Efficacy of Digital and Non-Digital Compensatory Strategies in Supporting Prospective Memory Task Completion among Community-Dwelling Mid-Life and Older Adults

OBJECTIVE

Compensatory strategies can be used to help mid-life and older adults successfully manage instrumental activities of daily living that rely upon prospective memory. This study compared the quality of digital and non-digital compensatory strategies in supporting accurate completion of naturalistic, real-world prospective memory tasks.

METHOD

Participants included 70 community-dwelling mid-life and older adults. In this cross-sectional study, participants were tested remotely via Zoom in their homes. They were tasked with completing four real-world prospective memory tasks and encouraged to use their typical compensatory strategies. Utilized strategies were categorized, counted, and assigned quality scores (rating of thoroughness and utility), and prospective memory performance was coded.

RESULTS

Participants who used any digital strategies utilized significantly more (ηp2 = .17) and better quality (ηp2 = .12) strategies than participants who did not use any digital strategies. However, the groups demonstrated equivalent prospective memory performance (ηp2 = .006). Within the digital group, participants' digital and non-digital strategies were of similar quality (d = .14) and resulted in similar prospective memory task accuracy (d = .01).

CONCLUSIONS

Digital and non-digital strategies led to similar performance on naturalistic prospective memory tasks. Findings suggest that many different types of strategies can provide adequate prospective memory support to healthy mid-life and older adults. To inform development of compensatory strategy interventions, future studies should explore other factors that lead to successful prospective memory, such as the specific strategy type and task type match, across the continuum of cognitive impairment.

The Benton Visual Form Discrimination Test as a Predictor of Neurocognitive Disorder in Older Veterans

OBJECTIVE

The Benton Visual Form Discrimination Test (VFDT) is a commonly used measure of visual discrimination and visual recognition memory and has shown promise in distinguishing between different levels of cognitive impairment. We assess the predictive diagnostic utility of the VFDT in a sample of older Veterans with cognitive concerns.

METHOD

Subjects included a total of 172 mostly male Veterans over the age of 64 (mean = 76.0; SD = 7.6) recruited from a VA clinic specializing in neuropsychological assessment of older Veterans. The clinical sample included 56 subjects diagnosed with Major Neurocognitive Disorder, 74 diagnosed with Mild Neurocognitive Disorder, and 42 with No Neurocognitive Impairment. Impairment categories were modeled in separate multinomial logistic regressions with two versions of the VFDT as predictors: the Visual Form Discrimination Test-Recognition Subtest (VFDT-Rec) test (visual recognition memory) and the Visual Form Discrimination Test-Matching Subtest VFDT-Mat test (visual form discrimination). Years of education were included as a covariate.

RESULTS

After adjusting for education, higher VFDT-Rec total scores were associated with lower odds of being categorized with a greater degree of cognitive/functional impairment (OR 0.66-0.83, p < .001). VFDT-Mat scores showed a similar pattern, but only reached statistical significance for the Major versus No Neurocognitive Impairment (OR = 0.77, p = .0010) and Major versus Mild comparisons (OR = 0.89, p = .0233).

CONCLUSIONS

The VFDT may enhance the confidence of differential diagnosis of dementia in older adult Veterans. Formal education-adjusted norms need to be established for clinical use.

Mindfulness Meditation: Impact on Attentional Control and Emotion Dysregulation

OBJECTIVE

Theoretical models of mindfulness meditation conceptualize the cultivation of focused attention and regulation of emotional states, with the attitudinal foundations that promote nonjudgment and acceptance, to facilitate cognitive and affective processing resulting in improved brain health. Within the scientific study of mindfulness meditation, outcomes assessing behavioral and neural correlates of attentional control and emotion regulation have been examined for their malleability as a function of engagement in mindfulness practices. This review synthesizes the results of our pilot trials examining the preliminary effects of mindfulness meditation on metrics of cognitive, affective, and brain health in older adults and in individuals with multiple sclerosis.

CONCLUSIONS

There is promising support for mindfulness meditation to enhance attentional control, reduce mind-wandering, and reduce emotion dysregulation. However, well-powered efficacy trials, with an objective assessment of mindfulness practice data are needed to further provide causal and comprehensive evidence supporting the efficacy of mindfulness meditation for brain health. Inclusion of independently derived and validated brain-based signatures of cognitive and affective functioning can additionally enable a parsimonious understanding of how mindfulness meditation can causally impact metrics of functional and structural integrity of the human brain.

The relationship of cognitive change over time to the self-reported Ascertain Dementia 8-item Questionnaire in a general population

OBJECTIVE

The aim of the study was to examine the relationship between longitudinally assessed cognitive functioning and self-reported dementia status using the Ascertain Dementia 8-item questionnaire (AD8) in a national population-based sample.

METHODS

The analysis included 14,453 participants from the REasons for Geographic and Racial Differences in Stroke study. A validated cutoff of ≥2 symptoms endorsed on the AD8 (administered 10 years after enrollment) represented positive AD8 status. Incident cognitive impairment was defined as change from intact to impaired status in the Six-Item Screener score, and cognitive decline was defined by trajectories of Letter "F" Fluency from the Montreal Cognitive Assessment, and Animal Fluency, Word List Learning, and Word List Delayed recall, all from the Consortium to Establish a Registry for Alzheimer's Disease battery. Logistic regression models controlled for demographics, health variables, and depressive symptoms.

RESULTS

Sensitivity and specificity of the AD8 to detect incident cognitive impairment were 45.2% and 78.4%, respectively. Incident cognitive impairment and a one-word decline in WLL increased the odds of self-reported positive AD8 by 96% (95% CI: 1.68-2.28) and 27% (95% CI: 1.17-1.37), respectively. There was a strong association between high depression risk and self-reported positive AD8 in sensitivity analyses.

CONCLUSIONS

Incident cognitive impairment and high depression risk were the strongest predictors of self-reported positive AD8 in this population-based sample. Our results inform the utility of the AD8 as a self-report measure in a large, national sample that avoids selection biases inherent in clinic-based studies. The AD8 is screening measure and should not be used to diagnose dementia clinically.

Gender Differences in Veterans Referred for Neuropsychological Evaluation in an Outpatient Neuropsychology Consultation Service

OBJECTIVE

The number of women veterans seeking Veterans Health Administration services has substantially increased over the past decade. Neuropsychology remains an understudied area in the examination of gender differences. The present study sought to delineate similarities and differences in men and women veterans presenting for neuropsychological evaluation in terms of demographics, referral, medical conditions, effort, and outcome diagnosis.

METHOD

A database collected from an outpatient VA neuropsychology clinic from 2013 to 2019 was analyzed (n = 232 women, 2642 men). Additional analyses examined younger (n = 836 men, 155 women) and older (n = 1805 men, 77 women) age cohorts.

RESULTS

Women veterans were younger and more educated than men, whereas men had higher prevalence of vascular risk factors. Both groups were most often referred from mental health clinics and memory was the most common referral question. Although men performed worse on performance validity measures, clinicians rated women as evidencing poorer effort on a cumulative rating based on formal and embedded performance validity measures, behavioral observations, and inconsistent test patterns. Older women reported more depressive symptoms than older men and were more commonly diagnosed with depression.

CONCLUSIONS

This exploratory study fills a gap in the understanding of gender differences in veterans presenting for neuropsychological evaluations. Findings emphasize consideration for the intersection of gender with demographics, medical factors, effort, and psychological symptoms by VA neuropsychologists. A better understanding of relationships between gender and these factors may inform neuropsychologists' test selection, interpretation of behavioral observations, and diagnostic considerations to best treat women veterans.

Superior Memory Reduces 8-year Risk of Mild Cognitive Impairment and Dementia But Not Amyloid β-Associated Cognitive Decline in Older Adults

OBJECTIVE

To prospectively examine 8-year risk of clinical disease progression to mild cognitive impairment (MCI)/dementia in older adults ≥60 with superior episodic memory (SuperAgers) compared to those cognitively normal for their age (CNFA). Additionally, to determine the extent to which SuperAgers were resilient to the negative effects of elevated amyloid-beta (Aβ+) on cognition.

METHOD

Participants were classified as SuperAgers based on episodic memory performance consistent with younger adults aged 30-44 and no impairment on non-memory tests (n = 179), and were matched with CNFA on age, sex, education, and follow-up time (n = 179). Subdistribution hazard models examined risk of clinical progression to MCI/dementia. Linear mixed models assessed the effect of Aβ on cognition over time.

RESULTS

Prevalence of Aβ+ and APOE ε4 was equivalent between SuperAgers and CNFA. SuperAgers had 69%-73% reduced risk of clinical progression to MCI/dementia compared to CNFA (HR: 0.27-0.31, 95% CI: 0.11-0.73, p < .001). Aβ+ was associated with cognitive decline in verbal memory and executive function, regardless of SuperAger/CNFA classification. In the absence of Aβ+, equivalent age-related changes in cognition were observed between SuperAgers and CNFA.

CONCLUSIONS

SuperAgers displayed resilience against clinical progression to MCI/dementia compared to CNFA despite equivalent risk for Alzheimer's disease (AD); however, SuperAgers had no greater protection from Aβ+ than CNFA. The deleterious effects of Aβ on cognition persist regardless of baseline cognitive ability. Thus, superior cognitive performance does not reflect resistance against the neuropathological processes associated with AD, and the observed resilience for SuperAgers may instead reflect neuropsychological criteria for cognitive impairment.

Iowa Gambling Task Performance in Parkinson Disease Patients with Impulse Control Disorders

OBJECTIVE

A subgroup of patients with Parkinson disease (PD) develops impulse control disorders (ICD) associated with their dopamine replacement therapy. Patients and their families may be reluctant to report ICD symptoms or unaware these symptoms are related to PD medication, which can make detecting an ICD difficult for clinicians. Ideally, a behavioral measure that is sensitive to ICD could be employed to ensure that patients with these behaviors are identified and treated. The Iowa Gambling Task (IGT), a standardized decision-making task, has proven sensitive in other populations with impulse control problems. We hypothesized that the IGT would differentiate between PD patients with and without ICD.

METHODS

We compared IGT performance and disease variables in 24 PD patients with ICD and 24 PD patients without ICD. Patient groups were matched in terms of age, sex, and duration of PD.

RESULTS

There were no significant differences in IGT scores between PD groups. IGT performance declined with increasing age, but the majority of patients performed within normal limits based on published age- and education-corrected normative data.

CONCLUSIONS

The IGT did not distinguish between PD patients with and without ICD. Increasing age negatively impacted performance in both groups. Other studies have found that IGT performance may decline in normal aging. Our results suggest that the IGT lacks the sensitivity and specificity needed to differentiate between age-related deficits and disruption in frontal-subcortical circuits underlying ICD associated with PD medications. Therefore, the IGT is not an appropriate behavioral measure for ICD in PD patients.

Diagnostic Accuracy, Item Analysis and Age Effects of the UPSIT Spanish Version in Parkinson's Disease

OBJECTIVE

The University of Pennsylvania Smell Identification Test (UPSIT) is the most commonly used test to detect olfactory impairment in Parkinson's disease (PD), but the cut-off score for clinical purposes is often difficult to establish because of age and sex effects. The current work aims to study the sensitivity and specificity of the UPSIT Spanish version and its accuracy in discriminating PD patients at different age groups from healthy controls (HC), and to perform an item analysis.

METHOD

Ninety-seven non-demented PD patients and 65 HC were assessed with the UPSIT Spanish version. Sensitivity, specificity, and diagnostic accuracy for PD were calculated. Multiple regression analysis was used to define predictors of UPSIT scores.

RESULTS

Using the normative cut-off score for anosmia (≤18), the UPSIT showed a sensitivity of 54.6% with a specificity of 100.0% for PD. We found that, using the UPSIT cut-off score of ≤25, sensitivity was 81.4% and specificity 84.6% (area under the receiver operating characteristic curve = 0.908). Diagnosis and age were good predictors of UPSIT scores (B = -10.948; p < .001; B = -0.203; p < .001). When optimal cut-off scores were considered according to age ranges (≤60, 61-70, and ≥71), sensitivity and specificity values were >80.0% for all age groups.

CONCLUSIONS

In the Spanish UPSIT version, sensitivity and specificity are improved when specific cut-off scores for different age groups are computed.

Independent and Differential Effects of Obesity and Hypertension on Cognitive and Functional Abilities

Objective

The primary aim of this study was to identify the independent and differential associations of obesity and hypertension with cognitive, physical, and directly observed functional abilities among middle age and older adults.

Method

Participants were 119 adults between the ages of 51 and 89, who underwent a cross-sectional assessment of cognitive, physical, functional and relevant health-related variables.

Results

Obesity predicted significantly poorer executive functions (β = -.301, t = -3.86, p < .001), mobility (β = .329, t = 3.59, p < .001), observed functional abilities (β = .220, t = 2.52, p = .013), and self-reported ability to perform activities of daily living that require physical capability (β = -.365, t = -4.23, p < .001). In contrast, hypertension was not independently associated with any of the outcome measures (ps > .05). Results from the path analysis revealed that executive functions mediated the association between obesity and poorer directly observed functional abilities. Additionally, obesity had a direct and indirect (through mobility) effect on self-reported basic activities of daily living.

Conclusions

These findings suggest a link between obesity, executive functions, and limitations in physical function and instrumental activities of daily living among middle age and older adults, however, longitudinal research is needed to further delineate the trajectory of these factors.

Memory Binding Test Distinguishes Amnestic Mild Cognitive Impairment and Dementia from Cognitively Normal Elderly

OBJECTIVE

We aimed to assess reliability and cross-sectional discriminative validity of the Memory Binding Test (MBT) to distinguish persons with amnestic cognitive impairment (aMCI) and dementia from cognitively normal elderly controls.

METHOD

The MBT was administered to 20 participants with dementia, 31 with aMCI and 246 controls, who received the first administration of the MBT from May 2003 to December 2007, as a substudy of the community-based Einstein Aging Study (age range: 70+). The optimal index resulted from comparing the partial area under the receiver operating characteristic curves (ROC AUC) of four major MBT indices for specificities ≥0.70. Optimal cut-score of the optimal index was selected by maximizing the sum of sensitivity and specificity. Age and education effects were assessed using stratified cut-scores and adjusted logistic regression. Reliability was computed as intraclass correlation between scores at baseline and 1-year follow-up for participants who remained cognitively normal.

RESULTS

Total number of Items recalled in the Paired condition (TIP) was elected the optimal index. TIP cut-score was ≤22 for differentiating aMCI alone (sensitivity = 0.74, specificity = 0.73) and aMCI and dementia combined (sensitivity = 0.84, specificity = 0.73) from controls. It was ≤17 for differentiating dementia from aMCI and controls (sensitivity = 0.95, specificity = 0.87). Age and education adjustments did not materially improve discriminative validity. The reliability of TIP was 0.77.

CONCLUSIONS

MBT achieved moderate to good reliability. TIP had superior cross-sectional discriminative validity than the other MBT indices. We recommend using the empirical cut-score of TIP ≤22 for discriminating aMCI and dementia and ≤17 for discriminating dementia alone.

Neuropsychological Assessment of Driving Capacity

Clinicians are increasingly requested to make determinations regarding patients' driving capacity in the context of neurological injury/conditions and a growing cohort of older drivers. The capability to drive safely involves a number of cognitive, physical, and sensorimotor abilities that may be impacted by injury, illness, or substances that influence alertness. Neuropsychological measures are an important component of a multidisciplinary approach for evaluation of driving capacity. Clinicians should become familiar with measures that have the best predictive validity so they may incorporate a patient's neurocognitive strengths and weaknesses in decisions about driving ability.

Critical Flicker Fusion Predicts Executive Function in Younger and Older Adults

Critical flicker fusion (CFF), a measure of visual processing speed, has often been regarded as a basic metric underlying a number of higher cognitive functions. To test this, we measured CFF, global cognition, and several cognitive subdomains. Because age is a strong covariate for most of these variables, both younger (n = 72) and older (n = 57) subjects were measured. Consistent with expectations, age was inversely related to CFF and performance on all of the cognitive measures except for visual memory. In contrast, age-adjusted CFF thresholds were only positively related to executive function. Results showed that CFF predicted executive function across both age groups and accounted for unique variance in performance above and beyond age and global cognitive status. The current findings suggest that CFF may be a unique predictor of executive dysfunction.

Fund of Information is More Strongly Associated with Neuropsychological Functioning Than Education in Older Spanish Adults

Educational influence on cognitive performance has been extensively agreed in Neuropsychology. Nonetheless, recent studies highlighted the need of better measurements to assess benefit from the schooling experience in order to further understand schooling influence on cognition. The WAIS-III Information subtest is proposed here to measure this influence at old age. Ninety-five older adults were divided according to their educational attainment and their Information subtest score, and completed extensive neuropsychological assessment. Performance on the Information subtest had a significant effect on all same cognitive functions as educational attainment, but also on additional domains. Moreover, cognitive performance on several tasks can be classified in three levels as a function of Information score. The WAIS-III Information subtest could be of special interest as a measurement of the benefit from educational experience not only to study cognition in Spanish older populations but also heterogeneous samples in terms of educational experiences and environments.

Depressive symptoms are more strongly related to executive functioning and episodic memory among African American compared with non-Hispanic White older adults

We examined whether the reserve capacity model can be extended to cognitive outcomes among older African Americans. Two hundred and ninety-two non-Hispanic Whites and 37 African Americans over age 54 participated in the normative study for the NIH Toolbox for the Assessment of Neurological and Behavioral Function. Multiple-group path analysis showed that associations between depressive symptoms and cognition differed by race, independent of age, education, reading level, income, health, and recruitment site. Depressive symptoms were associated with slowed processing speed among Whites and worse task-switching, inhibition, and episodic memory among African Americans. African Americans may be more vulnerable to negative effects of depression on cognition than non-Hispanic Whites. Further research is needed to explicate the psychological and neurobiological underpinnings of this greater vulnerability.