The 12-Word Philadelphia Verbal Learning Test Performances in Older Adults: Brain MRI and Cerebrospinal Fluid Correlates and Regression-Based Normative Data

Recent Advances in Neuropsychological Test Interpretation for Clinical Practice

Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.

Multi-Site Cross-Site Inter-Rater and Test-Retest Reliability and Construct Validity of the MarkVCID White Matter Hyperintensity Growth and Regression Protocol

BACKGROUND

White matter hyperintensities (WMH) that occur in the setting of vascular cognitive impairment and dementia (VCID) may be dynamic increasing or decreasing volumes or stable over time. Quantifying such changes may prove useful as a biomarker for clinical trials designed to address vascular cognitive-impairment and dementia and Alzheimer's Disease.

OBJECTIVE

Conducting multi-site cross-site inter-rater and test-retest reliability of the MarkVCID white matter hyperintensity growth and regression protocol.

METHODS

The NINDS-supported MarkVCID Consortium evaluated a neuroimaging biomarker developed to track WMH change. Test-retest and cross-site inter-rater reliability of the protocol were assessed. Cognitive test scores were analyzed in relation to WMH changes to explore its construct validity.

RESULTS

ICC values for test-retest reliability of WMH growth and regression were 0.969 and 0.937 respectively, while for cross-site inter-rater ICC values for WMH growth and regression were 0.995 and 0.990 respectively. Word list long-delay free-recall was negatively associated with WMH growth (p < 0.028) but was not associated with WMH regression.

CONCLUSIONS

The present data demonstrate robust ICC validity of a WMH growth/regression protocol over a one-year period as measured by cross-site inter-rater and test-retest reliability. These data suggest that this approach may serve an important role in clinical trials of disease-modifying agents for VCID that may preferentially affect WMH growth, stability, or regression.

Associations between cerebrospinal fluid markers and cognition in ageing and dementia: A systematic review

A biomarker associated with cognition in neurodegenerative dementias would aid in the early detection of disease progression, complement clinical staging and act as a surrogate endpoint in clinical trials. The current systematic review evaluates the association between cerebrospinal fluid protein markers of synapse loss and neuronal injury and cognition. We performed a systematic search which revealed 67 studies reporting an association between cerebrospinal fluid markers of interest and neuropsychological performance. Despite the substantial heterogeneity between studies, we found some evidence for an association between neurofilament-light and worse cognition in Alzheimer's diseases, frontotemporal dementia and typical cognitive ageing. Moreover, there was an association between cerebrospinal fluid neurogranin and cognition in those with an Alzheimer's-like cerebrospinal fluid biomarker profile. Some evidence was found for cerebrospinal fluid neuronal pentraxin-2 as a correlate of cognition across dementia syndromes. Due to the substantial heterogeneity of the field, no firm conclusions can be drawn from this review. Future research should focus on improving standardization and reporting as well as establishing the importance of novel markers such as neuronal pentraxin-2 and whether such markers can predict longitudinal cognitive decline.

The development, validation and normative data study of the English in Ireland adaption of the Philadelphia repeatable Verbal Learning Test (EirPrVLT-12) for use in an older adult population

OBJECTIVE

Cultural adaptations of verbal serial list-learning tests such as the California Verbal Learning Test (CVLT) and the Philadelphia (repeatable) Verbal Learning Test (P(r)VLT) have been shown to be clinically necessary. This paper aimed to culturally adapt, validate and provide normative data for an English in Ireland adaptation of the P(r)VLT, i.e. the EirPrVLT-12, in order to improve episodic memory assessments for Irish adults. Method: EirPrVLT-12 word lists were constructed using a word frequency study of Irish adults (n = 58). Two twelve-word, four-trial forms were constructed (standard and alternate form). A normative study included 145 participants who met strict inclusion criteria. Results: EirPrVLT-12 performance varied depending on age, gender, education, estimated IQ and socioeconomic status. Construct validity was established by correlations with other cognitive tests. Principal component analysis yielded a three-factor solution relating to general verbal learning, intrusions and interference. Normed EirPrVLT-12 scaled scores and percentiles stratified by age are available on the Open Science Framework at https://osf.io/vjzsp/, as are regression equations to predict individual scores based on age, gender and education. Conclusions: The data obtained underscores the clinical ultility of the EirPrVLT-12 to assess episodic memory in Irish older adults. Future research was recommended to validate the EirPrVLT-12 in a clinical population, extend normative data to younger populations and develop norms for the alternate form.

Long-term cognitive trajectory and activities of daily living in healthy aging

Objective: The purpose of the present study was to investigate if participants in NANOK study (National Normative Study of Cognitive Determinants of Healthy Ageing) who show no cognitive decline throughout five years (successful healthy agers; SHA) will show less age-related differences in instrumental activities of daily living (IADL) based on Functional Activities Questionnaire in comparison to participants who show subtle cognitive decline (Decliners) over time.Method: We used two different classifications of SHA: Rogalski (N = 25 SHA and N = 15 Decliners) based on cross-sectional neuropsychology measures and linear mixed model (LMEM; 20 SHA and 20 Decliners) based on the Montreal Cognitive Assessment longitudinal 5-years follow-up. Whole-brain T1- and T2-weighted images were corrected for distortions and segmented using Freesurfer. Whole-brain volumetry was performed using FSL's voxel-based morphometry tool.Results: The cognitive decline after four years follow-up but not age predicts subtle impairment in IADL in healthy ageing participants. We found brain volumetric differences between SHA and Decliners based on Rogalski but not LMEM classification especially in bilateral insular cortices and ventrolateral frontal cortex. The logistic regression model achieved an accuracy of 75% for the Rogalski in comparison to 67.5% for the LMEM classification.Conclusions: Slight restrictions in IADL seem to be a useful tool for screening healthy ageing participants at risk of developing subtle cognitive decline over a period of five years and the cross-sectional Rogalski criteria based on standardized neuropsychological measures were superior for tapping age-related brain changes to longitudinal LMEM classification based on screening (Montreal Cognitive Assessment).

Visual and Verbal Serial List Learning in Patients with Statistically-Determined Mild Cognitive Impairment

Background and Objective

Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes.

Research Design and Methods

Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively.

Results

BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored better than other groups on all parameters. aMCI and mixed/dys MCI did not differ on immediate or delayed free recall. Both delayed BVMT-R and P(r)VLT recognition test performance dissociated all three groups. Logistic regression analyses found that BVMT-R delayed free recall and delayed recognition scores correctly classified more patients with MCI (75.40%) than analogous P(r)VLT scores (66.20%). Visual versus verbal memory within-group analyses found no differences among non-MCI patients; P(r)VLT immediate free recall was worse among aMCI patients, but BVMT-R immediate free recall and delayed recognition were worse among mixed/dys MCI patients.

Discussion and Implications

Between-group analyses found convergent patterns of performance such that both tests identified elements of amnesia. However, logistic and within-group analyses found differing performance patterns suggesting that impaired visual episodic memory performance may be specific to emergent illness in mixed/dys MCI. Complementary but divergent neurocognitive networks may underlie visual versus verbal episodic memory performance in some patients with MCI.