An interplay between cross-cultural and psychometric factors in the Montreal Cognitive Assessment: Experience from the language of a small nation.

The present study aimed to test the hypothesis that the total word length on the Memory subtest of the Czech version of the MoCA, which is 12 syllables compared to the English version of 7 syllables, would have a significant effect on Delayed Recall scores compared to the newly created well-balanced version of the test (further MoCA-WLE). In the original Czech version of MoCA, we replaced the 12-syllable word list in the Memory subtest with a 7-syllable list (MoCA-WLE) to make it equivalent to the standard English version in this respect. We analyzed data from 83 participants in the original MoCA group (70.63 ± 7.01 years old, 14.61 ± 3.17 years of education, 30.12% males) and 83 participants in the MoCA-WLE group (70.72 ± 6.95 years old, 14.93 ± 3.48 years of education, 30.12% males). We did not find evidence for a significant word-length effect in the original MoCA versus MoCA-WLE Delayed Recall in either the Mann-Whitney U test (W = 3418.0, p = .932) or multilevel binomial regression (b = 0.10, 95% posterior probability interval [-0.46, 0.68]). The present study shows cross-cultural limits in the adaptation of the test material. The results underline the caveats of such an approach to test adaptation. Fortunately, 12-syllables in the MoCA Memory Czech version versus the original 7-syllable list did not show a detectable word-length effect. We did not find evidence for differential item functioning or cultural item bias. The original MoCA Czech version is psychometrically comparable to the original English version.

Small effects of olfactory identification and discrimination on global cognitive and executive performance over 1 year in aging people without a history of age-related cognitive impairment.

Olfactory and cognitive performance share neural correlates profoundly affected by physiological aging. However, whether odor identification and discrimination scores predict global cognitive status and executive function in healthy older people with intact cognition is unclear. Therefore, in the present study, we set out to elucidate these links in a convenience sample of 204 independently living, cognitively intact healthy Czech adults aged 77.4 ± 8.7 (61-97 years) over two waves of data collection (one-year interval). We used the Czech versions of the Montreal Cognitive Assessment (MoCA) to evaluate global cognition, and the Prague Stroop Test (PST), Trail Making Test (TMT), and several verbal fluency (VF) tests to assess executive function. As a subsidiary aim, we aimed to examine the contribution of olfactory performance towards achieving a MoCA score above vs. below the published cut-off value. We found that the MoCA scores exhibited moderate associations with both odor identification and discrimination. Furthermore, odor identification significantly predicted PST C and C/D scores. Odor discrimination significantly predicted PST C/D, TMT B/A, and standardized composite VF scores. Our findings demonstrate that olfaction, on the one hand, and global cognition and executive function, on the other, are related even in healthy older people.

Processing speed predicts SuperAging years later.

BACKGROUND: SuperAging is one of the current concepts related to elite, resilient or high-functioning cognitive aging. The main aim of our study was to find possible predictors of SuperAgers (SA). METHODS: Community-dwelling older persons (N = 96) aged 80-101 years in 2018 were repeatedly tested (year 2012 and 2018). SA were defined based on their performance in 2018 as persons of 80+ years of age who recalled ≥ 9 words in the delayed recall of the Philadelphia Verbal Learning Test, and had a normal performance in non-memory tasks [the Boston Naming Test, the Trail Making Test Part B, and Category Fluency ("Animals")], which was defined as a score within or above one standard deviation from the age and education appropriate average. Three composite scores (CS; immediate memory, processing speed, and executive functions) were created from the performance in 2012, and analysed as possible predictors of SA status in 2018. RESULTS: We identified 19 SA (15 females) and 77 nonSA (42 females), groups did not significantly differ in age, years of education, and sex. The logistic regression model (p = 0.028) revealed three predictors of SA from the baseline (year 2012), including processing speed (p = 0.006; CS-speed: the Prague Stroop Test-Dots and the Digit Symbol Substitution Test), sex (p = 0.015), and age (p = 0.045). CONCLUSIONS: Thus, SA may be predicted based on the level of processing speed, which supports the hypothesis of the processing speed theory of healthy aging.

Reducing misclassification of mild cognitive impairment based on base rate information from the Uniform data set.

The current study aimed to define and validate the criteria for characterizing possible and probable cognitive deficits based on the psychometric approach using the Uniform data set Czech version (UDS-CZ 2.0) to reduce the rate of misdiagnosis. We computed the prevalence of low scores on the 14 subtests of UDS-CZ 2.0 in a normative sample of healthy older adults and validated criteria for possible and probable cognitive impairment on the sample of amnestic Mild Cognitive Impairment (MCI) patients. The misclassification rate of the validation sample using psychometrically derived criteria remained low: for classification as possible impairment, we found 66-76% correct classification in the clinical sample and only 2-8% false positives in the healthy control validation sample, similar results were obtained for probable cognitive impairment. Our findings offer a psychometric approach and a computational tool to minimize the misdiagnosis of mild cognitive impairment compared to traditional criteria for MCI.

The 30-item and 15-item Boston naming test Czech version: Item response analysis and normative values for healthy older adults.

OBJECTIVE: The Boston Naming Test (BNT) is the most widely used test to assess visual confrontation naming in both research and clinical settings. Recently, an abbreviated Czech version of the BNT was described. The purpose of this study is to assess the validity of this new test at the item level with advanced psychometric methods to assess its equivalence with the original test. The rationale was to help busy clinicians in the differential diagnosis of language disorders. METHOD: We administered the BNT-30 (odd item form of BNT-60) (N = 535; 75.61 ± 9.11; 60-96 years) and shortened the BNT-15 (N = 754; 71.94 ± 7.88; 60-96 years) to a large sample of healthy older adults. RESULTS: Significant but low associations between BNT performance and age, education, and sex were found. We found strong evidence for the unidimensionality of both BNT-15/BNT-30 versions in healthy adults (p's < .001). CONCLUSION: In-depth psychometric analysis of the BNT-15 and BNT-30 Czech versions show that test stimuli function in a similar fashion as the original BNT. Normative values adjusting for the influence of age, education, and sex are provided for use in clinical settings and future cross-cultural comparisons.

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

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

Brief Visuospatial Memory Test-Revised: normative data and clinical utility of learning indices in Parkinson's disease.

Introduction: The Brief Visual Memory Test-Revised (BVMT-R) is a frequently used visuospatial declarative memory test, but normative data in the Czech population are lacking. Moreover, the BVMT-R includes promising learning indexes that can be used to detect learning deficits in Parkinson's disease (PD). However, its clinical usefulness has not yet been thoroughly examined. Early detection of memory impairment in PD is essential for effective treatment. Therefore, this study aimed to provide BVMT-R Czech normative data for clinical use and to find the detection potential of the principal BVMT-R scores, including new learning indices, to capture the cognitive deficit in PD. Method: The BVMT-R were administered to a normative sample of 920 participants aged 17 to 95 years and to a clinical sample of 60 PD patients; 25 with mild cognitive impairment (PD-MCI) and 35 with normal cognition (PD-NC). In order to provide normative values, multiple regression analyses were employed, and to compare the clinical and control sample, Bayesian Hierarchical Linear Models were used. Results: The best model for regression-based norms showed to be with age + age2 + education + sex as predictors. From all learning indexes, L6 (sum of trials 1-3), followed by, L4 (sum of trials 1-3 multiplied by the difference between the highest and the lowest score) best differentiated between controls or PD-NC and PD-MCI. Conclusions: We provide regression-based normative values for BVMT-R that could be used in clinical settings and meta-analytic efforts. Furthermore, we revealed visuospatial learning and memory deficit in PD-MCI. We have also identified the most discriminative learning index adapted to BVMT-R.

Determining a Short Form Montreal Cognitive Assessment (s-MoCA) Czech Version: Validity in Mild Cognitive Impairment Parkinson's Disease and Cross-Cultural Comparison.

The Montreal Cognitive Assessment (MoCA) is one of the most common screening instruments for mild cognitive impairment. However, the standard MoCA is approximately two times longer to administer than the Mini-Mental State Examination. A total of 699 Czech and 175 American participants received the standard MoCA Czech and English versions and in the clinical part, a sample of 102 nondemented patients with Parkinson's disease (PD). We created a validated Czech short version (s-MoCA-CZ) from the original using item response theory. As expected, s-MoCA-CZ scores were highly correlated with the standard version (Pearson r = .94, p < .001). s-MoCA-CZ also had 80% classification accuracy in the differentiation of PD mild cognitive impairment from PD without impairment. The s-MoCA-CZ, a brief screening tool, is shorter to administer than the standard MoCA. It provides high-classification accuracy for PD mild cognitive impairment and is equivalent to that of the standard MoCA-CZ.

Young-Old City-Dwellers Outperform Village Counterparts in Attention and Verbal Control Tasks.

Cognitive performance is dynamic and shaped by individual biological and environmental factors throughout life. In psychology, besides the effects of age, education, and other often studied factors, the complexity of the lived-in environment and urbanicity in that context are yet to be elucidated. In this observational cross-sectional study, we compare cognitive performance in standard neuropsychological tests in healthy older persons from three different types of settlements in the Czechia: the capital city of Prague, towns, and villages. The groups were equal in terms of the age-band (60-74 years), the distribution of gender, education, past and current leisure activities, and cognitive health status (MMSE score). The results showed that Prague citizens had consistently better performance in all verbal tests (for memory and verbal control, i.e., executive function) and attention than persons from other areas. The groups did not differ in timed visuo-graphomotor performance. The conclusion is that the complex environment of a city may promote, in the long-term, certain cognitive abilities, distinguishable even in a developed, culturally homogenous country. The implications are: (a) the description of samples used in normative studies should include information on the lived-in environment for the reference of researchers and clinicians; and (b) individual clinical assessment should reflect the role of the patient's environment where appropriate. The exact mechanisms and causes of the differences need further investigation.

Differences in Subjective Cognitive Complaints Between Non-Demented Older Adults from a Memory Clinic and the Community.

BACKGROUND: Subjective cognitive complaints (SCCs) may represent an early cognitive marker of Alzheimer's disease (AD). There is a need to identify specific SCCs associated with an increased likelihood of underlying AD. OBJECTIVE: Using the Questionnaire of Cognitive Complaints (QPC), we evaluated the pattern of SCCs in a clinical sample of non-demented older adults in comparison to cognitively healthy community-dwelling volunteers (HV). METHODS: In total, 142 non-demented older adults from the Czech Brain Aging Study referred to two memory clinics for their SCCs were classified as having subjective cognitive decline (SCD, n = 85) or amnestic mild cognitive impairment (aMCI, n = 57) based on a neuropsychological evaluation. Furthermore, 82 age-, education-, and gender-matched HV were recruited. All subjects completed the QPC assessing the presence of specific SCCs in the last six months. RESULTS: Both SCD and aMCI groups reported almost two times more SCCs than HV, but they did not differ from each other in the total QPC score. Impression of memory change and Impression of worse memory in comparison to peers were significantly more prevalent in both SCD and aMCI groups in comparison to HV; however, only the latter one was associated with lower cognitive performance. CONCLUSION: The pattern of QPC-SCCs reported by SCD individuals was more similar to aMCI individuals than to HV. A complaint about memory change seems unspecific to pathological aging whereas a complaint about worse memory in comparison to peers might be one of the promising items from QPC questionnaire potentially reflecting subtle cognitive changes.

Beck Depression Inventory-II: Self-report or interview-based administrations show different results in older persons.

ABSTRACTBeck Depression Inventory-II (BDI-II) is one of the most-used rating scales. It was developed as a tool administered either as a self-rating or interview-based, observer-rating scale. OBJECTIVE: The goal of this study is to compare BDI-II scores obtained with two standard methods of administration in community-based older persons. METHODS: BDI-II was administered at first in the self-rated version to a sample of 60 mentally healthy older persons (age 60-87 years). Afterward, the interview-based administration was performed. ANALYSES: We compared the scores with nonparametric tests - Spearman's correlation coefficient and Wilcoxon Signed Ranks test. We also computed internal consistency. RESULTS: Self-rated BDI-II yielded significantly higher total score than interview (p < 0.001, P = 88%). The correlation between total scores was moderate (rs = 0.46, p < 0.001). Item analysis revealed a larger decrease (lower scores) in the somatic items in the interview-based version. CONCLUSIONS: The two methods of administration result in different total score in healthy older persons. Therefore, interpretation of the scores should reflect the administration, which should be always specified in the studies.