Sex-, age- and education-adjusted norms for the WHO/UCLA version of the Rey Auditory Verbal Learning Test for Sinhala-speaking Sri Lankan adults

Demographically-adjusted norms for Rey-Osterrieth Complex Figure Test (RCFT) for Sri Lankan adults

Objective: The aim of this study was to create demographically-adjusted norms for Rey-Osterrieth Complex Figure Test (RCFT) for Sri Lankan adults. Method: Four-hundred and twenty-two healthy, adult participants (age: 19-83 years, education: 5-23 years, 202 men) underwent the RCFT copy, 3-min and 30-minute-recall trials. Age- and education-stratified percentile-based norms and demographically-adjusted regression-based norms were created for copy-trial scores and recall trial scores, respectively. Results: There was a ceiling effect of the copy scores where the maximum possible score (i.e. 36) reached between 25th and 90th percentile depending of the age and the education band. Age, years of education and sex accounted for 25.0% of the variance of the RCFT 3-min-recall scores (adjusted R2 = 0.25, p < .0001). The age and years of education explained 25.1% of the variance of the 30-minute recall score (adjusted R2 = 0.251, p < .0001). Age accounted for 7%-8% and years of education accounted for 10%-11% of the variances of the recall trial scores. Sex only affected the 3-min recall scores and accounted for only about 1% of the variance. No significant differences in RCFT scores were observed among different ethnic groups. Conclusions: These RCFT norms for Sri Lankan adults fill a hiatus in neuropsychological assessment of visuospatial construction and visual memory. The percentile tables and accompanying software-based calculator with embedded regression equations help clinicians more readily interpret individual test results and account for the RCFT performance variability introduced by demographic variables.

Age-stratified norms for Raven's standard progressive matrices for Sri Lankan adults

OBJECTIVE

The aim of this study was to create age-stratified norms for the Raven's Standard Progressive Matrices (SPM) for Sri Lankan adults.

METHODS

A sample of 610 adults (age: 18-72 years; education: 1-19 years), underwent the 60-item version of the SPM under individual supervision of a test administrator. The sample was stratified into 5-year age bands, and the norms are presented as percentile tables and percentile curves.

RESULTS

The age-related changes were more accurately predicted by a curvilinear model (overall R2 = 0.961) than a linear regression model (R2 = 0.639). The SPM norms are presented as age-stratified percentile tables, as well as sex-, age- and education-adjusted multiple regression equations. The highest percentiles in the younger end of the age spectrum showed a ceiling effect. In the context of age-stratified US (1993) and British (1992) norms, older individuals in the Sri Lankan sample scored much lower than their Western counterparts. However, the difference narrowed in the younger age bands, showing no difference among the 18-to-22-year age bands in the three countries.

CONCLUSIONS

This age-by-country interaction can be partly explained by poorer education in the older individuals in the present sample compared to those in the US and UK standardization samples. SPM norms presented in this paper fill a hiatus in assessment of general intellectual ability in Sri Lankan adults. Given that Sri Lanka improves its educational, socioeconomic and health standards faster than the nations who have already reached higher standards, these norms would require re-standardization in the coming decades.

WHO-UCLA auditory verbal learning test: Normative data for Spanish-speaking adults in the United States

BACKGROUND

Hispanics are a significant demographic in the U.S., with diverse cultures and languages. Assessing cognition in this group is complex as cultural and linguistic factors have been found to affect test performance.

OBJECTIVE

To generate normative data on the World Health Organization-University of California Los Angeles Auditory Verbal Learning Test (WHO-UCLA AVLT) in a sample of Spanish-speaking Hispanics residing in the U.S.

METHODS

The sample included 245 Spanish-speaking individuals aged 18-80 across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered the WHO-UCLA AVLT as part of a comprehensive neuropsychological battery. A Bayesian regression approach was used to estimate normative data, including covariates found to be important for predicting performances on measures of learning and memory.

RESULTS

Bayesian models showed a logarithmic link between education and all WHO-UCLA AVLT trials, except recognition. For delayed recall, increased Spanish proficiency benefited women's performance exclusively. Time in the U.S. was a significant predictor for total recall, indicating worse performance with longer residency.

CONCLUSION

Recognizing cultural factors like language proficiency and duration of U.S. residence is essential for accurately evaluating cognitive function among Spanish-speaking Hispanics. This research emphasizes the importance of accounting for cultural nuances in developing norms for neuropsychological assessments, thereby improving their relevance and effectiveness in diverse communities.

Subclinical memory impairment in unaffected siblings of patients with dementia

Objective: Family history of dementia is a known risk factor for dementia. The cognitive performance of unaffected siblings of dementia patients has been poorly studied. We aimed to determine whether clinically unaffected siblings of dementia patients have significant cognitive impairment compared to individuals who do not have first-degree relatives with dementia. Methods: We compared the cognitive performance of 67 patients with dementia (24 males; mean age 69.5), 90 healthy siblings of those patients (34 males; mean age 61.56) and 92 healthy adults (35 males; mean age 60.96) who have no first-degree relatives with dementia. We assessed learning and memory (Rey Auditory Verbal Learning Test (RAVLT)), short-term/working memory (Digit Span) executive functions (Stroop Test) and general intelligence (Raven Progressive Matrices). Test scores were compared among three groups, with regression-based adjustments for age, sex, and education. Results: As expected, the patients with dementia were impaired in all cognitive domains. In the Sibling Group, RAVLT total learning was significantly lower compared to controls (B = -3.192, p = .005). In a subgroup analysis, compared to controls, RAVLT delayed recall was poorer in the siblings of patients with early-onset (<65 years) dementia. No significant differences were observed in other cognitive domains. Conclusion: Clinically unaffected siblings of dementia patients seem to have a selective subclinical impairment in memory encoding. This impairment seems to be more prominent in siblings of patients with early-onset dementia who also have deficits in delayed recall. Future studies are needed to determine if the observed cognitive impairment deteriorates to dementia.

Hippocampal Estrogen Signaling Mediates Sex Differences in Retroactive Interference

Despite being a crucial physiological function of the brain, the mechanisms underlying forgetting are still poorly understood. Estrogens play a critical role in different brain functions, including memory. However, the effects of sex hormones on forgetting vulnerabilitymediated by retroactive interference (RI), a phenomenon in which newly acquired information interferes with the retrieval of already stored information, are still poorly understood. The aim of our study was to characterize the sex differences in interference-mediated forgetting and identify the underlying molecular mechanisms. We found that adult male C57bl/6 mice showed a higher susceptibility to RI-dependent memory loss than females. The preference index (PI) in the NOR paradigm was 52.7 ± 5.9% in males and 62.3 ± 13.0% in females. The resistance to RI in female mice was mediated by estrogen signaling involving estrogen receptor α activation in the dorsal hippocampus. Accordingly, following RI, females showed higher phosphorylation levels (+30%) of extracellular signal-regulated kinase1/2 (ERK1/2) in the hippocampus. Pharmacological inhibition of ERK1/2 made female mice prone to RI. The PI was 70.6 ± 11.0% in vehicle-injected mice and 47.4 ± 10.8% following PD98059 administration. Collectively, our data suggest that hippocampal estrogen α receptor-ERK1/2 signaling is critically involved in a pattern separation mechanism that inhibits object-related RI in female mice.

Differentiation of memory processing stages and effect of demographic variables with alternative scoring approaches to the Rey auditory verbal learning test

BACKGROUND

The Rey Auditory Verbal Learning Test (RAVLT) is the third most popular verbal memory test and the tenth most frequently used neuropsychological test. The original scoring system of RAVLT does not differentiate stages of memory processing, but a recently developed composite scoring system has this potential. The objectives were to compare the two systems in terms of their capacity to differentiate the stages of memory processing and to study the effect of demographic variables on the learning trials (T) of the Turkish form of RAVLT (T-RAVLT).

METHOD

The sample consisted of 600 Caucasian Turkic adults, who were categorized into three levels of age, three levels of education, and two levels of gender. Individual administration of T-RAVLT was performed using the standard procedures of RAVLT.

RESULTS

The components in the exploratory factor analysis (EFA) and latent variables in the confirmatory factor analysis (CFA) of the original scores were consistent with sequentially ordered T-RAVLT stages. Demographic variables (age, education, and gender) affected performances in all of the learning trials. The composite scores revealed retrieval and retention as separate components, but these scores could not be predicted from the relevant T-RAVLT scores.

CONCLUSIONS

Findings recommend a combined utilization of the two scoring systems: The original system to provide scores on the performance at each stage of T-RAVLT and the combined system to provide separate scores on learning, retention, and retrieval, the three stages of memory processing. A selective effect of demographic variables on T1 was not observed, indicating a need for cross-cultural studies that are meticulously controlled for age and education.

Regression-based, demographically adjusted norms for Victoria Stroop Test, Digit Span, and Verbal Fluency for Sri Lankan adults

OBJECTIVE

Lack of test norms is a major limitation in neuropsychological assessment in many non-English-speaking countries. Our objective was to generate sex-, age-, and education-adjusted, regression-based norms for three pen-and-paper-based executive function/working memory tests, viz. Victoria Stroop Test (VST), Digit Span, and Verbal Fluency, for Sinhala-Speaking Sri Lankan adults.

METHOD

Six-hundred and six healthy, community-living, Sinhala-speaking adults (273 men) aged 19-83 years completed VST, Digit Span (forward and backward), and Phonemic (Sinhala phonemes "N," "P," and "S") and Category (animals and vegetables) Fluency tests. We conducted multiple linear regression analyses with sex, age, and years of education fitted as predictors to model the test outcome variables.

RESULTS

Younger age was associated with better performance in all tests except in Phonemic Fluency. Longer education was associated with better performance in all outcomes except VST errors and interference. Women had a significant but small advantage over men in VST Neutral and Color Word tests, and Phonemic Fluency. We report regression equations to predict norms for the test performance measures based on sex, age, and years of education; and the test variances accounted by these factors.

CONCLUSIONS

We propose demographically adjusted norms for VST, Digit Span, and Verbal Fluency for Sinhala-speaking Sri Lankans aged 19-83 years, and supplement the regression formulae with a calculator that produces predicted and standard scores. These norms would help in interpreting the results of clinical samples in the future, taking into account the variability introduced by sex, age, and education.

A year of turmoil and change: Editorial from the TCN Department of Culture and Gender in Neuropsychology

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