Quality of education predicts performance on the Wide Range Achievement Test-4th Edition Word Reading subtest

A Demographic-Conditioned Variational Autoencoder for fMRI Distribution Sampling and Removal of Confounds

Objective

fMRI and derived measures such as functional connectivity (FC) have been used to predict brain age, general fluid intelligence, psychiatric disease status, and preclinical neurodegenerative disease. However, it is not always clear that all demographic confounds, such as age, sex, and race, have been removed from fMRI data. Additionally, many fMRI datasets are restricted to authorized researchers, making dissemination of these valuable data sources challenging.

Methods

We create a variational autoencoder (VAE)-based model, DemoVAE, to decorrelate fMRI features from demographics and generate high-quality synthetic fMRI data based on user-supplied demographics. We train and validate our model using two large, widely used datasets, the Philadelphia Neurodevel-opmental Cohort (PNC) and Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP).

Results

We find that DemoVAE recapitulates group differences in fMRI data while capturing the full breadth of individual variations. Significantly, we also find that most clinical and computerized battery fields that are correlated with fMRI data are not correlated with DemoVAE latents. An exception are several fields related to schizophrenia medication and symptom severity.

Conclusion

Our model generates fMRI data that captures the full distribution of FC better than traditional VAE or GAN models. We also find that most prediction using fMRI data is dependent on correlation with, and prediction of, demographics.

Significance

Our DemoVAE model allows for generation of high quality synthetic data conditioned on subject demographics as well as the removal of the confounding effects of demographics. We identify that FC-based prediction tasks are highly influenced by demographic confounds.

A Demographic-Conditioned Variational Autoencoder for fMRI Distribution Sampling and Removal of Confounds

Objective

fMRI and derived measures such as functional connectivity (FC) have been used to predict brain age, general fluid intelligence, psychiatric disease status, and preclinical neurodegenerative disease. However, it is not always clear that all demographic confounds, such as age, sex, and race, have been removed from fMRI data. Additionally, many fMRI datasets are restricted to authorized researchers, making dissemination of these valuable data sources challenging.

Methods

We create a variational autoencoder (VAE)-based model, DemoVAE, to decorrelate fMRI features from demographics and generate high-quality synthetic fMRI data based on user-supplied demographics. We train and validate our model using two large, widely used datasets, the Philadelphia Neurodevelopmental Cohort (PNC) and Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP).

Results

We find that DemoVAE recapitulates group differences in fMRI data while capturing the full breadth of individual variations. Significantly, we also find that most clinical and computerized battery fields that are correlated with fMRI data are not correlated with DemoVAE latents. An exception are several fields related to schizophrenia medication and symptom severity.

Conclusion

Our model generates fMRI data that captures the full distribution of FC better than traditional VAE or GAN models. We also find that most prediction using fMRI data is dependent on correlation with, and prediction of, demographics.

Significance

Our DemoVAE model allows for generation of high quality synthetic data conditioned on subject demographics as well as the removal of the confounding effects of demographics. We identify that FC-based prediction tasks are highly influenced by demographic confounds.

Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study

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.

ImageNomer: Description of a functional connectivity and omics analysis tool and case study identifying a race confound

Most packages for the analysis of fMRI-based functional connectivity (FC) and genomic data are used with a programming language interface, lacking an easy-to-navigate GUI frontend. This exacerbates two problems found in these types of data: demographic confounds and quality control in the face of high dimensionality of features. The reason is that it is too slow and cumbersome to use a programming interface to create all the necessary visualizations required to identify all correlations, confounding effects, or quality control problems in a dataset. FC in particular usually contains tens of thousands of features per subject, and can only be summarized and efficiently explored using visualizations. To remedy this situation, we have developed ImageNomer, a data visualization and analysis tool that allows inspection of both subject-level and cohort-level demographic, genomic, and imaging features. The software is Python-based, runs in a self-contained Docker image, and contains a browser-based GUI frontend. We demonstrate the usefulness of ImageNomer by identifying an unexpected race confound when predicting achievement scores in the Philadelphia Neurodevelopmental Cohort (PNC) dataset, which contains multitask fMRI and single nucleotide polymorphism (SNP) data of healthy adolescents. In the past, many studies have attempted to use FC to identify achievement-related features in fMRI. Using ImageNomer to visualize trends in achievement scores between races, we find a clear potential for confounding effects if race can be predicted using FC. Using correlation analysis in the ImageNomer software, we show that FCs correlated with Wide Range Achievement Test (WRAT) score are in fact more highly correlated with race. Investigating further, we find that whereas both FC and SNP (genomic) features can account for 10-15% of WRAT score variation, this predictive ability disappears when controlling for race. We also use ImageNomer to investigate race-FC correlation in the Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP) dataset. In this work, we demonstrate the advantage of our ImageNomer GUI tool in data exploration and confound detection. Additionally, this work identifies race as a strong confound in FC data and casts doubt on the possibility of finding unbiased achievement-related features in fMRI and SNP data of healthy adolescents.

Surface-based correlates of cognition along the Alzheimer's continuum in a memory clinic population

Composite cognitive measures in large-scale studies with biomarker data for amyloid and tau have been widely used to characterize Alzheimer's disease (AD). However, little is known about how the findings from these studies translate to memory clinic populations without biomarker data, using single measures of cognition. Additionally, most studies have utilized voxel-based morphometry or limited surface-based morphometry such as cortical thickness, to measure the neurodegeneration associated with cognitive deficits. In this study, we aimed to replicate and extend the biomarker, composite study relationships using expanded surface-based morphometry and single measures of cognition in a memory clinic population. We examined 271 clinically diagnosed symptomatic individuals with mild cognitive impairment (N = 93) and Alzheimer's disease dementia (N = 178), as well as healthy controls (N = 29). Surface-based morphometry measures included cortical thickness, sulcal depth, and gyrification index within the "signature areas" of Alzheimer's disease. The cognitive variables pertained to hallmark features of Alzheimer's disease including verbal learning, verbal memory retention, and language, as well as executive function. The results demonstrated that verbal learning, language, and executive function correlated with the cortical thickness of the temporal, frontal, and parietal areas. Verbal memory retention was correlated to the thickness of temporal regions and gyrification of the inferior temporal gyrus. Language was related to the temporal regions and the supramarginal gyrus' sulcal depth and gyrification index. Executive function was correlated with the medial temporal gyrus and supramarginal gyrus sulcal depth, and the gyrification index of temporal regions and supramarginal gyrus, but not with the frontal areas. Predictions of each of these cognitive measures were dependent on a combination of structures and each of the morphometry measurements, and often included medial temporal gyrus thickness and sulcal depth. Overall, the results demonstrated that the relationships between cortical thinning and cognition are widespread and can be observed using single measures of cognition in a clinically diagnosed AD population. The utility of sulcal depth and gyrification index measures may be more focal to certain brain areas and cognitive measures. The relative importance of temporal, frontal, and parietal regions in verbal learning, language, and executive function, but not verbal memory retention, was replicated in this clinic cohort.

Identifiability in Functional Connectivity May Unintentionally Inflate Prediction Results

Functional magnetic resonance (fMRI) is an invaluable tool in studying cognitive processes in vivo. Many recent studies use functional connectivity (FC), partial correlation connectivity (PC), or fMRI-derived brain networks to predict phenotypes with results that sometimes cannot be replicated. At the same time, FC can be used to identify the same subject from different scans with great accuracy. In this paper, we show a method by which one can unknowingly inflate classification results from 61% accuracy to 86% accuracy by treating longitudinal or contemporaneous scans of the same subject as independent data points. Using the UK Biobank dataset, we find one can achieve the same level of variance explained with 50 training subjects by exploiting identifiability as with 10,000 training subjects without double-dipping. We replicate this effect in four different datasets: the UK Biobank (UKB), the Philadelphia Neurodevelopmental Cohort (PNC), the Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP), and an OpenNeuro Fibromyalgia dataset (Fibro). The unintentional improvement ranges between 7% and 25% in the four datasets. Additionally, we find that by using dynamic functional connectivity (dFC), one can apply this method even when one is limited to a single scan per subject. One major problem is that features such as ROIs or connectivities that are reported alongside inflated results may confuse future work. This article hopes to shed light on how even minor pipeline anomalies may lead to unexpectedly superb results.

Latent Similarity Identifies Important Functional Connections for Phenotype Prediction

OBJECTIVE

Endophenotypes such as brain age and fluid intelligence are important biomarkers of disease status. However, brain imaging studies to identify these biomarkers often encounter limited numbers of subjects but high dimensional imaging features, hindering reproducibility. Therefore, we develop an interpretable, multivariate classification/regression algorithm, called Latent Similarity (LatSim), suitable for small sample size but high feature dimension datasets.

METHODS

LatSim combines metric learning with a kernel similarity function and softmax aggregation to identify task-related similarities between subjects. Inter-subject similarity is utilized to improve performance on three prediction tasks using multi-paradigm fMRI data. A greedy selection algorithm, made possible by LatSim's computational efficiency, is developed as an interpretability method.

RESULTS

LatSim achieved significantly higher predictive accuracy at small sample sizes on the Philadelphia Neurodevelopmental Cohort (PNC) dataset. Connections identified by LatSim gave superior discriminative power compared to those identified by other methods. We identified 4 functional brain networks enriched in connections for predicting brain age, sex, and intelligence.

CONCLUSION

We find that most information for a predictive task comes from only a few (1-5) connections. Additionally, we find that the default mode network is over-represented in the top connections of all predictive tasks.

SIGNIFICANCE

We propose a novel prediction algorithm for small sample, high feature dimension datasets and use it to identify connections in task fMRI data. Our work can lead to new insights in both algorithm design and neuroscience research.

Predictors of treatment completion in group psychotherapy for male veterans with posttraumatic stress disorder

Group therapy is a frequently used therapy format for posttraumatic stress disorder (PTSD). However, factors contributing to treatment completion remain understudied. The current study examined predictors of treatment completion, defined as having completed 10 out of 14 sessions within 16 weeks, in veterans with PTSD who engaged in a hybrid efficacy-effectiveness randomized controlled trial of group psychotherapy for PTSD. Veterans (N = 198) were randomly assigned to 14 sessions of either group cognitive behavioral treatment (GBCT; n = 98) or group present-centered treatment (GPCT; n = 100). Four primary domains of predictors were examined, encompassing sociodemographic factors, the severity of PTSD and comorbid conditions, modifiable predictors, and treatment condition. Multilevel binomial logistic regression models following the Fournier analysis approach were used to examine significant predictors within domains, which were then included in a final model. Overall, 70.7% of participants completed treatment (GCBT = 61.6%, GPCT = 79.8%). Participants in the GPCT condition were 2.389 times, 95% CI [1.394, 4.092], more likely to complete treatment than those in the GCBT condition. Older age, a higher income and level of educational attainment, more lifetime and current mental health diagnoses, and higher use of positive reappraisal ER skills predicted treatment completion. Higher levels of depressive symptoms, cumulative trauma burden, and use of positive refocusing ER skills predicted treatment noncompletion. These findings are discussed in the context of current clinical and research practices for examining treatment noncompletion, with attention to the inclusion of translational predictors.

Cerebral cortical thickness and cognitive decline in Parkinson's disease

In Parkinson's disease (PD), reduced cerebral cortical thickness may reflect network-based degeneration. This study performed cognitive assessment and brain MRI in 30 PD participants and 41 controls at baseline and 18 months later. We hypothesized that cerebral cortical thickness and volume, as well as change in these metrics, would differ between PD participants who remained cognitively stable and those who experienced cognitive decline. Dividing the participant sample into PD-stable, PD-decline, and control-stable groups, we compared mean cortical thickness and volume within segments that comprise the prefrontal cognitive-control, memory, dorsal spatial, and ventral object-based networks at baseline. We then compared the rate of change in cortical thickness and volume between the same groups using a vertex-wise approach. We found that the PD-decline group had lower cortical thickness within all 4 cognitive networks in comparison with controls, as well as lower cortical thickness within the prefrontal and medial temporal networks in comparison with the PD-stable group. The PD-decline group also experienced a greater rate of volume loss in the lateral temporal cortices in comparison with the control group. This study suggests that lower thickness and volume in prefrontal, medial, and lateral temporal regions may portend cognitive decline in PD.

Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study

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.

Educational quality may be a closer correlate of cardiometabolic health than educational attainment

Educational quality may be a closer correlate of physical health than more commonly used measures of educational attainment (e.g., years in school). We examined whether a widely-used performance-based measure of educational quality is more closely associated with cardiometabolic health than educational attainment (highest level of education completed), and whether perceived control (smaller sample only), executive functioning (both samples), and health literacy (smaller sample only) link educational quality to cardiometabolic health. In two samples (N = 98 and N = 586) collected from different regions of the US, educational quality was associated with cardiometabolic health above and beyond educational attainment, other demographic factors (age, ethnoracial category, sex), and fluid intelligence. Counter to expectations, neither perceived control, executive function, nor health literacy significantly mediated the association between educational quality and cardiometabolic health. Findings add to the growing literature suggesting that current operationalizations of the construct of education likely underestimate the association between education and multiple forms of health. To the extent that educational programs may have been overlooked based on the apparent size of associations with outcomes, such actions may have been premature.

Association of Plasma and Cerebrospinal Fluid Alzheimer Disease Biomarkers With Race and the Role of Genetic Ancestry, Vascular Comorbidities, and Neighborhood Factors

IMPORTANCE

Differences in cerebrospinal fluid (CSF) tau Alzheimer dementia (AD) biomarkers by self-identified race have been observed in prior studies. More recently, plasma biomarkers have been gaining recognition, but whether they exhibit similar differences is unclear. Furthermore, the underlying explanation for these differences in AD biomarkers is still unexplored.

OBJECTIVES

To investigate differences in plasma biomarkers by race and genetic ancestry and explore potential underlying explanations for these differences.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used participant data from the Brain, Stress, Hypertension, and Aging Research Program (B-SHARP), an observational study conducted in the greater Atlanta metropolitan area. Participants were enrolled from March 1, 2016, to January 1, 2020.

MAIN OUTCOMES AND MEASURES

Main outcomes were plasma and CSF amyloid-β (Aβ) 42, Aβ40, phosphorylated tau181 (p-tau181), and neurofilament light. General linear models were used for key comparisons.

EXPOSURES

Main independent variables were self-identified race and genetic ancestry. Additional variables were cardiovascular factors, APOE4, educational attainment, Area Deprivation Index, and C-reactive protein (reflecting systemic inflammation state).

RESULTS

This analysis included 617 participants (mean [SD] age, 66 [7.9] years; 300 [49%] African American and 317 [51%] White; 429 [70%] with mild cognitive impairment). On the basis of self-reported race, plasma levels of Aβ42 (adjusted mean difference, -1.20 pg/mL; 95% CI, -2.33 to -0.07 pg/mL), Aβ40 (adjusted mean difference, -37.78 pg/mL; 95% CI, -60.16 to -15.39 pg/mL), p-tau181 (adjusted mean difference, -4.66 pg/mL; 95% CI, -7.05 to -1.90 pg/mL), and neurofilament light (adjusted mean difference, -1.58; 95% CI, -2.83 to -0.19 pg/mL) were consistently lower in African American individuals after adjusting for demographic characteristics, educational attainment, cognition, APOE4, and cardiovascular factors. A similar pattern was observed in the CSF biomarkers except for Aβ42 and Aβ40. Although unadjusted analyses revealed an association between these biomarkers and African ancestry, these associations were not significant after adjusting for the same covariates. Differences by self-reported race were not explained by varied cardiovascular risk factors, C-reactive protein, educational attainment, or Area Deprivation Index.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of plasma biomarkers by race and genetic ancestry, the results indicated that plasma p-tau181, Aβ40, and NFL were lower in African American individuals based on self-reported race but not genetic ancestry. These differences were not explained by cardiovascular risks or clinical stage differences. These racial differences should be considered in clinical interpretations and clinical trial screenings to avoid an additional increase in underrepresentation of African American individuals in AD trials.

A case-control and seven-year longitudinal neurocognitive study of adults with sickle cell disease in Ghana

Ageing in sickle cell disease (SCD) is associated with a myriad of end-organ complications, including cerebrovascular damage and cognitive impairment (CI). Although CI is very common in SCD, little is known about cognitive functioning and how it changes with age. This study examines cognitive patterns of 63 adults with SCD and 60 non-SCD, age- and education-matched controls in Ghana. Of those adults with SCD, 34 completed the neuropsychological battery at baseline and again seven years later. In cross-sectional data, adults with SCD performed worse than controls in all cognitive test domains (p < 0.01 for all). The seven-year follow-up data showed that the group exhibited a significant decline in visuospatial abilities (ranging from Cohen's d = 1.40 to 2.38), and to a lesser extent, in processing speed and executive functioning. Exploratory analyses showed a significant time-by-education interaction, indicating that education may be protective from decline in cognitive performance. These findings have implications for clinical practice. Early neuropsychological surveillance coupled with early assessment and remedial programmes will provide avenues for enhancing the quality of life of adults living with SCD in Ghana.

Correlates of subjective and objective everyday functioning in middle-aged and older adults with human immunodeficiency virus

People with human immunodeficiency virus (HIV) (PWH) are at an increased risk for impaired everyday functioning and they may also experience poor awareness of their functional status. This study identified factors associated with (1) subjective and objective instrumental activities of daily living (IADLs) and (2) awareness of functional capacity in PWH. In this cross-sectional study, 236 PWH completed a neurobehavioral assessment, including self-report and performance-based measures of IADLs. Multiple regressions were performed to identify demographic, personality, and cognitive factors contributing to subjective and objective evaluation of everyday functioning, as well as discrepancy between self-report and performance-based measures of IADLs. Results indicated that increased depression was associated with worsened self-report of everyday functioning but not performance of IADLs. Cognitive function and age were associated with IADL performance. Most participants (58.1%) demonstrated a discrepancy between self-report and actual performance of IADLs. Worse processing speed was correlated with greater discrepancy. Inaccurate self-reporters had worse overall cognitive functioning and lower levels of personality traits, including openness, conscientiousness, and agreeableness. In conclusion, self-report and actual performance of IADLs in PWH is influenced by different factors. Self-report may be more affected by psychological variables, such as mood and personality, while actual performance is more sensitive to age and cognitive function.

Do cognitive impairments limit treatment gains in a standalone digital intervention for psychosis? A test of the digital divide

Digital mental health interventions, such as those provided by smartphone applications (apps), show promise as cost-effective approaches to increasing access to evidence-based psychosocial interventions for psychosis. Although it is well known that limited financial resources can reduce the benefits of digital approaches to mental healthcare, the extent to which cognitive functioning in this population could impact capacity to engage in and benefit from these interventions is less studied. In the current study we examined the extent to which cognitive functioning (premorbid cognitive abilities and social cognition) were related to treatment engagement and outcome in a standalone digital intervention for social functioning. Premorbid cognitive abilities generally showed no association with aggregated treatment engagement markers, including proportion of notifications responded to and degree of interest in working on app content, though there was a small positive association with improvements in social functioning. Social cognition, as measured using facial affect recognition ability, was unrelated to treatment engagement or outcome. These preliminary findings suggest that cognitive functioning is generally not associated with engagement or outcomes in a standalone digital intervention designed for and with people with schizophrenia spectrum disorders.

Reading fluency as a measure of educational level

Education exerts a powerful influence on the performance on neuropsychological tests. Recently, the number of years that a person attends school has been the preferred method to operationalize educational level (EL). However, reading fluency (RF) has emerged as an alternative method that can define the quality of education.

A Short Form of the Financial Exploitation Vulnerability Scale

OBJECTIVES

The purpose of the present study was to develop a short form of the Financial Exploitation Vulnerability Scale (FEVS) with good psychometric properties to detect contextual risk exploitation.

METHODS

The sample included community volunteers who were 60 years and older, as well as elders who were referred to the SAFE program after being the victim of a financial scam or identity theft. All participants completed the FEVS as part of a larger test battery. Factors analysis was used to explore the underlying structure of the FEVS and eliminate items. ROC analysis and logistic regression were used to evaluate the clinical utility of the Financial Exploitation Vulnerability Scale - Short Form (FEVS-SF) to detect exploitation.

RESULTS

The resulting FEVS-SF was unidimensional, contained nine items, and had comparable internal consistency to the full FEVS. Sensitivity and specificity were good at a cut score of five or greater. FEVS-SF was a better predictor of exploitation than demographic factors and several measures of cognitive functioning.

CONCLUSIONS

The FEVS-SF can detect the experience of financial exploitation among older adults better than other known risk factors, and equally as well as a measure of executive functioning.

CLINICAL IMPLICATIONS

This tool serves a need in many professional settings (e.g., doctor's offices and Adult Protective Services) for a brief, standardized assessment measure of financial exploitation risk. This measure also provides actionable information for professionals to follow up with the standard of care for their clients.

Cognitive Reserve Moderates Associations Between Walking Performance Under Single- and Dual-Task Conditions and Incident Mobility Impairment in Older Adults

BACKGROUND

Among older adults, walking performance is a reliable indicator of adverse health outcomes including incident mobility impairment. Whereas, attention and executive functions have been implicated in cognitive control of locomotion, much less is known about the role of cognitive reserve (CR) in predicting mobility impairments among older adults. Specifically, whether CR moderates the relationship between gait performance and incident mobility impairment has not been reported. To address this gap in the literature, we examined whether gait performance under single-task walk (STW) and dual-task walk (DTW) conditions predicted incident mobility impairment and whether CR moderated this relationship.

METHOD

Participants were 176 (mean age = 75.57; % female = 53) older adults with baseline Short Physical Performance Battery (SPPB) scores of 10-12. Participants completed neuropsychological testing, the SPPB, and a DTW protocol. CR was evaluated using the Wide Range Achievement Test, third edition. Participants were followed for 3 years; individuals whose SPPB scores declined below 10 were defined as incident cases of mobility impairment (n = 42).

RESULTS

Moderation analyses revealed significant interaction effects of CR with walking velocity under STW (b = 0.09, 95% CI [0.01, 0.17], z = 2.30, p = .02) and DTW (b = 0.10, 95% CI [0.02, 0.17], z = 2.55, p = .01) conditions, wherein slower gait predicted increased risk of incident mobility impairment among individuals with lower CR.

CONCLUSION

These findings extend knowledge about the interrelation of cognitive and mobility functions, revealing the critical role of CR in identifying older adults at risk of developing incident mobility impairment.

The impact of sociocultural factors on prospective memory performance in HIV+ Latinx adults

OBJECTIVE

Prospective memory (PM), a salient component of neurocognitive functioning for people living with HIV (PLH), is necessary for planning and coordinating health-related behaviors and instrumental tasks of daily living. However, little is known regarding the impact of sociocultural factors on PM in diverse populations, particularly Latinx PLH. The aim of this study was to examine ethnic group differences and sociocultural factors related to PM.

METHOD

The sample of 127 PLH (91 Latinx and 36 non-Latinx white) completed measures of quality of education, socioeconomic status (SES), and a validated PM measure, the Memory for Intentions Screening Test (MIST). The Latinx group also completed a bicultural acculturation measure.

RESULTS

Results revealed the Latinx and the non-Latinx white groups did not significantly differ in overall MIST performance (all p > .05). In the entire sample, better quality of education was associated with better MIST performance (all p < .05). Within the Latinx group, higher Latinx acculturation was associated with worse MIST performance (p = .02), whereas higher U.S. acculturation was associated with better MIST performance at a trend level (p = .07). Multivariate regressions revealed quality of education and Latinx acculturation significantly predicted MIST performance and PM errors (all p < .05). SES was not related to the MIST (all p > .10).

CONCLUSIONS

In sum, clinicians must take sociocultural factors into consideration when working with Latinx PLH, as these factors influence cognitive functions (i.e., PM) vital to health-related behaviors. Integrating culturally-informed psychoeducation into care plans is an imperative first step. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Socioeconomic Mobility and Psychological and Cognitive Functioning in a Diverse Sample of Adults With and Without HIV

OBJECTIVE

This cross-sectional study examined the effects of socioeconomic status (SES) mobility from childhood to adulthood on psychological and cognitive well-being in African American and non-Hispanic White HIV-positive (HIV+) and HIV-seronegative (HIV-) adults who are part of an ongoing study investigating psychosocial and neurobehavioral effects of HIV.

METHODS

Participants (N = 174, 24.1% female, 59.2% African American, 67.8% HIV+) were categorized into four groups (upward mobility, downward mobility, stable-not-poor, chronic-poverty) based on self-reported childhood and current community SES (which were correlated with objective measures of SES and proxies of childhood SES). SES groups were compared on self-report measures of psychological well-being, subjective executive functioning ratings, and performance across six cognitive domains. Primary analyses were stratified by HIV status.

RESULTS

For the HIV+ group, SES mobility was associated with psychological well-being (chronic burden of stress: F(7,101) = 3.17, mean squared error [MSE] = 49.42, p = .030, η2 = 0.14; depressive symptoms: F(7,101) = 4.46, MSE = 70.49, p = .006,η2 = 0.14), subjective ratings of executive dysfunction (F(7,101) = 6.11, MSE = 114.29, p = .001,η2 = 0.18), and objective performance in executive functioning (F(9,99) = 3.22, MSE = 249.52, p = .030, η2 = 0.15) and learning (F(9,99) = 3.01, MSE = 220.52, p = .034, η2 = 0.13). In the control group, SES mobility was associated with chronic stress burden (F(5,49) = 4.677, p = .025, η2 = 0.15); however, no other relationships between SES mobility and outcomes of interest were observed (all p values > .20). In general, downward mobility and chronic poverty were associated with worse ratings across psychological well-being measures and cognitive performance.

CONCLUSIONS

Findings within the HIV+ group are consistent with previous studies that report downward mobility to be associated with poor psychological outcomes. People living with HIV may be particularly vulnerable to the adverse effects of socioeconomic instability.

Identification of Modifiable Social and Behavioral Factors Associated With Childhood Cognitive Performance

IMPORTANCE

Inequities in social environments are likely associated with a large portion of racial disparities in childhood cognitive performance. Identification of the specific exposures associated with cognitive development is needed to inform prevention efforts.

OBJECTIVE

To identify modifiable factors associated with childhood cognitive performance.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal pregnancy cohort study included 1503 mother-child dyads who were enrolled in the University of Tennessee Health Science Center-Conditions Affecting Neurodevelopment and Learning in Early Life study between December 1, 2006, and July 31, 2011, and assessed annually until the children were aged 4 to 6 years. The analytic sample comprised 1055 mother-child dyads. A total of 155 prenatal, perinatal, and postnatal exposures were included to evaluate environment-wide associations. Participants comprised a community-based sample of pregnant women who were recruited between 16 weeks and 28 weeks of gestation from 4 hospitals in Shelby County, Tennessee. Women with high-risk pregnancies were excluded. Data were analyzed from June 1, 2018, to April 15, 2019.

EXPOSURES

Individual and neighborhood socioeconomic position, family structure, maternal mental health, nutrition, delivery complications, birth outcomes, and parenting behaviors.

MAIN OUTCOMES AND MEASURES

Child's full-scale IQ measured by the Stanford-Binet Intelligence Scales, Fifth Edition, at age 4 to 6 years.

RESULTS

Of 1055 children included in the analytic sample, 532 (50.4%) were female. Among mothers, the mean (SD) age was 26.0 (5.6) years; 676 mothers (64.1%) were Black, and 623 mothers (59.0%) had an educational level of high school or less. Twenty-four factors were retained in the least absolute shrinkage and selection operator regression analysis and full models adjusted for potential confounding. Associations were noted between child cognitive performance and parental education and breastfeeding; for each increase of 1.0 SD in exposure, positive associations were found with cognitive growth fostering from observed parent-child interactions (β = 1.12; 95% CI, 0.24-2.00) and maternal reading ability (β = 1.42; 95% CI, 0.16-2.68), and negative associations were found with parenting stress (β = -1.04; 95% CI, -1.86 to -0.21). A moderate increase in these beneficial exposures was associated with a notable improvement in estimated cognitive test scores using marginal means (0.5% of an SD). Black children experienced fewer beneficial cognitive performance exposures; in a model including all 24 exposures and covariates, no racial disparity was observed in cognitive performance (95% CIs for race included the null).

CONCLUSIONS AND RELEVANCE

The prospective analysis identified multiple beneficial and modifiable cognitive performance exposures that were associated with mean differences in cognitive performance by race. The findings from this observational study may help guide experimental studies focused on reducing racial disparities in childhood cognitive performance.

Relationships between intrinsic functional connectivity, cognitive control, and reading achievement across development

There are vast individual differences in reading achievement between students. Besides structural and functional variability in domain-specific brain regions, these differences may partially be explained by the organization of domain-general functional brain networks. In the current study we used resting-state functional MRI data from the Philadelphia Neurodevelopmental Cohort (PNC; N = 553; ages 8-22) to examine the relation between performance on a well-validated reading assessment task, the Wide Range Achievement Word Reading Test (WRAT-Reading) and patterns of functional connectivity. We focused specifically on functional connectivity within and between networks associated with cognitive control, and investigated whether the relationship with academic test performance was mediated by cognitive control abilities. We show that individuals with higher scores on the WRAT-Reading, have stronger lateralization in frontoparietal networks, increased functional connectivity between dorsal striatum and the dorsal attention network, and reduced functional connectivity between dorsal and ventral striatum. The relationship between functional connectivity and reading performance was mediated by cognitive control abilities (i.e., performance on a composite measure of executive function and complex cognition), but not by abilities in other domains, demonstrating the specificity of our findings. Finally, there were no significant interactions with age, suggesting that the observed brain-behavior relationships stay relatively stable over the course of development. Our findings provide important insights into the functional significance of inter-individual variability in the network architecture of the developing brain, showing that functional connectivity in domain-general control networks is relevant to academic achievement in the reading domain.

Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study

Background

The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA).

Methods/design

We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events.

Discussion

We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.

Disparities in Electronically Monitored Antiretroviral Adherence and Differential Adherence Predictors in Latinx and Non-Latinx White Persons Living with HIV

Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.

Latent Factor Structure and Construct Validity of the Cognitive Emotion Regulation Questionnaire-Short Form Among Two PTSD Samples

The Cognitive Emotion Regulation Questionnaire-Short form (CERQ-Short; Garnefski & Kraaij, 2006) was developed to assess nine theoretically derived factors of emotion regulation. However, the psychometric properties of this measure have never been studied in a clinical sample. The present study examined the latent factor structure and construct validity of the CERQ-Short in two samples presenting for posttraumatic stress disorder treatment (N = 480). Results indicated that a six-factor solution, rather than the proposed nine factors, was the best-fitting measurement model. The original CERQ-Short factors of acceptance, positive refocusing, other-blame, and self-blame were retained. A novel perseveration factor incorporated both the original rumination and catastrophizing factors and a novel reappraisal factor incorporated items from the original positive reappraisal and putting into perspective factors. The revised six-factor measurement model provided good fit and demonstrated strong construct validity in a second clinical sample. Results support a more parsimonious six-factor CERQ-Short measurement model.

Academic aptitude mediates the relationship between socioeconomic status and race in predicting ImPACT scores in college athletes

Objective: To evaluate the influences of sociodemographic factors, estimated head impact exposure, and academic aptitude on ImPACT scores in college athletes.Methods: Data were reported on 18,886 participants (58% male) from the NCAA/DoD CARE Consortium. Race, SES, concussion history, estimated repetitive head impact exposure (eRHIE), and academic aptitude (SAT or ACT score) were our predictors of interest. Cognition was measured using ImPACT composite scores. We evaluated the mediating effects of academic aptitude on sociodemographic predictors and eRHIE on ImPACT scores. We then evaluated a football-only subsample and added age of first exposure to football (AFE) to the model. Males, females, and football players were analyzed separately using structural equation modeling.Results: Academic aptitude was associated with Black/African American race, SES, and each of the ImPACT composite scores. There were significant indirect effects of Black/African American race and SES on all ImPACT composite scores. Academic aptitude fully mediated SES effects and either fully or partially mediated race effects. Contrary to expectation, greater concussion history and eRHIE predicted better ImPACT scores.Conclusions: Academic aptitude, a stable indicator of premorbid cognitive function, consistently and most strongly predicted baseline ImPACT scores in collegiate student-athletes. Concussion and eRHIE history demonstrated a small positive, but non-significant, relationship with cognitive scores at the time of college athletic participation. This study suggests that attempts to characterize cognitive ability across the lifespan must consider premorbid functioning and sociodemographic variables.

Development and public release of the Penn Reading Assessment Computerized Adaptive Test (PRA-CAT) for premorbid IQ

An important component of neuropsychological testing is assessment of premorbid intelligence to estimate a patient's ability independent of neurological impairment. A common test of premorbid IQ-namely, the Reading section of the Wide Range Achievement Test (WRAT)-has been shown to have high measurement error in the high ability range, is unnecessarily long (55 items), and is proprietary. We describe the development of an alternative, nonproprietary, computerized adaptive test for premorbid IQ, the Penn Reading Assessment (PRA-CAT). PRA-CAT items were calibrated using a 1-parameter item response theory model in a large community sample (N = 9,498), Ages 8 to 21, and the resulting parameters were used to simulate computerized adaptive testing sessions. Simulations demonstrated that the PRA-CAT achieves low measurement error (0.25; equivalent to Cronbach's alpha = .94) and acceptable measurement error (0.40; Cronbach's alpha = .84) after only 18 and 6 items, respectively (on average). Correlation of WRAT and PRA-CAT scores with numerous clinical, cognitive, demographic, and neuroimaging criteria suggests that validity of PRA-CAT score interpretation is comparable (and sometimes superior) with the WRAT. The fully functioning PRA-CAT for public use (including item parameter estimates reported here) has been built using the open-source program Concerto, and can be installed by anyone on a local computer or on the "cloud." Given the length and proprietary nature of the WRAT, the PRA-CAT shows promise as a potential alternative (and with minimal or no cost). Further validation in the context of neurological injury is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cross-sectional and longitudinal associations between total and regional white matter hyperintensity volume and cognitive and motor function in Parkinson's disease

Background

White matter hyperintensities (WMH) are frequently observed on T2-weighted brain magnetic resonance imaging studies of healthy older adults and have been linked with impairments in balance, gait, and cognition. Nonetheless, few studies have investigated the longitudinal effects of comorbid WMH on cognition and motor function in Parkinson's disease.

Methods

The Lesion Segmentation Tool for Statistical Parametric Mapping was used to obtain total lesion volume and map regional WMH probabilities in 29 PD and 42 control participants at two study visits 18 months apart. Both cross-sectional and longitudinal comparisons were made between composite scores in the domains of executive function, memory, and language, and Unified Parkinson's Disease Rating Scale (UPDRS) scores.

Results

We found no difference between disease and control groups in total WMH volume or progression during the study. Greater regional and global WMH at baseline was more strongly associated with lower executive function in PD subjects than in controls. Increased regional WMH was also more strongly associated with impaired memory performance in PD relative to controls. Longitudinally, no associations between cognitive change and total or regional WMH progression were detected in either group. A positive relationship between baseline regional WMH and total UPDRS scores was present in the control group, but not PD. However, greater WMH increase was associated with a greater increase in UPDRS motor sub-scores in PD.

Conclusions

These findings suggest that although PD patients do not experience greater mean WMH load than normal aged adults, comorbid WMH do exacerbate cognitive and motor symptoms in PD.

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PD patients did not demonstrate greater white matter lesion burden at baseline.

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PD patients did not have increased white matter lesion accumulation over 18 months.

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Lesion burden was related to lower executive function and memory in PD patients.

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Greater total lesion accumulation was associated to worsening motor scores in PD.

Childhood polybrominated diphenyl ether (PBDE) serum concentration and reading ability at ages 5 and 8 years: The HOME Study

BACKGROUND

Polybrominated diphenyl ethers (PBDEs) exist extensively in the environment and human beings. PBDE concentrations are higher in children than adults. A previous study found that prenatal PBDE exposure was associated with decreased reading skills in children; however, evidence is limited on the potential impact of childhood exposure to PBDEs. The study examined the association between childhood PBDE exposures and reading ability in children at ages 5 and 8 years.

METHODS

The study included 230 children from an ongoing prospective pregnancy and birth cohort study, the Health Outcomes and Measures of Environment (HOME) Study, conducted in Cincinnati, Ohio. Children's serum concentrations of eleven PBDE congeners were measured at 1, 2, 3, 5, and 8 years. The Woodcock-Johnson Tests of Achievement - III and the Wide Range Achievement Test - 4 were administered to assess children's reading skills at ages 5 and 8 years, respectively. We used multiple informant models to examine the associations between repeated measures of PBDEs and reading scores at ages 5 and 8 years. We also estimated the βs and 95% CIs of the association of PBDE measure at each age by including interaction terms between PBDE concentrations and child age in the models.

RESULTS

All childhood BDE-153 concentrations were inversely associated with reading scores at 5 and 8 years, but associations were not statistically significant after covariate adjustment. For example, a 10-fold increase in BDE-153 concentrations at ages 3 and 5 years was associated with a -5.0 (95% confidence interval (CI): -11.0, 1.0) and -5.5 (95% CI: -12.5, 1.4) point change in Basic Reading score at age 5 years, respectively. Similarly, the estimates for Brief Reading score at age 5 years were -4.5 (95% CI: -10.5, 1.5) and -5.2 (95% CI: -12.2, 1.7) point changes, respectively. Serum concentration of BDE-47, -99, -100, and Sum₄PBDEs (sum of BDE-47, 99, 100, and 153) at every age were inversely associated with reading scores at ages 5 and 8 years in unadjusted analyses. While the adjusted estimates were much attenuated and became non-significant, the direction of most of the associations was not altered.

CONCLUSION

Our study has shown a suggestive but non-significant trend of inverse associations between childhood PBDE serum concentrations, particularly BDE-153, and children's reading skills. Future studies with a larger sample size are needed to examine these associations.

Cognitive deficit in methamphetamine users relative to childhood academic performance: link to cortical thickness

Individuals with cognitive problems may be predisposed to develop substance use disorders; therefore, differences in cognitive function between methamphetamine users and control participants may be attributable to premorbid factors rather than methamphetamine use. The goal of this study was to clarify the extent to which this is the case. Childhood academic transcripts were obtained for 37 methamphetamine-dependent adults and 41 control participants of similar educational level and premorbid IQ. Each participant completed a comprehensive cognitive battery and received a structural magnetic resonance imaging scan. Data from control participants and linear regression were used to develop a normative model to describe the relationship between childhood academic performance and scores on the cognitive battery. Using this model, cognitive performance of methamphetamine users was predicted from their premorbid academic scores. Results indicated that methamphetamine users' childhood grade point average was significantly lower than that of the control group (p < 0.05). Further, methamphetamine users' overall cognitive performance was lower than was predicted from their grade point average prior to methamphetamine use (p = 0.001), with specific deficits in attention/concentration and memory (ps < 0.01). Memory deficits were associated with lower whole-brain cortical thickness (p < 0.05). Thus, in addition to having an apparent premorbid weakness in cognition, methamphetamine users exhibit subsequent cognitive function that is significantly lower than premorbid estimates would predict. The results support the view that chronic methamphetamine use causes a decline in cognition and/or a failure to develop normative cognitive abilities, although aside from methamphetamine use per se, other drug use and unidentified factors likely contribute to the observed effects.

Cerebral Structure and Cognitive Performance in African Americans and European Americans With Type 2 Diabetes

Background

African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes.

Methods

Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors.

Results

The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p = .001) was lower and WMLV higher in African Americans than European Americans (p = .001), with similar GMV (p = .30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10-23-7 × 10-62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p = .0009-.65).

Conclusions

African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT.

The association between educational parameters and a cognitive screening measure in older blacks

ABSTRACTBackground:To expand on prior literature by examining how various education parameters (performance-based reading literacy, years of education, and self-rated quality of education) relate to a cognitive screening measure's total and subscale scores of specific cognitive abilities.

METHODS

Black adults (age range: 55-86) were administered self-rated items years of education and quality of education, and a measure of performance-based reading literacy. The Mini-Mental State Examination (MMSE) was used to screen for overall cognitive functioning as well as performance on specific cognitive abilities.

RESULTS

Sixty-nine percent of the sample had reading grade levels that were less than their reported years of education. Lower years of education and worse reading literacy are associated with poorer MMSE performance, particularly on the attention and calculation subscales.

CONCLUSIONS

Years of education, a commonly used measure for education, may not be reflective of Black adults' educational experiences/qualities. Thus, it is important to account for the unique educational experiences of adults that could influence their MMSE performance. Incorporating quality and quantity of education will provide a more comprehensive understanding of the individual's performance on cognitive measures, specifically as it relates to sociocultural differences.

Investigation of Summer Learning Loss in the UK-Implications for Holiday Club Provision

This study sought to examine whether summer learning loss occurs in spelling and word reading in a population of 77 primary school aged children aged between 5 and 10 years (37 boys, mean age 100 months, SD 18 months, and 40 girls mean age 103 months, SD 16 months) attending three schools in areas of low socioeconomic status in Scotland and the North East of England. Word reading and spelling was measured using the word reading and spelling subtests of the Wide Ranging Achievement Test. Participants were tested on three occassions: immediately before and immediately after a 7-week summer break, and again after 7-weeks of teaching. The results showed a significant main effect of time for spelling scores, F(2,136) = 21.60, p < 0.001, [Formula: see text]. Post-hoc analysis [t(73) = 4.84, p ≤ 0.001] showed that spelling scores were significantly higher at the end of the summer term (M = 26.57) than at the start of the new academic year (M = 25.38). Likewise, spelling scores after 7 weeks post return to school (M = 27.61) were significantly higher than at the start of the Autumn term, t(73) = 7.79, p ≤ 0.001. Performance in spelling declined when children returned to school immediately after the summer holiday (M = 25.38) but 7 weeks later, performance had improved beyond the baseline reported immediately before the summer break (M = 26.57) [t(73) = 4.40, p ≤ 0.001]. There was also a main effect of school in relation to spelling scores, [F(2,68) = 6.49, p < 0.05, [Formula: see text]], with children from school 2 and school 3 outperforming children from school 1. There was no signficant main effect of gender [F(1,68) = 1.47, p > 0.05, [Formula: see text]]. None of the interactions were significant. There was no main effect of time on word reading scores [F(2,136) = 1.12, p ≥ 0.05, [Formula: see text]]. However, there was a main effect of school [F(2,68) = 4.85, p ≤ 0.01, [Formula: see text]] in relation to reading scores, with children from school 2 and school 3 outperforming children from school 1. There was no significant main effect of gender [F(1,68) = 0.37, p ≥ 0.05, [Formula: see text]]. None of the interactions were significant. This is the first such study in the UK to demonstrate that after a summer break of seven weeks, summer learning loss occurred, or at least stagnation in learning, in a population of primary school aged children attending schools in areas of low SES in relation to spelling. However, after seven weeks of teaching, children caught up to and exceeded the level achieved in spelling prior to the summer break. However, the summer holiday period did not result in a loss of word reading skill, reading scores were consistent across the entire study.

Prenatal PBDE and PCB Exposures and Reading, Cognition, and Externalizing Behavior in Children

BACKGROUND

Prenatal polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) exposures may influence children's neurodevelopment.

OBJECTIVE

We examined the association of prenatal PBDE and PCB exposures with children's reading skills at ages 5 and 8 years, Full-Scale Intelligence Quotient (FSIQ), and externalizing behavior problems at age 8 years.

METHODS

From 239 mother-child pairs recruited (2003-2006) in Cincinnati, Ohio, we measured maternal serum PBDE and PCB concentrations, assessed child's reading skills using the Woodcock-Johnson Tests of Achievement III (WJ-III) at age 5 years and the Wide Range Achievement Test-4 (WRAT-4) at age 8 years, tested FSIQ using the Wechsler Intelligence Scale for Children-IV (WISC-IV), and externalizing behavior problems using the Behavioral Assessment System for Children-2 (BASC-2) at age 8 years. We used multiple linear regression to examine the association of prenatal PBDE and PCB concentrations and reading, FSIQ, and externalizing behavior problems after adjusting for covariates.

RESULTS

An increase of Sum4PBDEs (BDE-47, BDE-99, BDE-100, and BDE-153) by 10 times was not significantly associated with reading scores at age 5 years at the p = 0.05 level but was inversely associated with Reading Composite scores (β: -6.2, 95% CI: -11.7, -0.6) and FSIQ (β: -5.3, 95% CI: -10.6, -0.02) at age 8 years; it was positively associated with the score for externalizing behavior problems (β: 3.5, 95% CI: -0.1, 7.2) at age 8 years. Prenatal Sum4PCBs (PCB-118, -153, -138-158, and -180) was not significantly associated with a child's reading skills, FSIQ, and externalizing behavior problems.

CONCLUSION

Prenatal PBDE concentration was inversely associated with reading skills and FSIQ and positively associated with externalizing behavior problems at age 8 years. No significant associations were found in prenatal PCB concentration.

Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults

Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9% of the variance in years of schooling, 6% of memory, and 12% of language. Among HRS African Americans, state of school attendance accounted for 13% of the variance in years of schooling and also contributed to variance in cognitive function (7%), memory (2%), and vocabulary (12%). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education.

RBANS Norms based on the Relationship of Age, Gender, Education, and WRAT-3 Reading to Performance within an Older African American Sample

OBJECTIVE

Due to factors including differences in educational opportunity, African Americans and Caucasians frequently differ on cognitive tests creating diagnostic error risks. Such differences have been found on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and preliminary norms based on a small sample of African Americans have been generated. In a larger sample of community-dwelling older African Americans, we explored sources of variance including age, gender, common medical conditions, years of education, and reading level to generate norms stratified on the most relevant bases.

METHOD

Three hundred and fifty-five African Americans aged 55+ and living independently completed the RBANS and health, education, and psychosocial interviews.

RESULTS

Hypertension and type 2 diabetes were unrelated to overall RBANS performance once age and education were accounted for. Age, education, and WRAT-3 Reading score (a proxy for scholastic attainment) were independent predictors of RBANS performance. Females performed better on List Learning, Story Memory, Fluency, Coding, List Recall, and List Recognition; males were superior on Line Orientation and Picture Naming.

CONCLUSIONS

In addition to generating norms stratified by age, we provide descriptive statistics grouped by age and education, and by age and WRAT-3 Reading grade level, to provide clinicians with the opportunity to tailor their interpretation of scores based upon perceived best fit for their patient. Regression formulas are provided to address gender differences. To complement the standard index norms, we provide norms for alternative indexes representing additional an factor structure of cognitive domains.