MATERIALS AND METHODS

A sample of 340 healthy participants, aged between 20 and 89, took part in the study. Norms were developed using a regression approach and defined using rank equivalent scores and percentiles.

RESULTS

Age and education influenced Corsi's Span, while SupraSpan Learning and Recall were influenced by age, education, and span. The comparison with previous norms for Span and SupraSpan Learning shows a high level of agreement.

CONCLUSIONS

This study provides integrated norms to evaluate visuospatial memory in all aspects of immediate recall, long-term learning and delayed recall. Its use is needed to assess specific neuropsychological deficits, dissociate visuospatial versus verbal memory deficits and allow the evaluation of memory in patients with limited verbal abilities.

Cognitive Testing During Mild Acute Ischemic Stroke Predicts Long-Term Return to Work

OBJECTIVES

Many survivors of a mild ischemic stroke do not return to work or driving. Cognitive testing is commonly done to assess long-term cognitive impairment after stroke. Inpatient cognitive testing during the acute period of ischemic stroke may also be a predictor for workforce reengagement and functional outcome.

MATERIALS AND METHODS

At our comprehensive stroke center, we prospectively enrolled previously working adults < 65 years old who were diagnosed with first-ever ischemic stroke, had a prestroke modified Rankin Scale (mRS) ≤ 1 and NIHSS ≤ 3. Testing performed within 1 week of stroke included the Montreal Cognitive Assessment (MOCA), Clock Drawing Test (CDT), Trail Making Tests A and B, Backward Digit Span Test, and Hospital Anxiety and Depression Scale (HADS). Other data obtained included age, gender, years of education, occupation, stroke location, stroke laterality, and presence of white matter disease on imaging. Outcome measures assessed at 3 months, 6 months, and 12 months post-stroke included return to work, return to driving, and mRS. In a logistic regression analysis, we performed both univariate and multivariate analyses. Multivariate analysis was completed on variables with p-value ≤ 0.05 in the univariate analysis.

RESULTS

Of 39 total stroke patients enrolled and tested (median [IQR] age 55 [46-60] years; 77.5% male; 22.5% female), 36 completed 3-month follow up, of which 58% returned to work, 78% returned to driving, and 72% had mRS of 0-1. In multivariate analysis, a single point increase in the clock drawing task score increased the odds of return to work by 3.79 (95% CI, 1.10-14.14) and return to driving by 6.74 (95% CI, 1.22-37.23) at 3 months. MOCA and HADS were both associated with mRS ≤ 1. MOCA was associated with return to work at 6 months and CDT was associated with return to work at 12 months.

CONCLUSION

Cognitive testing with CDT and MOCA in the acute period after ischemic stroke may predict common patient goals post stroke, including return to work, driving, and independence. These tools can potentially be used for prognosis and identifying those who may benefit from further interventions.

Digit Span, Forward and Backward: Separate and Unequal Components of the WAIS Digit Span

WAIS Digit Span scores of 50 subjects were evaluated to determine the relationship of Digits Forward and Digits Backward to intellectual functioning in an intellectually subnormal population. The subjects fell into one of five levels of intelligence, 50—59, 60—69, 70—79, 80—89, and 90—99, based upon Full Scale WAIS IQ. WAIS IQs and Digits Backward are significantly more highly correlated to all three WAIS IQs than are Digits Forward. Only the WAIS Digit Span (combined forward and backward) and Digits Backward discriminated across the five levels of intelligence.

Short-Term Memory and Crystallized-Fluid Intelligence in Adulthood

To assess the contributions of two types of short-term memory (STM)-passive span of apprehension and working memory-to the intellectual, (that is, fluid [Gf] and crystallized [Gc]) functioning of adults and age differences therein, data from a test battery assessing STM, Gf, and Gc administered to three (n = 54) groups of adults, aged 17-26, 39-51, and 59-76 years (N = 162), were analyzed. Measures of STM and Gf showed substantial and significant negative relationships with age, while the Gc-age relations were significantly positive, but weak. Age declines in Gf functioning appear related to working STM (as measured by backward digits) deficits but not to passive STM (as measured by forward digits) deficits. In contrast to previous literature suggesting that memory span tasks have little utility as measures of STM deficits among the aged, these results suggest great utility if the forward versus backward memory span distinction is maintained.

A perturbation-based balance training program for older adults: study protocol for a randomised controlled trial

Background

Previous research investigating exercise as a means of falls prevention in older adults has shown mixed results. Lack of specificity of the intervention may be an important factor contributing to negative results. Change-in-support (CIS) balance reactions, which involve very rapid stepping or grasping movements of the limbs, play a critical role in preventing falls; hence, a training program that improves ability to execute effective CIS reactions could potentially have a profound effect in reducing risk of falling. This paper describes: 1) the development of a perturbation-based balance training program that targets specific previously-reported age-related impairments in CIS reactions, and 2) a study protocol to evaluate the efficacy of this new training program.

Methods/Design

The training program involves use of unpredictable, multi-directional moving-platform perturbations to evoke stepping and grasping reactions. Perturbation magnitude is gradually increased over the course of the 6-week program, and concurrent cognitive and movement tasks are included during later sessions. The program was developed in accordance with well-established principles of motor learning, such as individualisation, specificity, overload, adaptation-progression and variability. Specific goals are to reduce the frequency of multiple-step responses, reduce the frequency of collisions between the stepping foot and stance leg, and increase the speed of grasping reactions. A randomised control trial will be performed to evaluate the efficacy of the training program. A total of 30 community-dwelling older adults (age 64–80) with a recent history of instability or falling will be assigned to either the perturbation-based training or a control group (flexibility/relaxation training), using a stratified randomisation that controls for gender, age and baseline stepping/grasping performance. CIS reactions will be tested immediately before and after the six weeks of training, using platform perturbations as well as a distinctly different method of perturbation (waist pulls) in order to evaluate the generalisability of the training effects.

Discussion

This study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions. These results will help to guide the development of more effective falls prevention programs, which may ultimately lead to reduced health-care costs and enhanced mobility, independence and quality of life.

The community competence scale as a measure of functional daily living skills

Competence assessment is of growing interest to administrators and clinicians who work with deinstitutionalized psychiatric and geriatric populations. A new instrument, the Community Competence Scale (CCS), is a multiscale structured interview administered in a similar manner to the Wechsler Intelligence Scales. The CCS requires the subject to answer questions and perform tasks which are proximal corollaries of daily living skills. The psychometric properties of the CCS are reviewed. Results of studies involving administration of the CCS to deinstitutionalized psychiatri patients and geriatric patients are presented. The available data suggest that the CCS has considerable value as a preplacement screening instrument for determination of residential settings for chronic psychiatric patients. Since the original CCS requires between 60 and 90 minutes for administration, several recent studies have focused upon development of a short form. The results of this research effort are described. In sum, the CCS appears to demonstrate considerable value as a tool to aid decision making about community placement, social skills training and clinical competence determinations.

Intrusions in Alzheimer's disease in immediate and delayed memory as a function of presentation modality

Young and elderly participants, and participants with Alzheimer's disease (AD) were compared via the suffix paradigm, where a not-to-be-recalled item is appended onto sequences to be immediately recalled. This task was followed by delayed tasks. In immediate recall, AD subjects showed both extralist and suffix intrusions. Recall of auditorily as compared with visually presented stimuli was superior, with the difference increasing in older subjects. The auditory but not the visual suffix produced an end-of-sequence decrement, which was greater in AD than in other groups. After delay, the elderly and young showed virtually perfect performance. The AD participants showed relatively high performance; however, extralist intrusions were frequent, resulting in a relatively low hit rate. As in immediate recall, intrusions showed specificity for AD, and in this paradigm appeared to be a marker differentiating AD and normal subjects. However, the sample size limits the power and generalizability of these findings.

The management of temperature during cardiopulmonary bypass: effect on neuropsychological outcome

Laboratory studies demonstrate that mild degrees of brain cooling (2 degrees C to 5 degrees C) confer substantial protection from ischemic brain injury, and that mild elevation of brain temperature can be markedly deleterious. During hypothermic cardiopulmonary bypass (CPB) patients are made hypothermic and then rewarmed at a time when they are exposed to neurological insults. Our studies show that during rewarming, peak brain temperatures near 39 degrees C often are achieved inadvertently. We hypothesize that maintaining brain temperature < or = 34 degrees C during and after CPB will reduce the incidence of postoperative neuropsychological deficits. We present safety data from a study of 30 patients assigned either to conventional hypothermic CPB with rewarming or a protocol where brain temperature is raised only to 34 degrees C at the time of separation from CPB. There was no difference in bleeding, cardiac morbidity, or time to extubation between groups. We designed a neuropsychological test battery to detect postoperative neuropsychological deficits and tested its usefulness in a preliminary sample of 15 patients undergoing hypothermic CPB. We found patient acceptability and compliance were good. Sensitivity also seemed adequate in that 30% of patients were identified as having deteriorated at 1 week postoperatively compared to preoperatively, a result similar to that reported by others. Clinical trials of the efficacy of mild hypothermia in modulating brain injury in humans are needed before techniques of CPB can be designed to optimize neuroprotection.

Central anticholinergic hypersensitivity in aging

Although neurochemical reductions in cholinergic systems have been found to occur during aging, such changes do not necessarily translate to functional deficits. The cognitive deficits of normal aging have been attributed in part to hypocholinergic function, but anticholinergic hypersensitivity in the elderly has not been systematically documented. To test the cholinergic hypothesis of aging, we investigated the effects of scopolamine on memory and attention in healthy young and elderly subjects. Treatments included intramuscular glycopyrrolate (0.0044 mg/kg) and scopolamine (0.002, 0.004, and 0.007 mg/kg) in a randomized double-blind design. The test battery included the Selective Reminding Task (SRT), Digit Span, Paired Associates Learning (PAL), Symbol Digit Modalities Test (SDMT), and the Continuous Performance Task. Elderly controls were more impaired at lower scopolamine doses than were the young on SRT, PAL, and SDMT. These results demonstrate anticholinergic hypersensitivity and are consistent with decremental changes in cholinergic status during normal aging.

The association of memory complaint with computer-simulated everyday memory performance

The relationship of memory self-report to self-rated depression and to actual performance on computer-simulated everyday memory tasks was investigated in 125 normal adults. Canonical correlation analyses demonstrated that self-rated memory performance and objective computer-simulated everyday memory performance shared from 27.9% to 29.4% of common variance. These data provide initial concurrent validity for a new memory self-report scale, the MAC-S. Results are discussed in relation to psychometric factors important in the design and validation of self-report memory scales.

Disappearance of memory deficits in outpatient depressives responding to imipramine

We evaluated learning and memory in 50 depressed patients prior to and following 4 week treatment with imipramine compared to 21 normal controls tested at corresponding times. At baseline, the depressives did worse than normals on most memory tasks with the difficult memory tasks, regardless of store, modality or type of task best distinguishing between depressive and normal memory. Following imipramine treatment, responders performed better than nonresponders on the difficult memory tasks, and not significantly differently from controls on most tasks. This, as well as the fact that the responders improved to a greater degree than controls on most measures (in a few cases the difference was statistically significant) and the fact that at 4 weeks complete responders to imipramine did significantly better than partial responders to imipramine, indicates that relief from depression is highly related to improved memory functioning. The finding that complete responders to imipramine were not significantly worse than normal controls suggests that imipramine did not have significant adverse effects on memory.

Development of an "early" detection battery for dementia of the Alzheimer type

1. To develop a diagnostic battery sensitive to and specific for the early detection of Alzheimer disease (AD) dementia, the authors reviewed over 400 journal articles dealing with the diagnosis of A.D. or senile dementia and cognitive assessment in organic brain dysfunction and closed head injury. 2. We culled those studies that met our criteria for solid, reliable and statistically significant results and recommend the testing paradigms that most often produced good discrimination of mild AD dementia from normal senescence. 3. These include tests of language, verbal and non-verbal memory, perception, praxis, attention and reasoning. 4. The battery we assembled takes less than 1 hour to administer, requires no special equipment, and was designed as an early screen for use by psychologists, psychiatrists and other trained health care professionals; it is not intended for repeated administration, as in pharmacological or longitudinal studies.

The Misplaced Objects Test: a measure of everyday visual memory

The Misplaced Objects Test is a computerized test of object location recall. The test is structurally similar to tasks used in the evaluation of age and drug effects in preclinical animal research. Delayed recall of 20 common objects which the subject has placed using a touch sensitive screen in a computer-simulated 12-room house is evaluated with three measures. Scores include the number of objects found on the first attempt (Found 1), the number of objects found on the second attempt (Found 2), and the total number of objects found on both attempts (Found T). Performance was evaluated in relation to age, gender, education, and affective status, as well as in relation to several traditional neuropsychological measures. Misplaced Objects Test performance was most strongly associated with age and Wechsler Memory Scale Paired Associate Learning. Additional significant relationships were found with gender, education, and the WAIS Digit Symbol subtest. Potential future applications of the test were discussed.

Ability to register new information: a memory measure for the aged

Ability to register new information is a necessity for the maintenance of autonomy. Its measurement is especially critical with older patients to distinguish cognitive from other aging losses. This paper introduces the Aronson Shopping List, constructed to assess that ability. It describes a check on the test's reliability and an aspect of construct validity for its use. The subjects were 67 community volunteers aged 62 to 89 yr. Those aged 80 to 89 yr. required more training than members of the two preceding decades. Correlations of learning scores on the Aronson Shopping List with WAIS or WAIS--R subtests and prorated IQs were significant. Alternate form stability/reliability, checked after a mean interval of 11 mo. was .75. Assessing cognitive aging was discussed and related to memory.

Age-related sex differences in verbal memory

Verbal learning and memory were studied in 196 healthy men and women aged 40 to 89. The Rey Auditory Verbal Learning Task (RAVLT), a 15-word list, was presented over five trials followed by free recall after each trial. A recognition trial of 50 words subsequently was administered. A stepwise regression that examined the contributions of age, sex, and vocabulary on the five trials of the RAVLT showed that age and sex accounted for a significant portion of the variance on each trial. Vocabulary accounted for a significant portion of the variance only on trials 4 and 5. The recognition trial was not affected by age, sex, or vocabulary. Men had lower scores overall as compared to women. In the older age group (ages 66-89), this difference was significant on trials two through five. Possible mechanisms that may underlie these age-related sex differences in learning curves are discussed.

Memory span and long-term memory deficits in brain-impaired patients

Measures of verbal and visuospatial memory span and long-term memory were obtained from 21 brain-impaired and 21 neurologically unimpaired Veterans Administration medical patients. Significant deficits in both memory span and long-term memory were observed in the brain-impaired patients. Contrary to predictions from the experimental literature, memory span tests that require more processing of item content and location were not superior in detecting the memory span deficits. Discriminant function analyses revealed that measures of verbal and visuospatial long-term memory provided unique discrimination between the brain-impaired and unimpaired patients. However, when memory span measures were analyzed alone, inclusion of more than one measure of memory span did not provide additional unique discrimination. Implications for the clinical assessment of memory functioning are discussed.

Acquisition and retention of categorized material in normal aging and senile dementia

The "shopping list task" is a new verbal learning task with a high degree of face validity for elderly subjects. Learning and delayed recall performance were examined for three groups of subjects: young normals (n = 63, median age = 21), elderly normals (n = 44, median age = 69) and mild to moderately impaired senile dementia patients (n = 60, median age = 70). The young normal subjects performed best of the three groups in both initial learning and delayed recall measures. The elderly normals showed significant decrements in learning and recalling the list items (p less than .01). The impaired elderly showed much greater performance decrements in both learning and recall. None of the subjects showed a deficit in delayed recognition. These results suggest that both storage and retrieval difficulties occur in normal aging and dementia. The recognition test results suggest that recall deficits evidenced by both elderly groups are in large part due to faulty retrieval mechanisms. Since the shopping list task discriminated well among the three groups, it has potential for memory assessment in clinical settings.