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Suchy-Dicey AM, Vo TT, Oziel K, Buchwald DS, Nelson LA, Verney SP, French BF. Psychometric reliability, validity, and generalizability of 3MSE scores among American Indian adults: the Strong Heart Study. J Int Neuropsychol Soc 2024; 30:454-463. [PMID: 38263740 DOI: 10.1017/s1355617723011438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians. METHODS We recruited 818 American Indians aged 65-95 for 3MSE examinations in 2010-2013; 403 returned for a repeat examination in 2017-2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models. RESULTS This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small. CONCLUSION These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.
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Affiliation(s)
- Astrid M Suchy-Dicey
- Huntington Medical Research Institutes, Pasadena, CA, USA
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Thao T Vo
- Washington State University, College of Education, Pullman, WA, USA
| | - Kyra Oziel
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Dedra S Buchwald
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Lonnie A Nelson
- Washington State University, College of Nursing, Spokane, WA, USA
| | | | - Brian F French
- Washington State University, College of Education, Pullman, WA, USA
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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore‐Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez‐Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 PMCID: PMC11032522 DOI: 10.1002/alz.13752] [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: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of MedicineAlzheimer's Disease Resource Center for Minority Aging ResearchUniversity of Texas Rio Grande ValleyBrownsvilleTexasUSA
| | - Carl Hill
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Percy Griffin
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Stephen Hall
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for HealthHealth Care Policy, and Aging ResearchNew BrunswickNew JerseyUSA
| | - Jason Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ganesh Babulal
- Department of NeurologySchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Roland Thorpe
- Center on AgingCenter on Health Disparities SolutionsHopkins Population CenterAlzheimer's Disease Resource Center for Minority Aging ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State UniversitySeattleWashingtonUSA
| | - Spero Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Andrea Gilmore‐Bykovskyi
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alyssa Gamaldo
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | | | - Lisa Barnes
- Rush University Medical CenterChicagoIllinoisUSA
| | - Amy Kind
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Bryan James
- Rush University Medical CenterChicagoIllinoisUSA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public HealthDepartment of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Sarah Szanton
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Rachel Whitmer
- Department of Public Health SciencesDepartment of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | | | - Kacie Deters
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rina Das
- National Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | | | - Maria Carrillo
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Suchy-Dicey AM, Vo TT, Oziel K, King R, Barbosa-Leiker C, Rhoads K, Verney S, Buchwald DS, French BF. Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study. Assessment 2024; 31:745-757. [PMID: 37338127 PMCID: PMC10840386 DOI: 10.1177/10731911231180127] [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] [Indexed: 06/21/2023]
Abstract
The Controlled Oral Word Association (COWA) test is used to assess phonemic fluency and executive function. Formal validation of test scores is important for accurate cognitive evaluation. However, there is a dearth of psychometric validation among American Indian adults. Given high burden of dementia risk and key contextual factors associated with cognitive assessments, this represents a critical oversight. In a large, longitudinal population-based cohort study of adult American Indians, we examined several validity inferences for COWA, including scoring, generalization, and extrapolation inferences, by investigation of factor structure, internal consistency, test-retest reliability, and differential test functioning. We found adequate unidimensional model fit, with high factor loadings. Internal consistency reliability and test-retest reliability were 0.88 and 0.77, respectively, for the full group. COWA scores were lowest among the oldest, lowest education, bilingual speakers; group effects for sex and bilingual status were small; age effect was medium; and education effect was largest. However, Wide Range Achievement Test (WRAT) score effect was stronger than education effect, suggesting better contextualization may be needed. These results support interpretation of total COWA score, including across sex, age, or language use strata.
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Affiliation(s)
| | - Thao T. Vo
- Washington State University, Seattle, USA
| | - Kyra Oziel
- Washington State University, Seattle, USA
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Suchy-Dicey AM, Oziel K, Sawyer C, Olufadi Y, Ali T, Fretts AM, Umans JG, Shibata DK, Longstreth WT, Rhoads K, Buchwald DS, Grabowski TJ. Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study. Neurology 2022; 99:e2637-e2647. [PMID: 36289000 PMCID: PMC9757873 DOI: 10.1212/wnl.0000000000201261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about incidence of vascular and Alzheimer dementias in American Indians. METHODS We conducted a large, heterogeneous, population-based, longitudinal cohort study of brain aging in community-dwelling American Indians aged 64-95 years from 11 tribes across 3 states, with neurologic examinations, 1.5T MRI, and extensive cognitive testing. Visit 1 in 2010-2013 (n = 817) and visit 2 in 2017-2019 (n = 403) included all willing, surviving participants. Standardized cognitive tests at both visits included Modified Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale digit symbol coding (WAIS), Controlled Oral Word Association (COWA), and California Verbal Learning Test short form (CVLT). Test materials added at follow-up included Wide Range Achievement (reading) Test (WRAT) and National Alzheimer Coordinating Center Uniform Data Set cognitive battery (v3 form C2), including Montreal Cognitive Assessment (MoCA). MRI neuroradiologists coded infarcts, hemorrhages, white matter hyperintensities, sulcal atrophy, and ventricle enlargement. RESULTS The mean time between examinations was 6.7 years (SD 1.1, range 3.8-9.1 years). Years of formal education had modest correlation with WRAT reading score (r = 0.45). Prevalence and incidence (respectively) of infarcts were 32% and 12.8/1,000 person-years (PYs) hemorrhages 6% and 4.4/1000 PY worsening sulci 74% and 19.0/1000 PY worsening ventricle 79% and 30.1/1000 PY worsening leukoaraiosis 44% and 26.1/1000 PY. Linear losses per year in cognitive scores were 0.6% MMSE, 1.2% WAIS, 0.6% COWA, and 2.2% CVLT. The mean MoCA scores were 18.9 (SD 4.3). DISCUSSION These are the first data on longitudinal cognitive and imaging changes in American Indians and first reports of Alzheimer disease-related features. The mean scores in MoCA were similar or lower than standard cutoffs used to diagnose dementia in other racial/ethnic groups, suggesting that standardized cognitive tests may not perform well in this population. Test validation, adaptation, and score adjustment are warranted. Years of education were a poor proxy for premorbid function, suggesting novel methods for cognitive score contextualization is also needed in this population. Evaluation of selective survival suggests attrition from death, and frailty should be accounted for in causal analyses. Overall, these data represent a unique opportunity to examine neurology topics of critical importance to an understudied population.
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Affiliation(s)
- Astrid M Suchy-Dicey
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle.
| | - Kyra Oziel
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Charles Sawyer
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Yunusa Olufadi
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Tauqeer Ali
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Amanda M Fretts
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Jason G Umans
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dean K Shibata
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - W T Longstreth
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Kristoffer Rhoads
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dedra S Buchwald
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Thomas J Grabowski
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
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Suchy-Dicey A, Eyituoyo H, O’Leary M, Cole SA, Traore A, Verney S, Howard B, Manson S, Buchwald D, Whitney P. Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1421-1433. [PMID: 35157091 PMCID: PMC9247016 DOI: 10.1007/s00127-022-02237-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Our study examined psychosocial risk and protective features affecting cardiovascular and mortality disparities in American Indians, including stress, anger, cynicism, trauma, depression, quality of life, and social support. METHODS The Strong Heart Family Study cohort recruited American Indian adults from 12 communities over 3 regions in 2001-2003 (N = 2786). Psychosocial measures included Cohen Perceived Stress, Spielberger Anger Expression, Cook-Medley cynicism subscale, symptoms of post-traumatic stress disorder, Centers for Epidemiologic Studies Depression scale, Short Form 12-a quality of life scale, and the Social Support and Social Undermining scale. Cardiovascular events and all-cause mortality were evaluated by surveillance and physician adjudication through 2017. RESULTS Participants were middle-aged, 40% male, with mean 12 years formal education. Depression symptoms were correlated with anger, cynicism, poor quality of life, isolation, criticism; better social support was correlated with lower cynicism, anger, and trauma. Adjusted time-to-event regressions found that depression, (poor) quality of life, and social isolation scores formed higher risk for mortality and cardiovascular events, and social support was associated with lower risk. Social support partially explained risk associations in causal mediation analyses. CONCLUSION Altogether, our findings suggest that social support is associated with better mood and quality of life; and lower cynicism, stress, and disease risk-even when said risk may be increased by comorbidities. Future research should examine whether enhancing social support can prospectively reduce risk, as an efficient, cost-effective intervention opportunity that may be enacted at the community level.
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Affiliation(s)
- Astrid Suchy-Dicey
- Washington State University Elson S Floyd College of Medicine, 1100 Olive Way Suite 1200, Seattle, WA, 98101, USA.
| | - Harry Eyituoyo
- Washington State University Elson S Floyd College of Medicine, 1100 Olive Way Suite 1200, Seattle, WA 98101, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research, Inc., Eagle Butte, USA
| | | | | | - Steve Verney
- Department of Psychology, University of New Mexico, Albuquerque, USA
| | | | | | - Dedra Buchwald
- Washington State University Elson S Floyd College of Medicine, 1100 Olive Way Suite 1200, Seattle, WA 98101, USA
| | - Paul Whitney
- Department of Psychology, Washington State University, Pullman, USA
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