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Lunia P, Krishnan K, Irani F, Hundal JS, Arastu S, Vonk JMJ, Sunderaraman P. A scoping review of neuropsychological assessment for Asian Indians in the United States - research and clinical recommendations. Clin Neuropsychol 2024:1-21. [PMID: 38565847 DOI: 10.1080/13854046.2024.2327674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Objective: There is an increasing focus on understanding health disparities among various cultural groups in the United States. The need for heterogeneity in norms and test stimuli across ethnically diverse individuals are being increasingly recognized. However, to date it remains unknown whether and to what extent differences in cognitive norms and tests exist in Asian Indians, a fast-growing population in the U.S. It is essential to understand these differences to improve diagnostic accuracy and provide timely and appropriate clinical care. Method: In this study, we conducted a scoping review of available cognitive tests that were normed, developed, or adapted for Asian Indians living in the U.S. Results: The results suggested a paucity of norms and tests specifically examining cognition in this community. Conclusions: Based on the findings, we provide suggestions for research directions focusing on the development of culturally sensitive neuropsychological tools, normative data representative of this demographic, and interventions addressing healthcare access barriers. Overall, this review provides readers with relevant clinical information to immediately enhance patient care as well as provide actionable items in research to improve the future utility of neuropsychology for Asian Indians in the United States.
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Affiliation(s)
- Palak Lunia
- Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Kamini Krishnan
- Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland, OH, USA
| | | | | | - Sana Arastu
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jet M J Vonk
- Memory and Aging Center, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Preeti Sunderaraman
- Department of Neurology, Medical Campus, Boston, MA, USA
- The Framingham Heart Study - Brain Aging Program, Framingham, MA, USA
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Ding H, Kim M, Searls E, Sunderaraman P, De Anda-Duran I, Low S, Popp Z, Hwang PH, Li Z, Goyal K, Hathaway L, Monteverde J, Rahman S, Igwe A, Kolachalama VB, Au R, Lin H. Digital neuropsychological measures by defense automated neurocognitive assessment: reference values and clinical correlates. Front Neurol 2024; 15:1340710. [PMID: 38426173 PMCID: PMC10902432 DOI: 10.3389/fneur.2024.1340710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Although the growth of digital tools for cognitive health assessment, there's a lack of known reference values and clinical implications for these digital methods. This study aims to establish reference values for digital neuropsychological measures obtained through the smartphone-based cognitive assessment application, Defense Automated Neurocognitive Assessment (DANA), and to identify clinical risk factors associated with these measures. Methods The sample included 932 cognitively intact participants from the Framingham Heart Study, who completed at least one DANA task. Participants were stratified into subgroups based on sex and three age groups. Reference values were established for digital cognitive assessments within each age group, divided by sex, at the 2.5th, 25th, 50th, 75th, and 97.5th percentile thresholds. To validate these values, 57 cognitively intact participants from Boston University Alzheimer's Disease Research Center were included. Associations between 19 clinical risk factors and these digital neuropsychological measures were examined by a backward elimination strategy. Results Age- and sex-specific reference values were generated for three DANA tasks. Participants below 60 had median response times for the Go-No-Go task of 796 ms (men) and 823 ms (women), with age-related increases in both sexes. Validation cohort results mostly aligned with these references. Different tasks showed unique clinical correlations. For instance, response time in the Code Substitution task correlated positively with total cholesterol and diabetes, but negatively with high-density lipoprotein and low-density lipoprotein cholesterol levels, and triglycerides. Discussion This study established and validated reference values for digital neuropsychological measures of DANA in cognitively intact white participants, potentially improving their use in future clinical studies and practice.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Minzae Kim
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Edward Searls
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Preeti Sunderaraman
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Ileana De Anda-Duran
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Spencer Low
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Zachary Popp
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Zexu Li
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Kriti Goyal
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Lindsay Hathaway
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jose Monteverde
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Salman Rahman
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Akwaugo Igwe
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Computer Science, Faculty of Computing & Data Sciences, Boston University, Boston, MA, United States
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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De Anda‐Duran I, Sunderaraman P, Searls E, Moukaled S, Jin X, Popp Z, Karjadi C, Hwang PH, Ding H, Devine S, Shih LC, Low S, Lin H, Kolachalama VB, Bazzano L, Libon DJ, Au R. Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts. J Am Heart Assoc 2024; 13:e032733. [PMID: 38226519 PMCID: PMC10926794 DOI: 10.1161/jaha.123.032733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored. METHODS AND RESULTS A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive Z score (Global Cognitive Score [GCS]), and neuropsychological domain-specific Z scores. FHS participants' mean age was 57 (SD, 9.75) years, and 44% (179) were men. BHS participants' mean age was 49 (4.4) years, and 28% (16) were men. Participants in both cohorts with the lowest neuropsychological performance (lowest quartile, GCS1) demonstrated lower DANA digital scores. In the FHS, GCS1 participants had slower average response times and decreased cognitive efficiency scores in all DANA tasks (P<0.05). In BHS, participants in GCS1 had slower average response times and decreased cognitive efficiency scores for DANA Code Substitution and Go/No-Go tasks, although this was not statistically significant. In both cohorts, GCS was significantly associated with DANA tasks, such that higher GCS correlated with faster average response times (P<0.05) and increased cognitive efficiency (all P<0.05) in the DANA Code Substitution task. CONCLUSIONS Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a composite measure of traditional neuropsychological tests. This supports the potential of using smartphone-based assessments in cognitive screening across diverse populations and the scalability of digital assessments to community-dwelling individuals.
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Affiliation(s)
- Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Edward Searls
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Shirine Moukaled
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Xuanyi Jin
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Zachary Popp
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Sherral Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Honghuang Lin
- University of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Computer ScienceBoston UniversityBostonMAUSA
| | - Lydia Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - David J. Libon
- Department of PsychologyRowan UniversityMullica HillNJUSA
- New Jersey Institute of Successful AgingRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Rhoda Au
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
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Sunderaraman P, De Anda‐Duran I, Karjadi C, Peterson J, Ding H, Devine SA, Shih LC, Popp Z, Low S, Hwang PH, Goyal K, Hathaway L, Monteverde J, Lin H, Kolachalama VB, Au R. Design and Feasibility Analysis of a Smartphone-Based Digital Cognitive Assessment Study in the Framingham Heart Study. J Am Heart Assoc 2024; 13:e031348. [PMID: 38226510 PMCID: PMC10926817 DOI: 10.1161/jaha.123.031348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/09/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based digital technology is increasingly being recognized as a cost-effective, scalable, and noninvasive method of collecting longitudinal cognitive and behavioral data. Accordingly, a state-of-the-art 3-year longitudinal project focused on collecting multimodal digital data for early detection of cognitive impairment was developed. METHODS AND RESULTS A smartphone application collected 2 modalities of cognitive data, digital voice and screen-based behaviors, from the FHS (Framingham Heart Study) multigenerational Generation 2 (Gen 2) and Generation 3 (Gen 3) cohorts. To understand the feasibility of conducting a smartphone-based study, participants completed a series of questions about their smartphone and app use, as well as sensory and environmental factors that they encountered while completing the tasks on the app. Baseline data collected to date were from 537 participants (mean age=66.6 years, SD=7.0; 58.47% female). Across the younger participants from the Gen 3 cohort (n=455; mean age=60.8 years, SD=8.2; 59.12% female) and older participants from the Gen 2 cohort (n=82; mean age=74.2 years, SD=5.8; 54.88% female), an average of 76% participants agreed or strongly agreed that they felt confident about using the app, 77% on average agreed or strongly agreed that they were able to use the app on their own, and 81% on average rated the app as easy to use. CONCLUSIONS Based on participant ratings, the study findings are promising. At baseline, the majority of participants are able to complete the app-related tasks, follow the instructions, and encounter minimal barriers to completing the tasks independently. These data provide evidence that designing and collecting smartphone application data in an unsupervised, remote, and naturalistic setting in a large, community-based population is feasible.
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Affiliation(s)
- Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health & Tropical MedicineNew OrleansLAUSA
| | - Cody Karjadi
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Julia Peterson
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Sherral A. Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Zachary Popp
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Spencer Low
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Kriti Goyal
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Lindsay Hathaway
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Jose Monteverde
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Computer Science and Faculty of Computing & Data SciencesBoston UniversityBostonMAUSA
| | - Rhoda Au
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
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Popp Z, Low S, Igwe A, Rahman MS, Kim M, Khan R, Oh E, Kumar A, De Anda‐Duran I, Ding H, Hwang PH, Sunderaraman P, Shih LC, Lin H, Kolachalama VB, Au R. Shifting From Active to Passive Monitoring of Alzheimer Disease: The State of the Research. J Am Heart Assoc 2024; 13:e031247. [PMID: 38226518 PMCID: PMC10926806 DOI: 10.1161/jaha.123.031247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Most research using digital technologies builds on existing methods for staff-administered evaluation, requiring a large investment of time, effort, and resources. Widespread use of personal mobile devices provides opportunities for continuous health monitoring without active participant engagement. Home-based sensors show promise in evaluating behavioral features in near real time. Digital technologies across these methodologies can detect precise measures of cognition, mood, sleep, gait, speech, motor activity, behavior patterns, and additional features relevant to health. As a neurodegenerative condition with insidious onset, Alzheimer disease and other dementias (AD/D) represent a key target for advances in monitoring disease symptoms. Studies to date evaluating the predictive power of digital measures use inconsistent approaches to characterize these measures. Comparison between different digital collection methods supports the use of passive collection methods in settings in which active participant engagement approaches are not feasible. Additional studies that analyze how digital measures across multiple data streams can together improve prediction of cognitive impairment and early-stage AD are needed. Given the long timeline of progression from normal to diagnosis, digital monitoring will more easily make extended longitudinal follow-up possible. Through the American Heart Association-funded Strategically Focused Research Network, the Boston University investigative team deployed a platform involving a wide range of technologies to address these gaps in research practice. Much more research is needed to thoroughly evaluate limitations of passive monitoring. Multidisciplinary collaborations are needed to establish legal and ethical frameworks for ensuring passive monitoring can be conducted at scale while protecting privacy and security, especially in vulnerable populations.
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Affiliation(s)
- Zachary Popp
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Akwaugo Igwe
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Md Salman Rahman
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Minzae Kim
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Raiyan Khan
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Emily Oh
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Ankita Kumar
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health & Tropical MedicineNew OrleansLAUSA
| | - Huitong Ding
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Preeti Sunderaraman
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMA
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Rhoda Au
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
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Sunderaraman P, Dunn CB, Kamper JE, DeDios-Stern S, Azar M, Feigon M, Cooper S, Gooding A. Characteristics of and Professional Issues Experienced by Early Career Neuropsychologists in the United States - Findings from a Survey Study. Arch Clin Neuropsychol 2023; 38:1017-1034. [PMID: 36864589 DOI: 10.1093/arclin/acad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Multiple transitions occur during the early career stage of a psychologist, perhaps to a higher extent and with more potent ramifications than subsequent career stages. However, limited information exists on the various expectations, concerns, and challenges experienced by early career psychologists (ECPs) broadly, and more specifically in clinical neuropsychology. Therefore, the Society for Clinical Neuropsychology (SCN)/Division 40's Early Career Neuropsychologist Committee developed a Needs Assessment Survey with the primary goal of identifying various training and professional development issues encountered by ECPs in clinical neuropsychology. METHOD A comprehensive survey was distributed electronically via listserv announcements and SCN communication tools (Newsletters and Neuroblasts). Data collection occurred from 29 May, 2020 to 02 August, 2020. The total sample comprised of 89 respondents (85% aged 31-40 years; 83% female; 82% Caucasian, followed by 18% Asian; 3% of Hispanic ethnicity). RESULTS Majority of the respondents graduated from APA-accredited doctoral programs and from postdoctoral programs that adhered to Houston Conference Guidelines. About 7% took >2 years to complete their residency and about 10%-15% of ECPs expressed clear dissatisfaction with at least some aspect of their residency training. Becoming board certified in neuropsychology was the highest ranked career goal for ECPs in neuropsychology (45%), whereas 72% indicated difficulty understanding billing and insurance-related issues as the most frequently encountered professional challenge. About 57% of ECPs were concerned about maintaining work/life balance. CONCLUSIONS Specific ways to aid and strengthen trainees and ECPs' professional needs are discussed with a focus on activities that can be undertaken at individual-, department-, profession-, and higher legislative-specific levels. IMPACT STATEMENT Question: Using survey data, this study aimed to characterize early career psychologists (ECPs) training history and their current work settings, identify their needs, and understand their perspectives about challenges and expectations. Findings: Results reveal that the workforce comprising of ECPs is getting increasingly diverse, and their needs are typically focused on obtaining board certification. ECPs identified areas for improvement in their training, such as increasing their knowledge of billing and insurance, and expressed concerns about maintaining work/life balance. Importance: The Minnesota 2022 Update Conference seems like a promising platform for addressing several of the needs identified by the survey and providing updated guidelines for ECPs. Next Steps: Based on the findings, general guidelines have been proposed for state and local level organizations along with call for action to higher-level legislation.
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Affiliation(s)
- Preeti Sunderaraman
- Department of Neurology & The Framingham Heart Study - Brain Aging Program, Boston University School of Medicine, Framingham, MA, USA
| | | | - Joel E Kamper
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | | | | | - Shanna Cooper
- Department of Psychiatry, Brain Institute, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amanda Gooding
- Department of Psychiatry, University of California, San Diego, CA, USA
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7
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Lunia P, Hundal J, Irani F, Krishnan K, Sunderaraman P. B - 36 Indian Educational System and Neuropsychological Evaluation among Indian Americans: a Review with Clinical and Cultural Considerations. Arch Clin Neuropsychol 2023; 38:1400. [PMID: 37807399 DOI: 10.1093/arclin/acad067.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE India's educational system is highly complex and intricate. Individuals who emigrate to the United States from India, commonly referred to as Indian Americans, demonstrate a wide range of educational backgrounds. Nonetheless, little is known about the impact of their education on cognition. This study sought to investigate the association between education and cognition among Indian Americans who moved to the United States subsequent to obtaining minimum high school education in India. METHOD A literature review was undertaken to determine the extent and the nature of the relationship between education and cognitive performance in Indian Americans. RESULTS No studies were identified that systematically examined the links between educational attainment and cognitive performance among Indian Americans. Previous research conducted in India found that higher educational attainment was associated with better cognitive performance in the domains of attention, memory, language, and executive functioning. However, other studies report gender and regional differences as variables influencing association between education and cognitive performance. CONCLUSION The study provides clinicians with a deeper understanding of the nuanced and multifaceted nature of educational experiences among Indian Americans. Variability in education stemming from a multitude of factors including language of instruction in the school vs. language/s spoken at home, school's funding, location of the school, school curriculum (public vs. private schools), and societal attitudes towards gender and literacy can impact cognitive performance. These aspects need to be clearly parsed out for accurate selection of the test battery and interpretation of the test performance.
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Christianson K, Prabhu M, Popp ZT, Rahman MS, Drane J, Lee M, Lathan C, Lin H, Au R, Sunderaraman P, Hwang PH. Adherence type impacts completion rates of frequent mobile cognitive assessments among older adults with and without cognitive impairment. Res Sq 2023:rs.3.rs-3350075. [PMID: 37841867 PMCID: PMC10571616 DOI: 10.21203/rs.3.rs-3350075/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Prior to a diagnosis of Alzheimer's disease, many individuals experience cognitive and behavioral fluctuations that are not detected during a single session of traditional neuropsychological assessment. Mobile applications now enable high-frequency cognitive data to be collected remotely, introducing new opportunities and challenges. Emerging evidence suggests cognitively impaired older adults are capable of completing mobile assessments frequently, but no study has observed whether completion rates vary by assessment frequency or adherence type. Methods Thirty-three older adults were recruited from the Boston University Alzheimer's Disease Research Center (mean age = 73.5 years; 27.3% cognitively impaired; 57.6% female; 81.8% White, 18.2% Black). Participants remotely downloaded and completed the DANA Brain Vital application on their own mobile devices throughout the study. The study schedule included seventeen assessments to be completed over the course of a year. Specific periods during which assessments were expected to be completed were defined as subsegments, while segments consisted of multiple subsegments. The first segment included three subsegments to be completed within one week, the second segment included weekly subsegments and spanned three weeks, and the third and fourth segments included monthly subsegments spanning five and six months, respectively. Three distinct adherence types - subsegment adherence, segment adherence, and cumulative adherence - were examined to determine how completion rates varied depending on assessment frequency and adherence type. Results Adherence type significantly impacted whether the completion rates declined. When utilizing subsegment adherence, the completion rate significantly declined (p = 0.05) during the fourth segment. However, when considering completion rates from the perspective of segment adherence, a decline in completion rate was not observed. Overall adherence rates increased as adherence parameters were broadened from subsegment adherence (60.6%) to segment adherence (78.8%), to cumulative adherence (90.9%). Conclusions Older adults, including those with cognitive impairment, are able to complete remote cognitive assessments at a high-frequency, but may not necessarily adhere to prescribed schedules.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rhoda Au
- Boston University School of Medicine
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9
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Azar M, Chapman S, Joyce J, Schultheis M, Zhang Z, Waltrip L, Shagalow S, Zeiger P, Sunderaraman P, Cosentino S. Education as a Moderator of Help Seeking Behavior in Subjective Cognitive Decline. Alzheimer Dis Assoc Disord 2023; 37:184-188. [PMID: 37561937 PMCID: PMC10530107 DOI: 10.1097/wad.0000000000000571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Disparities in Alzheimer disease (AD) and differences in help seeking (HS) across sociodemographic groups warrant public health concern. Research addressing such disparities must shift toward the earliest clinical manifestations of AD to optimize diagnosis, intervention and care planning. Subjective cognitive decline (SCD), a risk state for AD, provides an important context in which to examine sociodemographic-related disparities in HS. PARTICIPANTS AND METHODS One hundred sixty-seven cognitively healthy older adults (M age =73, M education =16) (26.4% Black, Asian, or "Other") completed SCD questionnaire, HS questions, and mood measures (depression and anxiety). Binary logistic adjusted regressions examined: (a) the association between SCD and HS; and (b) the extent to which education moderated the relationship between SCD and HS. SCD [b = 0.06, SE=0.13, P <0.001, odds ratio=1.06, 95% CI (1.03, 1.08)] and education [b=0.32, SE=0.09, P <0.001, odds ratio=1.37, 95% CI (1.15, 1.64)] were independently associated with HS, with significant interaction between education and SCD on HS [b=0.2, SE=0.01, P =0.01, odds ratio=1.02, 95% CI (1.00, 1.03)]. CONCLUSIONS Findings elucidate the importance of tailoring SCD-related psychoeducational resources depending on educational background as a preliminary stepping-stone in encouraging HS among older adults who may be at particular risk for developing dementia.
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Affiliation(s)
- Martina Azar
- Psychology Department, VA Boston Healthcare System, Boston, MA, USA
| | - Silvia Chapman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, NY, NY, USA
| | - Jillian Joyce
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, NY, NY, USA
| | - Maria Schultheis
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Zoe Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Leah Waltrip
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, NY, NY, USA
| | - Shaina Shagalow
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, NY, NY, USA
| | - Peter Zeiger
- Vagelos College of Physicians and Surgeons, Columbia University, NY, NY, USA
| | | | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, NY, NY, USA
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10
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Sunderaraman P, Lee S, Varangis E, Habeck C, Chapman S, Joyce JL, Hartstone W, Brickman AM, Stern Y, Cosentino S. Correction to: Self-awareness for financial decision making abilities is linked to right temporal cortical thickness in older adults. Brain Imaging Behav 2022; 16:1926. [PMID: 35286588 DOI: 10.1007/s11682-022-00663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Eleanna Varangis
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Whitney Hartstone
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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11
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Rehman SS, Irani F, Cheung AM, Tan A, Madore MR, Sunderaraman P. “The journey of a thousand miles begins with one step”: An Asian American perspective on mentoring in neuropsychology. J Clin Exp Neuropsychol 2022; 44:409-419. [DOI: 10.1080/13803395.2022.2108769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sonia S. Rehman
- Fielding Graduate University, Department of Psychology, CA, USA
| | - Farzin Irani
- AAA Neuropsychology, Independent Practice, Malvern, PA, USA
| | - Angeles M. Cheung
- Independent Practice, New York, NY, USA
- Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Tan
- Children’s Hospital of Orange County, Department of Psychology, CA, USA
| | - Michelle R. Madore
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, CA, USA
- Stanford School of Medicine, Department of Psychiatry and Behavioral Sciences, CA, USA
| | - Preeti Sunderaraman
- Boston University School of Medicine, Department of Neurology, MA, USA
- The Framingham Heart Study - Brain Aging Program, Framingham, MA, USA
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12
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Abstract
Financial literacy is linked to financial well-being and decision making. While financial literacy and numeracy skills are strongly related, the relevance of different aspects of numeracy (mental arithmetic, math achievement, and numerical reasoning) for financial literacy has not yet been examined. Data were collected from 88 cognitively healthy adults, mean age = 50 years (SD = 15); mean education = 15 years (SD = 2); 61% females; with 56% Caucasian, 36% Black, and 90% non-Hispanic. Financial literacy was measured with the widely used Big Three scale, and numeracy was measured with the Wechsler Adult Intelligence Scale-III, Arithmetic subtest; the Wide Range Achievement Test-IV, Math Computation subtest; and the Weller's Abbreviated Numeracy Scale (WANS). Regressions analyses were conducted with financial literacy as the outcome variable and each numeracy measure along with demographics (age, sex, and education) as the predictors. In all the models, only the numeracy measures were significant as individual predictors, with numerical reasoning holding the strongest association with financial literacy, followed by mental arithmetic and math achievement. The current study supports the existing literature that numeracy is important for financial literacy, and provides empirical evidence for the specific contributions of individual numeracy measures that clinicians may use to garner impressions about financial skills.
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Affiliation(s)
| | - Megan Barker
- Columbia University Medical Center, New York, NY, USA
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13
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Chapman S, Joyce JL, Barker MS, Sunderaraman P, Rizer S, Huey ED, Dworkin J, Gu Y, Cosentino S. Subjective Cognitive Decline Is More Accurate When Metamemory Is Better. Front Aging Neurosci 2022; 14:787552. [PMID: 35370602 PMCID: PMC8965471 DOI: 10.3389/fnagi.2022.787552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Subjective cognitive decline (SCD) has emerged as one of the first manifestations of Alzheimer's disease (AD). However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD's diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities. Methods The sample included 79 cognitively healthy older adults (77% female, 68% White, and 32% Black participants) with a mean age of 74.4 (SD = 6.1) and 15.9 (SD = 2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions ("Will you know the correct answer?"). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory. Results Subjective cognitive decline was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = -0.30, p = 0.003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = -0.71, p = 0.005; b = -0.62, p = 0.034). Metamemory, however, did not moderate the association of SCD with retroactive semantic interference nor short term memory binding. Discussion The accuracy of an individual's metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Jillian L. Joyce
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, United States
| | - Megan S. Barker
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, United States
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- Brain Aging Program, Framingham Heart Study, Framingham, MA, United States
| | - Sandra Rizer
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Edward D. Huey
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, United States
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Jordan Dworkin
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Yian Gu
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, United States
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, United States
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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14
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Sunderaraman P, Gazes Y, Ortiz G, Langfield C, Mensing A, Chapman S, Joyce JL, Brickman AM, Stern Y, Cosentino S. Financial decision-making and self-awareness for financial decision-making is associated with white matter integrity in older adults. Hum Brain Mapp 2022; 43:1630-1639. [PMID: 34984770 PMCID: PMC8886641 DOI: 10.1002/hbm.25747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 11/11/2022] Open
Abstract
Financial decision-making (FDM) and awareness of the integrity of one's FDM abilities (or financial awareness) are both critical for preventing financial mistakes. We examined the white matter correlates of these constructs and hypothesized that the tracts connecting the temporal-frontal regions would be most strongly correlated with both FDM and financial awareness. Overall, 49 healthy older adults were included in the FDM analysis and 44 in the financial awareness analyses. The Objective Financial Competency Assessment Inventory was used to measure FDM. Financial awareness was measured by integrating metacognitive ratings into this inventory and was calculated as the degree of overconfidence or underconfidence. Diffusion tensor imaging data were processed with Tracts Constrained by Underlying Anatomy distributed as part of the FreeSurfer analytic suite, which produced average measures of fractional anisotropy and mean diffusivity in 18 white matter tracts along with the overall tract average. As expected, FDM showed the strongest negative associations with average mean diffusivity measure of the superior longitudinal fasciculus -temporal (SLFT; r = -.360, p = .011) and -parietal (r = -.351, p = .014) tracts. After adjusting for FDM, only the association between financial awareness and average mean diffusivity measure of the right SLFT (r = .310, p = .046) was significant. Overlapping white matter tracts were involved in both FDM and financial awareness. More importantly, these preliminary findings reinforce emerging literature on a unique role of right hemisphere temporal connections in supporting financial awareness.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yunglin Gazes
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Gema Ortiz
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Langfield
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Ashley Mensing
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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15
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Kenepp A, Johnson E, Lee GJ, Sunderaraman P, Denburg NL, Nguyen CM. A Comprehensive Approach to Assessment of Testamentary Capacity. Front Psychol 2021; 12:789494. [PMID: 35002883 PMCID: PMC8733255 DOI: 10.3389/fpsyg.2021.789494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
The growing aging population raises important implications for legal and clinical systems, including testamentary capacity (TC) assessment. Yet, there are limited comprehensive and standardized assessment measures for TC readily available for clinical use. A review of current assessment methods and standardized approaches for TC assessment is provided. Although several guidelines regarding TC assessment have been proposed in prior literature, existing standardized approaches do not appear to meet full criteria for TC. A comprehensive approach to assessment of testamentary capacity is proposed.
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Affiliation(s)
- Amanda Kenepp
- Department of Psychology, Queens College and The Graduate Center (CUNY), New York, NY, United States
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ellen Johnson
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Grace J. Lee
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Preeti Sunderaraman
- Department of Neurology & The Framingham Heart Study - Brain Aging Program, Boston University School of Medicine, Boston, MA, United States
| | - Natalie L. Denburg
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa, IA, United States
| | - Christopher M. Nguyen
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- *Correspondence: Christopher M. Nguyen,
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16
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Joyce JL, Chapman S, Barker MS, Sunderaraman P, Rizer S, Huey ED, Kreisl WC, Cosentino S. Apathy may be a key link between depressive symptoms and subjective cognitive decline. Alzheimers Dement 2021. [DOI: 10.1002/alz.056334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Silvia Chapman
- Columbia University Irving Medical Center New York NY USA
| | | | | | - Sandra Rizer
- Columbia University Medical Center New York NY USA
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17
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Sunderaraman P, Gazes Y, Ortiz G, Chapman S, Joyce JL, Langfield C, Mensing A, Stern Y, Cosentino S. White matter integrity is associated with self‐awareness of financial decision‐making in cognitively healthy older adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.053312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Gema Ortiz
- Columbia University Medical Center New York NY USA
| | - Silvia Chapman
- Columbia University Irving Medical Center New York NY USA
| | | | | | | | - Yaakov Stern
- Columbia University Medical Center New York NY USA
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18
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Sunderaraman P, Irani F, Krishnan K, Hundal JS. A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning. Clin Neuropsychol 2021:1-19. [PMID: 34818985 DOI: 10.1080/13854046.2021.1987524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H.Sergeivsky Center, and the Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,The Framingham Heart Study - Brain Aging Program, 73 Mount Wayte Avenue, Framingham, MA, USA
| | | | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jasdeep S Hundal
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Sunderaraman P, Lee S, Varangis E, Habeck C, Chapman S, Joyce JL, Hartstone W, Brickman AM, Stern Y, Cosentino S. Self-awareness for financial decision making abilities is linked to right temporal cortical thickness in older adults. Brain Imaging Behav 2021; 16:1139-1147. [PMID: 34761323 PMCID: PMC9202645 DOI: 10.1007/s11682-021-00590-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Everyday financial decision making and the awareness of the integrity of one's financial decision making abilities (or financial awareness) are both critical to study in older adults as they can help identify those at risk for making suboptimal financial decisions and prevent financial loss. In the current study, we examined the cognitive and cortical thickness correlates of financial decision making and financial awareness in 59 community-dwelling participants co-enrolled in a larger study (mean age=68.35 years (SD=5.5), mean education=15.91 (SD=2.36), 61% = women, 67% = White, 30% = Black participants). Data from standardized measures of financial decision making and cognition was investigated along with FreeSurfer (v. 5.3) derived thickness regions. Based on metacognitive frameworks, financial awareness was measured along with a well-validated measure of memory awareness. Results revealed that numeracy, executive functioning and vocabulary were associated with financial decision making, whereas in analysis adjusted for financial decision making, memory awareness relative to cognition was most strongly linked to financial awareness. No significant associations between thickness and financial decision making were found. However, both financial and memory awareness were associated with the same right-hemisphere temporal thickness regions underscoring the idea of a common substrate of awareness. Interestingly, our findings converge with the emerging work on financial exploitation in which the right sided temporal regions have been found to play a prominent role. Incorporating the contributing role of self-awareness in various models of financial exploitation will be an important consideration for future studies.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA. .,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA. .,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Eleanna Varangis
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Whitney Hartstone
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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Fox-Fuller JT, Rizer S, Andersen SL, Sunderaraman P. Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults. Arch Clin Neuropsychol 2021; 37:274-291. [PMID: 34564721 PMCID: PMC8513402 DOI: 10.1093/arclin/acab076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE In the wake of the coronavirus pandemic, teleneuropsychology utilization has increased. There is a need to characterize the first-hand experiences of individuals using teleneuropsychology, identify the common teleneuropsychology challenges, and devise practical strategies for mitigating/resolving these challenges. METHOD Survey data were collected from U.S. based neuropsychologists and other individuals (e.g., graduate students and research assistants) who were engaged in remote cognitive assessment with adults (n = 87). Frequency analyses were conducted to examine: how respondents used teleneuropsychology (e.g., duration of use, types of measures and devices/technology platforms used); challenges that were encountered with different technology platforms and teleneuropsychology use; and advice for navigating these challenges. RESULTS Most respondents began using teleneuropsychology relatively recently in the context of the coronavirus pandemic, with home-to-home or clinic-to-home settings being the most frequently reported teleneuropsychology settings. Zoom®, Doxy.Me®, and MyChart® were the most frequently used platforms, largely due to workplace mandates and/or Health Insurance Portability and Accountability Act-compliant features. Common challenges with teleneuropsychology included internet connection issues and environmental distractions in examinees' homes, and examinees having limited-to-no access to technologies requisite for teleneuropsychology. Providing clear instructions to the examinee prior to the teleneuropsychology visit was the most common advice for ensuring a successful teleneuropsychology evaluation. Similar response patterns were generally noted for those who used TeleNP for clinical or research purposes. CONCLUSIONS These survey results reflect common experiences and challenges with teleneuropsychology and identify priority targets for increasing its feasibility, reliability, and validity. Findings provide context for the development of formal teleneuropsychology competencies.
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Affiliation(s)
- Joshua T Fox-Fuller
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - Sandra Rizer
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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21
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Chapman S, Sunderaraman P, Joyce JL, Azar M, Colvin LE, Barker MS, McKeague I, Kreisl WC, Cosentino S. Optimizing Subjective Cognitive Decline to Detect Early Cognitive Dysfunction. J Alzheimers Dis 2021; 80:1185-1196. [PMID: 33646159 DOI: 10.3233/jad-201322] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The utility of subjective cognitive decline (SCD) as an indicator of preclinical AD is overshadowed by its inconsistent association with objective cognition. OBJECTIVE This study examines if manipulations of SCD measurement affect its association with early cognitive dysfunction characteristic of preclinical AD. METHODS Cognitively healthy older adults (n = 110) completed SCD questionnaires that elicited complaints in general, compared to 5 years ago (retrospective SCD) and compared to their peers (age-anchored SCD) in binary and Likert scales. Outcome cognitive tasks included an associative memory task (Face-Name Test), a visual short-term memory binding task (STMB test), and a clinical neuropsychological list learning test (Selective Reminder Test). RESULTS SCD complaints, when compared to age-matched peers (age-anchored SCD) were endorsed less frequently than complaints compared to 5 years ago (retrospective SCD) (p < 0.01). In demographically adjusted regressions, age-anchored ordinal-rated SCD was associated with short term memory binding (β= -0.22, p = 0.040, CI = -0.45, -0.01), associative memory (β= -0.26, p = 0.018, CI = -0.45, -0.06), and list learning (β= -0.31, p = 0.002, CI = -0.51, -0.12). Retrospective and general ordinal-rated SCD was associated with associative memory (β= -0.25, p = 0.012, CI = -0.44, -0.06; β= -0.29, p = 0.003, CI = -0.47, -0.10) and list learning only (β= -0.25, p = 0.014, CI = -0.45, -0.05; β= -0.28, p = 0.004, CI = -0.48, -0.09). CONCLUSION Ordinal age-anchored SCD appears better suited than other SCD measurements to detect early cognitive dysfunction characteristic of preclinical AD.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Martina Azar
- Department of Psychology, Drexel University, Philadelphia, PA, USA.,VA Boston Health Care System, Boston, MA, USA
| | | | - Megan S Barker
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Ian McKeague
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - William C Kreisl
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Medical Center, New York, NY, USA
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22
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Fox-Fuller JT, Rizer S, Andersen SL, Sunderaraman P. A-189 Survey Findings of Challenges with Teleneuropsychological Assessment and Advice in Mitigating these Challenges. Arch Clin Neuropsychol 2021. [DOI: 10.1093/arclin/acab062.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Teleneuropsychology (TeleNP) has experienced tremendous uptake during the coronavirus pandemic, and there is a need to document the challenges and practical advice for conducting remote cognitive assessments.
Method
87 respondents (licensed neuropsychologists = 56; others [e.g., trainees] = 31) conducting TeleNP evaluations with adult populations in the United States completed an online survey which was distributed via social media and list-servs in winter 2020–2021. Respondents were asked about their TeleNP experiences, including issues encountered and solutions to TeleNP challenges. Frequency analyses were conducted to examine the proportion of respondents endorsing specific TeleNP challenges. TeleNP advice was thematically coded to identify the most common suggestions to overcome/navigate these challenges.
Results
The most frequently reported TeleNP challenges included: poor internet connectivity (examinee’s home: 82.8%; an unknown source 58.6%); environmental distractions in the examinee’s location (78.2%); poor audio quality (55.2%); examinee’s unfamiliarity with the videoconferencing technology (52.9%); inability to easily conduct visuoconstructional tasks (52.9%) or adapt tests/find TeleNP norms (47.1%); and examinees’ limited access to technology (57.5%) or complete lack of access (35.6%). The most common responses to mitigate these challenges included: providing detailed instructions about the TeleNP visit and examinee expectations in advance; having a clear back-up or assistive plan (e.g., telephone call); and using TeleNP sparingly (e.g., for interview only).
Conclusion
These survey results reflect widely-encountered challenges with remote cognitive assessment and identify priority targets for increasing the feasibility and reliability of TeleNP. Findings can be incorporated into discussion about formalized TeleNP competencies.
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Sunderaraman P, Cosentino S, Schupf N, Manly J, Gu Y, Barral S. MEF2C Common Genetic Variation Is Associated With Different Aspects of Cognition in Non-Hispanic White and Caribbean Hispanic Non-demented Older Adults. Front Genet 2021; 12:642327. [PMID: 34386032 PMCID: PMC8353395 DOI: 10.3389/fgene.2021.642327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives Myocyte Enhancer Factor 2C (MEF2C) is identified as a candidate gene contributing to the risk of developing Alzheimer's disease. However, little is known about whether MEF2C plays a role in specific aspects of cognition among older adults. The current study investigated the association of common variants in the MEF2C gene with four cognitive domains including memory, visuospatial functioning, processing speed and language among non-demented individuals. Method Participants from two ethnic groups, Non-Hispanic White (NHW; n = 537) and Caribbean Hispanic (CH; n = 1,197) from the Washington Heights-Inwood Community Aging Project (WHICAP) study, were included. Genetic association analyses using WHICAP imputed genome-wide data (GWAS) were conducted for the various cognition domains. Results Single nucleotide polymorphisms (SNP) variants in the MEF2C gene showed nominally significant associations in all cognitive domains but for different SNPs across both the ethnic groups. In NHW participants, the strongest associations were present for memory (rs302484), language (rs619584), processing speed (rs13159808), and visuospatial functioning (several SNPs). In CH, strongest associations were observed for memory (rs34822815), processing speed (rs304141), visuospatial functioning (rs10066711 and rs10038371), and language (rs304153). Discussion MEF2C variant-cognitive associations shed light on an apparent role for MEF2C in both memory and non-memory aspects of cognition in individuals from NHW and CH ancestries. However, the little overlap in the specific SNP-cognition associations in CH versus NHW highlights the differences in genetic architectural variations among those from different ancestries that should be considered while studying the MEF2C gene.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Nicole Schupf
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Jennifer Manly
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yian Gu
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Sandra Barral
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, United States
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Sunderaraman P, Dong Z, Sampath S, Chapman S, Joyce J, Stern Y, Cosentino S. Development of the Online Money Management Credit Card Task. Innov Aging 2020. [PMCID: PMC7742905 DOI: 10.1093/geroni/igaa057.2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Older adults (OAs), a wealthy but vulnerable segment of our population, are at risk to make compromised financial decisions. Evidence suggests that OAs increasingly use technology to perform everyday financial transactions, such as to manage their credit card statements. However, current tools are lacking in terms of assessing how older adults navigate and handle the online financial milieu. We will discuss the development of a novel, simulated online money management (OMM) credit card statement task. OMM examines OAs performance on several indices including reaction time, nature and frequency of errors, and their ability to comprehend and trouble shoot problems. Psychometric properties related to the reliability and validity will be discussed. Ultimately, by examining the longitudinal performance of OMM in OAs, we can better characterize the natural course of OMM. Such an approach will enable clinicians to accurately and objectively examine OMM and identify those at risk for making financial errors.
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Affiliation(s)
| | - Ziqian Dong
- New York Institute of Technology, New York, New York, United States
| | | | - Silvia Chapman
- Columbia University, New York, Pennsylvania, United States
| | - Jillian Joyce
- Columbia University, New York, New York, United States
| | - Yaakov Stern
- Columbia University, New York, New York, United States
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Barker MS, Chapman S, Mejia A, Joyce JL, Sunderaraman P, Idnay BR, Kreisl WC, Cosentino S. Psycholinguistic properties of words on fluency testing relate to different aspects of subjective cognitive decline. Alzheimers Dement 2020. [DOI: 10.1002/alz.046108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Arlene Mejia
- Columbia University Medical Center New York NY USA
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Sunderaraman P, Chapman S, Barker MS, Cosentino S. Financial awareness is associated with metamemory in cognitively healthy adults. Alzheimers Dement 2020. [DOI: 10.1002/alz.046066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Joyce JL, Chapman S, Barker MS, Rizer S, Sunderaraman P, Charles Kreisl W, Cosentino S. Performance and intrusion errors on challenging cognitive assessments associate with subjective cognitive decline. Alzheimers Dement 2020. [DOI: 10.1002/alz.046141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Sandra Rizer
- Columbia University Medical Center New York NY USA
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Sunderaraman P, Chapman S, Barker MS, Cosentino S. Self-awareness for financial decision-making abilities in healthy adults. PLoS One 2020; 15:e0235558. [PMID: 32614887 PMCID: PMC7332073 DOI: 10.1371/journal.pone.0235558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Decades of research have established how to measure metacognition (i.e., awareness of one’s cognitive abilities), whereas relatively little is known about how to assess the integrity of financial awareness (FA; awareness of one’s financial abilities), a related construct with practical implications for vulnerable older adults. The current study’s goal was to apply established metacognitive frameworks to identify an objective measure of FA. Methods Metacognitive ratings were integrated into two financial decision making (FDM) assessments in order to derive two types of FA metrics: absolute accuracy (calibration) and relative accuracy (resolution) in each FDM task. Associations between each FA metric, demographic variables, FDM performances, and metamemory were examined. Design & setting Cross-sectional, community-based, prospective study. Participants 93 individuals with mean age = 59 years (SD = 15.12); mean education = 15.70 (SD = 2.39); 60% females. Measures FA was calculated using the Financial Competency Assessment Inventory (FCAI) and Decision Making Competence Assessment Tool, Finance Module (DMC-F), and memory awareness was calculated using an objective metamemory test. Results None of the FA metrics was associated with age, education or gender. FCAI calibration was inversely associated with FDM, and positively correlated with DMC-F calibration and metamemory calibration. None of the FA metrics for DMC-F was associated with metamemory. Conclusions Mirroring findings from metamemory studies, overconfidence in FDM was associated with lower FDM accuracy in healthy adults. Moreover, calibration scores on the FCAI and metamemory were related, suggesting that FA taps into metacognitive abilities. Our findings provide preliminary evidence for how to measure FA in both clinical and research contexts.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Megan S. Barker
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
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Sunderaraman P, Ho S, Chapman S, Joyce JL, Colvin L, Omollo S, Pleshkevich M, Cosentino S. Technology Use in Everyday Financial Activities: Evidence from Online and Offline Survey Data. Arch Clin Neuropsychol 2020; 35:385-400. [PMID: 31696205 PMCID: PMC7244884 DOI: 10.1093/arclin/acz042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Internet use and mobile devices permeate every aspect of our lives and are changing our financial habits. Assessment of financial decision-making (FDM) has not yet caught up to apparent changes in financial behavior. To modernize assessment methods and create current and comprehensive FDM frameworks, we first need to establish the most commonly used and most preferred methods of performing specific financial activities. METHOD Cross-sectional survey data were collected using an online platform and offline approaches (in person and by mail) (N = 234). The frequency of using technological (e.g., laptop) and non-technological (e.g., in-person banking) means of completing seven financial activities was assessed first, including Depositing checks, Reviewing bank statements, Keeping track of money spent, Transferring funds, Withdrawing cash, Paying bills, and Purchasing products online. Second, preference for technological versus non-technological methods was assessed. Finally, linear regression models examined associations between demographics and preference for technological methods for each financial activity. RESULTS The majority of respondents (77% online, 74% offline) used technology to perform various financial activities and preferred technological to non-technological methods for completing five out of the six financial activities. Increased preference for technological methods was associated with younger age for all the financial activities, and higher education was associated with reviewing bank statement and transferring funds. CONCLUSIONS Our survey findings provide empirical evidence for the changing nature of our financial habits. We discuss the implications of this change for researchers, clinicians, and the individuals themselves and emphasize the importance of modernizing FDM tools.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Sarah Ho
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Leigh Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Shalom Omollo
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Maria Pleshkevich
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Sunderaraman P, Ho S, Stern Y, Cosentino S. THE ASSOCIATION OF OBJECTIVE FINANCIAL DECISION MAKING WITH FINANCIAL LITERACY, EDUCATION, AND MATH SKILLS. Innov Aging 2019. [PMCID: PMC6841430 DOI: 10.1093/geroni/igz038.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rationale: Financial decision-making (FDM) is a critical ability with implications across the adult life-span. In healthy adults, demographic and cognitive factors impact FDM. However, the impact of these factors on FDM has yet to be fully investigated. The aim of the current study was to understand the extent to which demographics (age, education, sex), financial literacy (crystallized ability), and mathematical ability (fluid ability) influence FDM. Participants and Methods: The sample, recruited from a larger ongoing study, consisted of 73 adults; mean age=61.31 (13.76) years, mean education=15.68 (2.61) years, 59.5% female, 58% Caucasian. FDM was measured using the Financial Competence Assessment Inventory, financial literacy using a standard set of 23 questions, and math skills using WAIS-III Arithmetic, WRAT-IV Math and Cognitive Reflection Test. Results: Only variables that were significantly associated with FDM in bivariate analysis were selected for the multiple regression analysis. After adjusting for multicollinearity, stepwise multiple regression analyses revealed that the overall model with 3 predictors (education, financial literacy, WAIS-III Arithmetic) was significant (F =23.64, p < .001) and explained 50.7% of the variance in FDM. Education and WAIS-III Arithmetic predicted FDM to a higher extent than financial literacy. Conclusions: The finding that education and fluid ability has a relatively higher impact on FDM as compared to crystallized ability is important. As one ages, fluid abilities decline more rapidly than crystallized abilities. This may be one explanation for why FDM ability worsens with age. To increase confidence in these findings, future research should test these models using age-stratified analyses.
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Affiliation(s)
| | - Sarah Ho
- Columbia University Medical Center, New York City, New York, United States
| | - Yaakov Stern
- Columbia University Medical Center, New York City, New York, United States
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Shaked D, Sunderaraman P, Piscitello J, Cines S, Hale C, Devanand D, Karlawish J, Cosentino S. Modification of everyday activities and its association with self-awareness in cognitively diverse older adults. PLoS One 2019; 14:e0222769. [PMID: 31697690 PMCID: PMC6837494 DOI: 10.1371/journal.pone.0222769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023] Open
Abstract
Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.
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Affiliation(s)
- Danielle Shaked
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Jennifer Piscitello
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Sarah Cines
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Christiane Hale
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
| | - Davangere Devanand
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States of America
| | - Jason Karlawish
- Healthy Brain Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis M. Informant Report of Financial Capacity for Individuals With Chronic Acquired Brain Injury: An Assessment of Informant Accuracy. J Head Trauma Rehabil 2019; 33:E85-E94. [PMID: 29601341 PMCID: PMC6163092 DOI: 10.1097/htr.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Primarily, to investigate the association between informant report and objective performance on specific financial capacity (FC) tasks by adults with chronic, moderate to severe acquired brain injury, and to examine the nature of misestimates by the informants. DESIGN Cross-sectional design. SETTING A postacute, community-based rehabilitation center. PARTICIPANTS Data were obtained from 22 chronic acquired brain injury (CABI) adults, mean age of 46.6 years (SD = 8.67), mean years of education of 13.45 years (SD = 2.15), with moderate to severe acquired brain injury (86% had traumatic brain injury), with a mean postinjury period of 17.14 years (SD = 9.5). Whereas the CABI adults completed the Financial Competence Assessment Inventory interview-a combination of self-report and performance-based assessment, 22 informants completed a specifically designed parallel version of the interview. RESULTS Pearson correlations and 1-sample t tests based on the discrepancy scores between informant report and CABI group's performance were used. The CABI group's performance was not associated with its informant's perceptions. One-sample t tests revealed that informants both underestimated and overestimated CABI group's performance. CONCLUSIONS Results indicate lack of correspondence between self- and informant ratings. Further investigation revealed that misestimations by informants occurred in contrary directions with CABI adults' performance being inaccurately rated. These findings raise critical issues related to assuming that the informant report can be used as a "gold standard" for collecting functional data related to financial management, and the idea that obtaining objective data on financial tasks may represent a more valid method of assessing financial competency in adults with brain injury.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the G. H. Sergievsky Center (Drs Sunderaraman and Cosentino) and Department of Neurology (Dr Cosentino), Columbia University Medical Center, New York City, New York; Bancroft Brain Injury Services, Cherry Hill, New Jersey (Dr Lindgren); and Psychology Department, Drexel University, Philadelphia, Pennsylvania (Ms James and Dr Schultheis)
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Sunderaraman P, Maidan I, Kozlovski T, Apa Z, Mirelman A, Hausdorff JM, Stern Y. Differential Associations Between Distinct Components of Cognitive Function and Mobility: Implications for Understanding Aging, Turning and Dual-Task Walking. Front Aging Neurosci 2019; 11:166. [PMID: 31312137 PMCID: PMC6614511 DOI: 10.3389/fnagi.2019.00166] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Cognition and mobility are interrelated. However, this association can be impacted by the specific facets of cognition and mobility that are measured, and further by the different task conditions, e.g., single- versus dual-task walking, under which these associations are evaluated. Systematically studying the multiple facets of cognitive-mobility associations under both the task conditions is critical because both cognition and mobility change with age and pose significant risks associated with falls, morbidity, and disability. Methods Using a cross-sectional, prospective study design, data from 124 healthy adults [mean age (SD) = 61.51 (11.90); mean education (SD) = 15.94 (2.18)] were collected. A comprehensive battery of cognitive tests was administered, and gait was assessed using a small, lightweight, three-axis accelerometer with a gyroscope. Analytical Plan Data were transformed, and only relatively strong relationships survived after strict statistical criteria adjusting for multiple comparisons were applied. Spearman rho correlation coefficients were used to examine the matrix of correlations between the cognitive-motor variables while adjusting for age and gender. Results Executive functions, processing speed, and language were associated with distinct facets of variability, pace, and asymmetry, especially under the dual-task walking condition. Both turns and transitions were also associated with cognition during the Timed Up and Go Task. Conclusion Our results extend converging evidence of the involvement of executive functions and processing speed in specific aspects of mobility, along with the role of language. The study has important implications for aging in terms of both assessment and rehabilitation of cognition and gait as well as for the emerging dual-tasking theories and the role of the neural pathways involved in mobility.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Inbal Maidan
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tal Kozlovski
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zoltan Apa
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Anat Mirelman
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Yaakov Stern
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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Chapman S, Weiss D, Broulíková HM, Joyce JL, Sunderaraman P, McKeague IW, Cosentino S. P4-233: AGE STEREOTYPES INFLUENCE SUBJECTIVE COGNITIVE DECLINE VIA DEPRESSION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - David Weiss
- Columbia University Medical Center; New York NY USA
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis MT. An examination of financial capacity and neuropsychological performance in chronic acquired brain injury (CABI). Brain Inj 2019; 33:991-1002. [PMID: 30712402 DOI: 10.1080/02699052.2019.1570340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PRIMARY OBJECTIVE Financial Capacity (FC) is known to be impaired in the acute and subacute stages of brain injury. The current study sought to examine FC in the context of chronic, moderate to severe acquired brain injury (CABI). RESEARCH DESIGN The Financial Competence Assessment Inventory (FCAI), developed in Australia, was adapted to examine the integrity of FC in an American sample. METHODS AND PROCEDURES Healthy comparison (HC) participants were recruited from the community, whereas participants with CABI were recruited from a community-based rehabilitation center. Participants completed the FCAI and a neuropsychological battery. FCAI performance in the current study was compared against previously published Australian data. Multiple regression analyses examined group (CABI vs. HC) as a predictor of FC. Bivariate correlations examined the cognitive correlates of FCAI in the CABI group. MAIN OUTCOMES AND RESULTS The HC group in the current study obtained similar mean scores as those in the Australian sample. CABI group membership predicted lower performance on each FCAI dimension. In the CABI group, attention, working memory, delayed verbal memory, abstract reasoning and impulsivity were uniquely associated with FCAI dimensions. CONCLUSIONS Findings underscore the importance of continued monitoring of FC even after the subacute stage of injury, and identify cognitive impairments that may be particularly detrimental for specific dimensions of FC.
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Affiliation(s)
- Preeti Sunderaraman
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Stephanie Cosentino
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Karen Lindgren
- b Bancroft Brain Injury Services , Cherry Hill, New Jersey , USA
| | - Angela James
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
| | - Maria T Schultheis
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
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Sunderaraman P, Omollo S, Ho S, Stern Y, Cosentino S. Aging & Dementia - 5
Cognitive Contributors to Financial Capacity in Older Adults. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy060.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.
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Affiliation(s)
- Herbert Medetsky
- a Psychiatric Consultation Service , New York Community Hospital , Brooklyn , NY , USA
| | - Preeti Sunderaraman
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA
| | - Stephanie Cosentino
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA.,d Department of Neurology , Columbia University Medical Center , New York , NY , USA
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Affiliation(s)
- Amanda Gooding
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Cady K. Block
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine at Wexner Medical Center, Columbus, OH, USA
| | - Daniel S. Brown
- Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - Preeti Sunderaraman
- The Taub Institute and Sergievsky Center, Cognitive Neuroscience Division, Columbia University Medical Center, New York, NY, USA
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Meinerding M, DeFeis B, Sunderaraman P, Azar M, Lawless S, Perez-Vivaldo C, Gu Y, Stern Y, Cosentino S. Assessing Dependency in a Multiethnic Community Cohort of Individuals With Alzheimer's Disease. Innov Aging 2018; 2:igy011. [PMID: 29795795 PMCID: PMC5954614 DOI: 10.1093/geroni/igy011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinic-based studies of patients with Alzheimer's disease (AD) have demonstrated the value of assessing dependence when characterizing patients' functional status. The Dependence Scale, a validated tool to assess level of caregiving needs, is associated with markers of disease severity, cost, and progression, while offering independent functional information about patients. This study examines whether such associations between the Dependence Scale and markers of disease severity demonstrated in clinical cohorts are similarly exhibited in a multiethnic community population of individuals with AD. RESEARCH DESIGN AND METHODS One hundred fifty four elders with AD enrolled in the Predictors 3 cohort were assessed with the Dependence Scale, modified Mini-Mental State Examination (mMMS), instrumental (IADL) and basic (BADL) activities of daily living, and Clinical Dementia Rating (CDR) Scale, and were assigned an Equivalent Institutional Care (EIC) rating. Cross-sectional associations were examined using bivariate correlations and one-way analysis of variance analyses. Fisher-z tests examined differences in strengths of associations across previous clinic and current community cohorts. RESULTS Dependence Scale scores were associated with CDR (r = .20, p = .013), mMMS (r = -.23, p = .005), IADL (r = .39, p < .001), BADL (r = .65, p < .001), and EIC (r = .51, p < .001). Dependence was unassociated with ethnicity (F[3,144] = 1.027, p = .3822), age (r = .120, p = .145), and education (r = -.053, p = .519). The strength of the correlations was comparable across cohorts except that BADLs were more strongly associated with dependence (z = -4.60, p < .001) in the community cohort, and living arrangement was not associated with dependence (r = .13, p = .130). DISCUSSION AND IMPLICATIONS Associations between the Dependence Scale and markers of disease severity in a clinic-based cohort of AD patients are similar to associations in a multiethnic community cohort of individuals diagnosed with AD. The Dependence Scale relates to markers of disease severity rather than demographic factors, and may offer an unbiased assessment of care required in multiethnic and community populations.
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Affiliation(s)
- Maria Meinerding
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Brittany DeFeis
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Carlos Perez-Vivaldo
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York
- G.H. Sergievsky Center, Columbia University Medical Center, New York, New York
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
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Abstract
The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness and summarize both traditional and emerging approaches to assessing awareness from clinical and meta-cognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and meta-cognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying meta-cognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA.,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA. .,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA. .,Department of Neurology, Columbia University Medical Center, New York, NY, USA. .,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA.
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Sunderaraman P, Zahodne LB, Manly JJ. A commentary on 'generally representative is representative of none: pitfalls of IQ test standardization in multicultural settings' by A.B. Shuttleworth-Edwards. Clin Neuropsychol 2016; 30:999-1005. [PMID: 27560104 DOI: 10.1080/13854046.2016.1211321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We offer an appraisal of Professor Shuttleworth-Edwards's commentary (2016) on the extraordinary challenges of assessment of cognitive function in a culturally, educationally, racially, and linguistically diverse population. First, we discuss the purpose of using intelligence tests in South Africa and beyond in order to clarify the reference group on which norms will be based. Next, we discuss the psychometric consequences of Pearson's decisions to not adapt their measure of intellectual functioning to the cultural background of the majority of South Africans, and to use a population-matched normative sample in which the disadvantaged group is in the majority. We echo Professor Shuttleworth-Edwards's call for large-scale empirical studies of cognitive test performance in a multicultural context. We conclude the article by urging the entire community of neuropsychologists to hold test companies accountable to strict, ethical, and comprehensive standards for production of accurate and appropriate measurement of cognitive function.
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Affiliation(s)
- Preeti Sunderaraman
- a Department of Neurology, Taub Institute for Research on Alzheimer's Disease and The Aging Brain , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Laura B Zahodne
- a Department of Neurology, Taub Institute for Research on Alzheimer's Disease and The Aging Brain , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Jennifer J Manly
- a Department of Neurology, Taub Institute for Research on Alzheimer's Disease and The Aging Brain , College of Physicians and Surgeons, Columbia University , New York , NY , USA
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Sunderaraman P, Sokolov E, Cines S, Sullo E, Orly A, Lerer B, Karlawish J, Huey E, Cosentino S. Untimed Design Fluency in Aging and Alzheimer's Disease: Psychometrics and Normative Data. Appl Neuropsychol Adult 2015; 22:363-72. [PMID: 25679880 DOI: 10.1080/23279095.2014.940419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Design fluency tests, commonly used in both clinical and research contexts to evaluate nonverbal concept generation, have the potential to offer useful information in the differentiation of healthy versus pathological aging. Although normative data for older adults (OAs) are available for multiple timed versions of this test, similar data have been unavailable for a previously published untimed test, the Graphic Pattern Generation Test (GPG). Time constraints common to almost all of the available design fluency tests may cloud interpretation of higher-level executive abilities-for example, in individuals with slow processing speed. The current study examined the psychometric properties of the GPG and presents normative data in a sample of 167 healthy OAs and 110 individuals diagnosed with Alzheimer's disease (AD). Results suggest that a brief version of the GPG can be administered reliably and that this short form has high test-retest and interrater reliability. Number of perseverations was higher in individuals with AD as compared with OAs. A cutoff score of 4 or more perseverations showed a moderate degree of sensitivity (76%) and specificity (37%) in distinguishing individuals with AD and OAs. Finally, perseverations were associated with nonmemory indexes, thereby underscoring the nonverbal nature of this error in OAs and individuals with AD.
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Affiliation(s)
- Preeti Sunderaraman
- a Department of Psychology , Drexel University , Philadelphia , Pennsylvania
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Turekca S, Schultheis M, Sunderaraman P. B-89 * Comparison of Driving Performance, Cognition, and Physical Symptoms in Individuals with Multiple Sclerosis and Healthy Controls. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tiersky L, Sunderaraman P, Sylvester P, Ang J, Schultheis M, Newton S, Holland A, Burns K, Bunting J, Taylor J, Muetze H, Coe M, Harrison D, Putnam M, Tiersky L, Freer B, Holland A, Newton S, Sakamoto M, Bunting J, Taylor J, Coe M, Harrison D, Musso M, Hill B, Barker A, Pella R, Gouvier W, Davis J, Woods S, Wall J, Etherton J, Brand T, Hummer B, O'Shea C, Segovia J, Thomlinson S, Schulze E, Roskos P, Gfeller J, Loftis J, Fogel T, Barrera K, Sherzai A, Chappell A, Harrison A, Armstrong I, Flaro L, Pedersen H, Shultz LS, Roper B, Huckans M, Basso M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Silk-Eglit G, Stenclik J, Miele A, Lynch J, Musso M, McCaffrey R, Martin P, VonDran E, Baade L, Heinrichs R, Schroeder R, Hunter B, Calloway J, Rolin S, Akeson S, Westervelt H, Mohammed S, An K, Jeffay E, Zakzanis K, Lynch A, Drasnin D, Ikanga J, Graham O, Reid M, Cooper D, Long J, Lange R, Kennedy J, Hopewell C, Lukaszewska B, Pachalska M, Bidzan M, Lipowska M, McCutcheon L, Kaup A, 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POSTER SESSIONS SCHEDULE. Arch Clin Neuropsychol 2013. [DOI: 10.1093/arclin/act054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schultheis MT, Ang J, Blake T, Bradley SJ, Hong G, Martin D, Ricasa JC, Sunderaraman P. Driving and Post-Concussion Changes in Neuropsychological Performance. PM R 2012. [DOI: 10.1016/j.pmrj.2012.09.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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