Pain in the Context of Virtual Neuropsychological Assessment of Older Adults.

OBJECTIVE: Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. METHOD: The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. RESULTS: Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. CONCLUSIONS: Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.

Lexical Speech Features of Spontaneous Speech in Older Persons With and Without Cognitive Impairment: Reliability Analysis.

Background: Speech analysis data are promising digital biomarkers for the early detection of Alzheimer disease. However, despite its importance, very few studies in this area have examined whether older adults produce spontaneous speech with characteristics that are sufficiently consistent to be used as proxy markers of cognitive status. Objective: This preliminary study seeks to investigate consistency across lexical characteristics of speech in older adults with and without cognitive impairment. Methods: A total of 39 older adults from a larger, ongoing study (age: mean 81.1, SD 5.9 years) were included. Participants completed neuropsychological testing and both picture description tasks and expository tasks to elicit speech. Participants with T-scores of ≤40 on ≥2 cognitive tests were categorized as having mild cognitive impairment (MCI). Speech features were computed automatically by using Python and the Natural Language Toolkit. Results: Reliability indices based on mean correlations for picture description tasks and expository tasks were similar in persons with and without MCI (with r ranging from 0.49 to 0.65 within tasks). Intraindividual variability was generally preserved across lexical speech features. Speech rate and filler rate were the most consistent indices for the cognitively intact group, and speech rate was the most consistent for the MCI group. Conclusions: Our findings suggest that automatically calculated lexical properties of speech are consistent in older adults with varying levels of cognitive impairment. These findings encourage further investigation of the utility of speech analysis and other digital biomarkers for monitoring cognitive status over time.

Considerations regarding noncredible performance in the neuropsychological assessment of patients with multiple sclerosis: A case series.

Determining the validity of data during clinical neuropsychological assessment is crucial for proper interpretation, and extensive literature has emphasized myriad methods of doing so in diverse samples. However, little research has considered noncredible presentation in persons with multiple sclerosis (pwMS). PwMS often experience one or more factors known to impact validity of data, including major neurocognitive impairment, psychological distress/psychogenic interference, and secondary gain. This case series aimed to illustrate the potential relationships between these factors and performance validity testing in pwMS. Six cases from an IRB-approved database containing pwMS referred for neuropsychological assessment at a large, academic medical center involving at least one of the above-stated factors were identified. Backgrounds, neuropsychological test data, and clinical considerations for each were reviewed. Interestingly, no pwMS diagnosed with major neurocognitive impairment was found to have noncredible performance, nor was any patient with noncredible performance in the absence of notable psychological distress. Given the variability of noncredible performance and multiplicity of factors affecting performance validity in pwMS, clinicians are strongly encouraged to consider psychometrically appropriate methods for evaluating validity of cognitive data in pwMS. Additional research aiming to elucidate base rates of, mechanisms begetting, and methods for assessing noncredible performance in pwMS is imperative.

Feasibility of Predicting In-Season Mental Health Problems in College Student-Athletes From Pre-season Assessment.

OBJECTIVE: To examine whether pre-season assessment using a validated assessment tool, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), could predict college student-athletes identified as experiencing in-season mental health (MH) problems. DESIGN: A prospective study of athletes who completed a pre-season evaluation in August 2018. SETTING AND PARTICIPANTS: A total of 195 National Collegiate Athletic Association Division 1 student-athletes from a large midwestern university in northeast Ohio. INDEPENDENT VARIABLE: The MMPI-2-RF, a 338-item self-report measure of constructs relevant to the assessment of psychopathology and personality. MAIN OUTCOME MEASURE: Mental health problems of student-athletes tracked throughout the competitive season (August 2018-May 2019) by a team of athletic department personnel who met weekly with a licensed clinical psychologist. RESULTS: In pre-season assessment, 71.8% of athletes clinically elevated at least one MMPI-2-RF scale and underreporting was higher in student-athletes than normative controls. Pre-season levels of internalizing psychopathology, diffuse physical symptoms, and unusual thoughts predicted increased likelihood of experiencing MH problems during the competitive season. CONCLUSIONS: The current findings suggest that the MMPI-2-RF may be a promising tool for identifying student-athletes at risk for MH concerns.

Automated assessment of speech production and prediction of MCI in older adults.

The population of older adults is growing dramatically and, with it comes increased prevalence of neurological disorders, including Alzheimer's disease (AD). Though existing cognitive screening tests can aid early detection of cognitive decline, these methods are limited in their sensitivity and require trained administrators. The current study sought to determine whether it is possible to identify persons with mild cognitive impairment (MCI) using automated analysis of spontaneous speech. Participants completed a brief neuropsychological test battery and a spontaneous speech task. MCI was classified using established research criteria, and lexical-semantic features were calculated from spontaneous speech. Logistic regression analyses compared the predictive ability of a commonly-used cognitive screening instrument (the Modified Mini Mental Status Exam, 3MS) and speech indices for MCI classification. Testing against constant-only logistic regression models showed that both the 3MS [χ2(1) = 6.18, p = .013; AIC = 41.46] and speech indices [χ2(16) = 32.42, p = .009; AIC = 108.41] were able to predict MCI status. Follow-up testing revealed the full speech model better predicted MCI status than did 3MS (p = .049). In combination, the current findings suggest that spontaneous speech may have value as a potential screening measure for the identification of cognitive deficits, though confirmation is needed in larger, prospective studies.

Using Automatic Assessment of Speech Production to Predict Current and Future Cognitive Function in Older Adults.

Neurodegenerative conditions like Alzheimer disease affect millions and have no known cure, making early detection important. In addition to memory impairments, dementia causes substantial changes in speech production, particularly lexical-semantic characteristics. Existing clinical tools for detecting change often require considerable expertise or time, and efficient methods for identifying persons at risk are needed. This study examined whether early stages of cognitive decline can be identified using an automated calculation of lexical-semantic features of participants' spontaneous speech. Unimpaired or mildly impaired older adults (N = 39, mean 81 years old) produced several monologues (picture descriptions and expository descriptions) and completed a neuropsychological battery, including the Modified Mini-Mental State Exam. Most participants (N = 30) returned one year later for follow-up. Lexical-semantic features of participants' speech (particularly lexical frequency) were significantly correlated with cognitive status at the same visit and also with cognitive status one year in the future. Thus, automated analysis of speech production is closely associated with current and future cognitive test performance and could provide a novel, scalable method for longitudinal tracking of cognitive health.

Examining emotion-, personality-, and reward-related dispositional tendencies in relation to eating pathology and weight change over seven years in the Longitudinal Assessment of Bariatric Surgery (LABS) study.

This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments were conducted to evaluate eating pathology, using the Eating Disorder Examination-Bariatric Surgery Version, and percent weight change from pre-surgery. Dispositional measures were administered at the 6- or 7-year assessment and included the Affect Intensity Measure, Difficulties in Emotion Regulation Scale, UPPS-P Impulsive Behavior Scale, Adult Temperament Questionnaire-Effortful Control Scale, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Results from a series of linear mixed models revealed significant associations of emotion dysregulation, affect intensity, positive and negative urgency, effortful control, and reward sensitivity with eating pathology severity across 7 years; additionally, all but two of the subscales comprising the total scores were also significantly associated. Fewer statistically significant results were found in relation to weight change; emotion dysregulation and affect intensity (along with several subscales) were significantly associated with lower percent weight change (i.e., less weight loss), but of the reward-related and personality/temperament variables, only total effortful control emerged as significant. However, the associations of the other variables with both outcomes were consistently in the expected direction. Associations also appeared consistent across surgical procedures. Taken together, findings suggest that certain dispositional tendencies may relate to less optimal long-term outcomes following bariatric surgery and thus may be useful to assess in pre-surgical or early post-surgical evaluations to inform targeted recommendations.

Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery.

BACKGROUND: Bariatric surgery candidates exhibit cognitive impairment on neuropsychological testing and these deficits are associated with reduced post-operative weight loss. However, less is known about the prevalence of cognitive function in older adults that pursue surgery, despite being at higher risk for cognitive dysfunction. OBJECTIVE: To examine the prevalence and profile of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in elderly bariatric patients. We hypothesized that increased body mass index (BMI) and higher number of medications would be linked to lower MoCA score, and that men would evidence poorer MoCA scores than women given past work showing that men presenting for bariatric surgery have more medical comorbidities. METHODS: Data was retrospectively extracted from electronic medical records. Patients 65 and older who completed pre-surgical MoCA assessment and bariatric surgery were included in the study (n = 55). RESULTS: Twenty-two percent of patients scored below cutoff for impairment on the MoCA. MoCA total score was negatively correlated with BMI and number of medications pre-surgery. There was a significant effect for gender, with men outperforming women. CONCLUSIONS: The current findings suggest that cognitive impairment is common in older adults presenting for bariatric surgery. Future studies are needed to determine the most appropriate methods for detecting cognitive dysfunction in this high-risk population.

Performance of the Automated Neuropsychological Assessment Metrics (ANAM) in detecting cognitive impairment in heart failure patients.

OBJECTIVE: Evaluate capacity of the Automated Neuropsychological Assessment Metrics (ANAM) to detect cognitive impairment (CI) in heart failure (HF) patients. BACKGROUND: CI is a key prognostic marker in HF. Though the most widely used cognitive screen in HF, the Mini-Mental State Examination (MMSE) is insufficiently sensitive. The ANAM has demonstrated sensitivity to cognitive domains affected by HF, but has not been assessed in this population. METHODS: Investigators administered the ANAM and MMSE to 57 HF patients, compared against a composite model of cognitive function. RESULTS: ANAM efficiency (p < .05) and accuracy scores (p < .001) successfully differentiated CI and non-CI. ANAM efficiency and accuracy scores classified 97.7% and 93.0% of non-CI patients, and 14.3% and 21.4% with CI, respectively. CONCLUSIONS: The ANAM is more effective than the MMSE for detecting CI, but further research is needed to develop a more optimal cognitive screen for routine use in HF patients.

Development and psychometric evaluation of a cardiovascular risk and disease management knowledge assessment tool.

PURPOSE: This article describes the systematic construction and psychometric analysis of a knowledge assessment instrument for phase II cardiac rehabilitation (CR) patients measuring risk modification disease management knowledge and behavioral outcomes derived from national standards relevant to secondary prevention and management of cardiovascular disease. METHODS: First, using adult curriculum based on disease-specific learning outcomes and competencies, a systematic test item development process was completed by clinical staff. Second, a panel of educational and clinical experts used an iterative process to identify test content domain and arrive at consensus in selecting items meeting criteria. Third, the resulting 31-question instrument, the Cardiac Knowledge Assessment Tool (CKAT), was piloted in CR patients to ensure use of application. Validity and reliability analyses were performed on 3638 adults before test administrations with additional focused analyses on 1999 individuals completing both pretreatment and posttreatment administrations within 6 months. RESULTS: Evidence of CKAT content validity was substantiated, with 85% agreement among content experts. Evidence of construct validity was demonstrated via factor analysis identifying key underlying factors. Estimates of internal consistency, for example, Cronbach's α = .852 and Spearman-Brown split-half reliability = 0.817 on pretesting, support test reliability. Item analysis, using point biserial correlation, measured relationships between performance on single items and total score (P < .01). Analyses using item difficulty and item discrimination indices further verified item stability and validity of the CKAT. CONCLUSIONS: A knowledge instrument specifically designed for an adult CR population was systematically developed and tested in a large representative patient population, satisfying psychometric parameters, including validity and reliability.

Cross-cultural assessment of neuropsychological performance and electrical brain function measures: additional validation of an international brain database.

Previous studies have revealed significant differences in performance on nonlanguage dependent cognitive tests across international settings among younger individuals, with less pronounced differences evident among older individuals (>54 years of age). The present study examined a broad range of cognitive performance as well as electrophysiological indices of brain function in a multisite and international context. A total of 200 individuals in the United States, 233 individuals in Europe, and 829 individuals in Australia were administered a standardized computerized neuropsychological battery, and complementary electroencephalogram (EEG) recordings were completed. Results revealed no significant differences in cognitive function or electrophysiology across the three continents. Similarly, although there was a main effect for age, the interaction between age and continent was not significant in any of the omnibus analyses. These findings indicate a high degree of similarity in neurocognitive and electrophysiological function among individuals residing in developed Western cultures, consistent with a traitlike status and the high heritability of the EEG.