Assessing cognitive impairment using PROMIS(®) applied cognition-abilities scales in a medical outpatient sample.

Having a brief, standardized, reliable, and valid self-rated test of perceived cognitive functioning could be beneficial in psychiatry clinical practice, research, and clinical trials. The PROMIS(®) Applied Cognition-Abilities scales were developed, evaluated, and distributed by the National Institutes of Health to measure perceived cognitive functioning. This study examines several aspects of the reliability and validity of the PROMIS(®) Applied Cognition-Abilities eight and four-item scales in a sample of adult and older adult medical outpatients (N = 148). Internal consistency reliability was high for both PROMIS(®) cognition scales. The brief four-item scale was highly correlated with the full eight-item scale (rs = 0.98). There was a moderate correlation between the PROMIS(®) Applied Cognition-Abilities scales and measures of depression (PHQ-9) and anxiety (GAD-7). Subgroups of participants screening positively for depression or anxiety reported significantly worse cognitive functioning than medical controls, with large effect sizes. The base rates of individual items endorsed by depressed, anxious, and control participants are reported. More than 42% of depressed and anxious participants reported problems with their memory and concentration compared with fewer than 8% of medical controls. The field would benefit from studies using the PROMIS(®) Applied Cognition-Abilities scales in more demographically diverse samples and with other established measures of cognition.

RBANS embedded measures of suboptimal effort in dementia: effort scale has a lower failure rate than the effort index.

The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310-319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841-854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190-195). We explored failure rates on these effort measures in a non-litigating mixed dementia sample (N = 145). Failure rate on the EI was high (48%) and associated with dementia severity. In contrast, failure on the ES was 14% but differed based on type of dementia. ES failure was low (4%) when dementia was due to Alzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations.

Is poor sleep quality at high altitude separate from acute mountain sickness? Factor structure and internal consistency of the Lake Louise Score Questionnaire.

BACKGROUND: The factor structure and internal consistency of the Lake Louise Score Questionnaire (LLSQ) have not been determined in a large population at high altitude; however, a single-factor structure and a high internal consistency are preferable for accurate clinical and research applications of the LLSQ. METHODS: A large group of Nepalese pilgrims (n=491) were assessed for acute mountain sickness with a verbal Nepali translation of the LLSQ after rapidly ascending from 1950 m to 4380 m. The factor structure and internal consistency of the LLSQ were determined with a confirmatory factor analysis (CFA) and the ordinal alpha coefficient, respectively. RESULTS: A one-factor structure with all five items of the LLSQ was accepted. Four items (headache, gastrointestinal upset, fatigue/weakness, and dizziness/lightheadedness) loaded strongly on this factor (>0.70), but sleep quality had a low factor loading (0.33). The internal consistency (ordinal alpha coefficient) was 0.79, but removing the sleep quality item improved this value to 0.84. CONCLUSIONS: The sleep quality item of the LLSQ was weakly related to the other items of the LLSQ. Future research should further investigate whether impaired sleep at altitude should be considered separately from other symptoms of AMS.

Improving test interpretation for detecting executive dysfunction in adults and older adults: prevalence of low scores on the test of verbal conceptualization and fluency.

Knowing the prevalence of low scores on a battery of executive-functioning tests supplements clinical interpretation and can reduce the likelihood of misdiagnosing deficits in executive functioning. The purpose of this study is to examine the base rates of low scores on the Test of Verbal Conceptualization and Fluency (TVCF; Reynolds & Horton, 2006 ) in healthy adults (n = 332; M (age) = 33.0 years, SD = 10.5, range = 20-59) and older adults (n = 138; M (age) = 74.9 years, SD = 7.8, range = 60-89) from the TVCF standardization sample. The TVCF consists of four tests of executive functioning (i.e., Category Fluency, Letter Naming, Classification, and Trails C) that provide five age-adjusted T-scores. The prevalence of low scores was examined in the total sample and was stratified by educational level. When the five T-scores were considered simultaneously, having one or more scores that were 1 standard deviation (SD) below the mean was found in 28% of healthy adults and 38% of older adults. Education-based differences were also present with more lenient cutoff scores (e.g., 1 SD) but not with more conservative cutoffs. Consistent with the existing literature on other test batteries, at least one low subtest score on the TVCF is common in healthy adults and older adults.

Aboriginal experiences of aging and dementia in a context of sociocultural change: qualitative analysis of key informant group interviews with Aboriginal seniors.

Examining the role of culture and cultural perceptions of aging and dementia in the recognition, diagnosis, and treatment of age-related cognitive impairment remains an understudied area of clinical neuropsychology. This paper describes a qualitative study based on a series of key informant group interviews with an Aboriginal Grandmothers Group in the province of Saskatchewan. Thematic analysis was employed in an exploration of Aboriginal perceptions of normal aging and dementia and an investigation of issues related to the development of culturally appropriate assessment techniques. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system: (1) cognitive and behavioural changes were perceived as a normal expectation of the aging process and a circular conception of the lifespan was identified, with aging seen as going back "back to the baby stage", (2) a "big change in culture" was linked by Grandmothers to Aboriginal health, illness (including dementia), and changes in the normal aging process, and (3) the importance of culturally grounded healthcare both related to review of assessment tools, but also within the context of a more general discussion of experiences with the healthcare system. Themes of sociocultural changes leading to lifestyle changes and disruption of the family unit and community caregiving practices, and viewing memory loss and behavioural changes as a normal part of the aging process were consistent with previous work with ethnic minorities. This research points to the need to understand Aboriginal perceptions of aging and dementia in informing appropriate assessment and treatment of age-related cognitive impairment and dementia in Aboriginal seniors.

The effects of age, sex and Alzheimer's disease on strategy use during verbal fluency tasks.

Clustering and switching strategies during phonemic and semantic verbal fluency tasks were investigated in healthy adults (n = 193, 86 males, 20-90 years) in young, middle-aged, young-old, and old-old age groups (Study 1). Older groups produced fewer total words and lower switching scores; males relied more on clustering and females on switching to produce equivalent output. In Study 2, early Alzheimer's disease participants, compared to healthy older adults, (n = 26 per group) produced fewer total words and smaller average clusters. Sex, age, and clinical differences on switching and clustering strategies support a dual processing model of verbal fluency.

The effect of age and sex on clustering and switching during speeded verbal fluency tasks.

Past research has been inconsistent with regard to the effects of normal aging and sex on strategy use during verbal fluency performance. In the present study, both Troyer et al.'s (1997) and Abwender et al.'s (2001) scoring methods were used to measure switching and clustering strategies in 60 young and 72 older adults, equated on verbal ability. Young adults produced more words overall and switched more often during both phonemic and semantic fluency tasks, but performed similarly to older adults on measures of clustering. Although there were no sex differences in total words produced on either fluency task, males produced larger clusters on both tasks, and females switched more frequently than males on the semantic but not on the phonemic fluency task. Although clustering strategies appear to be relatively age-insensitive, age-related changes in switching strategies resulted in fewer overall words produced by older adults. This study provides evidence of age and sex differences in strategy use during verbal fluency tests, and illustrates the utility of combining Troyer's and Abwender's scoring procedures with in-depth categorization of clustering to understand interactions between age and sex during semantic fluency tasks.