Do we all do the same things? Applicability of daily activities at the intersection of demographics.

OBJECTIVE: To evaluate the extent to which demographic factors-and their intersections-influence the applicability of items assessing activities of daily living (ADLs) in a sample of older adults. METHOD: Participants' (n = 44,713) Functional Activities Questionnaire (FAQ) scores from a multicenter database were evaluated to see how participant and collateral demographics, contextual, and clinical characteristics impacted ADL nonapplicability (NA). Collateral, contextual, and clinical characteristics were matched in those with and without NA. The effect of participant demographics and their interactions on NA responses were modeled with logistic regression. RESULTS: At least one FAQ item (most commonly bill payment, taxes, playing games, and meal preparation) was rated as NA in up to one third of participants across ethnoracial groups. Dementia staging had the largest impact on NA, followed by participant demographics. In a matched sample, logistic models revealed that participant demographics, in particular sex, best predicted NA. However, meaningful interactions with ethnoracial group were noted for bill payment, taxes, meal preparation, and game engagement, suggesting that demographic intersections (e.g., younger vs. older Latinxs) meaningfully predict whether a given ADL was applicable to an individual participant. CONCLUSIONS: Neuropsychology is predicated on accurate assessments of both cognition and daily functioning and, in an increasingly diverse aging population, there should be careful consideration of demographic factors, their interactions, and historical contexts that drive day-to-day demands. This study establishes limitations of existing measures and paths forward for creating fair measures of functioning in older adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reliability and validity of the Montreal Cognitive Assessment's auditory items (MoCA-22).

Objective: To evaluate the latent structure, internal consistency, convergent and discriminant validity, diagnostic accuracy, and criterion validity of the Montreal Cognitive Assessment's auditory items (MoCA-22), which has previously been evaluated in small samples if at all. Methods: 11,284 participants completed the MoCA over 1-2 visits to an Alzheimer Disease Research Center (Mage = 69.2, Meducation = 15.9, 57.6% women, 92.4% non-Hispanic white). MoCA-22 items were probed with alpha, omega, confirmatory factor analysis, and test-retest correlations. Scores were related to measures of neurocognition, daily functioning, behavioral-psychological symptoms (BPS), and vision performance for convergent-discriminant and criterion validity. Dementia stage was used to calculate area under the receiver operating characteristic (AUC-ROC) curves and cutoffs for mild cognitive impairment (MCI) and dementia. Results: A single-factor had good fit (CFI = .961; TLI = .945; RMSEA = .061; SRMR = .031), with good internal consistency (Omega total = .83) and test-retest consistency (ICC = .92 at 2.7 years). The strongest convergent correlations were with general cognition and executive functioning, while discriminant validity was demonstrated with its weakest and negative correlations being with BPS. There was strong classification accuracy in distinguishing MCI from normal cognition (AUC = .79; optimal cutoff point < 18), and mild-to-moderate dementia from MCI (AUC = .85; optimal cutoff point < 13). Furthermore, the MoCA-22 had negligible-to-small differences among those with and without vision limitations. Conclusions: These findings add to the evidence of the MoCA-22's utility and it serves as a useful cognitive screening tool with sound reliability and validity.

Performance of the Dreem 2 EEG headband, relative to polysomnography, for assessing sleep in Parkinson's disease.

GOAL AND AIMS: To pilot the feasibility and evaluate the performance of an EEG wearable for measuring sleep in individuals with Parkinson's disease. FOCUS TECHNOLOGY: Dreem Headband, Version 2. REFERENCE TECHNOLOGY: Polysomnography. SAMPLE: Ten individuals with Parkinson's disease. DESIGN: Individuals wore Dreem Headband during a single night of polysomnography. CORE ANALYTICS: Comparison of summary metrics, bias, and epoch-by-epoch analysis. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES: Correlation of summary metrics with demographic and Parkinson's disease characteristics. CORE OUTCOMES: Summary statistics showed Dreem Headband overestimated several sleep metrics, including total sleep, efficiency, deep sleep, and rapid eye movement sleep, with an exception in light sleep. Epoch-by-epoch analysis showed greater specificity than sensitivity, with adequate accuracy across sleep stages (0.55-0.82). IMPORTANT SUPPLEMENTAL OUTCOMES: Greater Parkinson's disease duration and rapid eye movement behavior were associated with more wakefulness, and worse Parkinson's disease motor symptoms were associated with less deep sleep. CORE CONCLUSION: The Dreem Headband performs similarly in Parkinson's disease as it did in non-Parkinson's disease samples and shows promise for improving access to sleep assessment in people with Parkinson's disease.

Comparing behavioral and psychological symptom structures on the Neuropsychiatric Inventory Questionnaire.

The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a collateral-rated measure of behavioral and psychological symptoms commonly found in dementia (BPSD). Several factor structures have been published, but they have not been systematically compared. Furthermore, the possibility of hierarchical models or presence of measurement invariance around cognitive stage or dementia syndrome has not been previously evaluated. This study addressed these gaps with confirmatory factor analyses using a multicenter sample (n = 41,801; Mage = 71.4; 57% women; 79% White, 13% Black, 8% Hispanic; Meducation = 15.1) that was divided into exploratory, derivation, and holdover subsets for cross-validation. We found that a four-factor model had the best fit, with adequate reliability estimates, adequate τ-equivalence, and the least amount of measurement variance. Strict invariance across stage and syndrome was not supported, although there was adequate support for weaker restrictions (e.g., equal forms). Furthermore, all bifactor models had a significant increase in fit. In sum, the present study provides practical guidance on using NPI-Q factor-derived subscales and theoretical elaboration of BPSD's hierarchical and syndrome-variant structure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Re-Engaging Individuals & Societies for Structural Evolution: A Brain Health Equity Neuropsychology Research Framework.

OBJECTIVE: A brain health equity neuropsychology research framework (NRF) is crucial to the anti-racist movement in cognitive assessments. Universalist interpretation of neuropsychological tools contributes to systemic disparities, and there is a need for a clear conceptual framework for disentangling the direct and indirect impact of social determinants of health (SDH) on brain-behavior relationships and neuropsychological performance. The aim of this paper is to present a NRF anchored in the principles of brain health and health equity that is inclusive, and can be implemented across racially and ethnically diverse communities. METHODS: The Re-engaging Individuals and societies for Structural Evolution (RISE) NRF aims to address this via a two-pronged approach: 1. Focusing on community engagement and recruitment and retention of individuals and societies typically not equitably represented in brain health studies, and 2. Integrating the conceptual structure of individual, community, and SDH, while considering the broader historical and current structures that differentially shape these. RESULTS: The proposed RISE NRF is dynamic and multidirectional. It identifies barriers and proposes strategies to engage communities and diversify recruitment. It identifies evidence-based guidance on non-cognitive determinants of health to include, consider or explore in brain health research. CONCLUSION: The RISE NRF can guide the development of culturally and linguistically responsive methodologies and assist with clearly conceptualized and contextualized interpretation of neuropsychological tools to foment a transformative science that benefits the brain health of marginalized communities.

Subcortical lesions impact confrontation naming in bilinguals with later age of acquisition: An exploratory study.

The bilingual experience is believed to impact brain development and, possibly, cognitive performance. Subcortical structures, including the striatum and white matter, are believed related to confrontation naming performance among bilingual individuals with later age of acquisition (AoA) and lower proficiency of a second language (L2). However, these findings are primarily derived from healthy adult samples, although there is clinical significance for the interpretation of naming performance. The present study examined whether striatal and white matter lesions were associated with naming tasks in clinic-referred bilingual veterans (n = 29) and whether L2 AoA moderated this relationship. Clinically rated lesions, without regard for AoA, were not consistently correlated with naming performance. Moderation models (lesion × AoA) were significant across naming tasks (i.e., naming scores were negatively correlated with striatal lesions with increasing AoA). Effect sizes were higher among striatal models as compared to white matter models. Results extend prior neuroimaging findings with healthy bilinguals that AoA moderates the relationship between subcortical lesions and naming performance in bilingual patients, and suggests that clinicians should consider specifics of bilingual experience when interpreting test scores.

Brief Report: An Evaluation of Item Bias on the Functional Activities Questionnaire.

OBJECTIVE: To evaluate whether the Functional Activities Questionnaire (FAQ), a commonly used measure of functional status in neurodegenerative disease research, performs equivalently across demographically diverse subgroups of participants. METHOD: The FAQs from 30,613 National Alzheimer's Coordinating Center participants were evaluated with a hybrid graded response model-logistic ordinal regression approach to determine the presence of differential item functioning (DIF) within five demographic groups: education, ethnicity, race, language, and sex. RESULTS: Measurable DIF was observed for FAQ items in all groups; however, measures of effect size, latent trait distributions, and item characteristic curves suggested that the impact was minimal for research and practice. CONCLUSIONS: The FAQ is able to provide minimally biased assessments of daily functioning across diverse participants, suggesting potential value for offsetting disparities in diagnosis and treatment.

The plight of loneliness in Parkinson's disease: New opportunities.

The human phenomenon of loneliness has been increasing in prominence across societies, with precipitous increase since COVID-19, and individuals with Parkinson's disease are not unscathed. Loneliness is of clinical relevance as it is cross-sectionally related to, and longitudinally precedes, mortality and other health risks, including worse motor, cognitive, and behavioral-psychological functioning. Relatively few studies have evaluated loneliness, or associated social experiences, in the context of Parkinson's, but the existing data is provocative. The authors advocate for clinicians' awareness and researchers' investigational focus.

Blood biomarkers for cognitive decline and clinical progression in a Mexican American cohort.

Introduction: The clinical translation of biofluid markers for dementia requires validation in diverse cohorts. The study goal was to evaluate if blood biomarkers reflecting diverse pathophysiological processes predict disease progression in Mexican American adults. Methods: Mexican American adults (n = 745), 50 years of age and older, completed annual assessments over a mean of 4 years. Serum collected at baseline was assayed for total tau, neurofilament light (NFL), ubiquitin carboxyl-terminal hydrolase LI, glial fibrillary acidic protein (GFAP), soluble cluster of differentiation 14 (sCD14), and chitinase-3-like protein 1 (YKL-40). Results: Higher GFAP and NFL were associated with global cognitive decline. Only GFAP was associated with increased incident dementia risk (hazard ratio: 1.611 (95% confidence interval: 1.204-2.155)) and inclusion of additional biomarkers did not improve model fit. Discussion: Among a panel of six blood biomarkers previously associated with neurodegenerative disease, only GFAP predicted incident dementia in our cohort. The findings suggest that blood GFAP levels may aid dementia-risk prediction among Mexican American adults.

Comprehensive Evaluation of the Functional Activities Questionnaire (FAQ) and Its Reliability and Validity.

The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer's Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test-retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures (rs: -.30 to -.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.

Cognitive screening with functional assessment improves diagnostic accuracy and attenuates bias.

INTRODUCTION: Cognitive screening measures often lack sensitivity and are hampered by inequities across ethnoracial groups. A multitrait multimethod (MTMM) classification may attenuate these shortcomings. METHODS: A sample of 7227 participants across the diagnostic spectrum were selected from the National Alzheimer's Coordinating Center cohort. Random forest ensemble methods were used to predict diagnosis across the sample and within Black American (n = 1025) and non-Hispanic White groups (n = 5263) based on: (1) a demographically corrected Montreal Cognitive Assessment (MoCA), (2) MoCA and Functional Assessment Questionnaire (FAQ), (3) MoCA and FAQ with demographic correction. RESULTS: The MTMM approach with demographic correction had the highest diagnostic accuracy for the cognitively unimpaired (area under curve [AUC] [95% confidence interval (CI)]): 0.906 [0.892, 0.920]) and mild cognitive impairment (AUC: 0.835 [0.810, 0.860]) groups and reduced racial disparities. DISCUSSION: With further validation, the MTMM approach combining cognitive screening and functional status assessment may serve to improve diagnostic accuracy and extend opportunities for early intervention with greater equity.

Semiology of spontaneous generalized tonic-clonic seizures in the epileptic baboon.

OBJECTIVE: The epileptic baboon provides an animal model for juvenile myoclonic epilepsy (JME), demonstrating spontaneous generalized tonic-clonic seizures (GTCS) in addition to generalized myoclonic, absence and multifocal seizures. While photoconvulsive responses have been described in this model, spontaneous GTCS have not been characterized. METHODS: In this study, we characterized 46 seizures in 7 epileptic baboons (5 females, 12 ± 3 years old) by video recording. While housed in single cages, the baboons were monitored for a median of 2 (range 1-10) weeks, with high-resolution, infrared-capable camera systems. Each GTCS was evaluated for evidence of preconvulsive ictal symptoms, focal convulsive behaviors, duration of the preconvulsive and convulsive periods, postictal immobility, and recovery of an upright posture. The circadian pattern of GTCS was also for each baboon. RESULTS: More than half of GTCS occurred in sleep, beginning from an upright position in all but one tethered baboon. Focal semiological findings were noted in 19 (41%) GTCS, and these included preconvulsive focal ictal motor behaviors as well as lateralized motor activity during the convulsions. The convulsive portion lasted 47 ± 10 seconds, whereas the entire seizure lasted 54 ± 21 seconds. Postictally, the baboons remained immobile for a median latency of 40 (range 14-347) seconds, recovering an upright posture after 173 (range 71-1980) seconds. GTCS demonstrated circadian patterns in all but one baboon, with 34 (74%) all seizures occurring between 1-9 am. SIGNIFICANCE: GTCS in the baboon revealed intersubject variability, but semiology remained stereotyped in a given baboon. Similar to GTCS in people with JME, focal symptoms were also observed in epileptic baboons. The postictal recovery period, characterized by postictal immobility and myoclonus as well as time to recumbency, also varied among baboons.

The Emotional Approach Coping Scales in Chinese: Validation, Psychometric Properties, and Measurement Invariance.

American and Chinese literatures on emotion-focused coping show inconsistent associations with distress, attributable to criterion contamination problems with measures. This problem was remedied by the American Emotional Approach Coping (EAC) scales, which are not confounded with distress; however, there is no Chinese counterpart. The EAC is of theoretical interest for exploring cross-cultural models of psychological and physical health since it allows one to measure emotion processing (theoretically lowering distress) without emotion expression (maintaining collectivist group harmony). In the present study, the EAC scales were translated into Chinese and their factorial, criterion, and discriminant validity as well as measurement invariance of the two versions were examined in 353 Chinese and 491 Americans. Previous validational findings for American EAC scales were replicated and configural and metric invariance demonstrated, supporting the comparable reliability and validity of the Chinese EAC scales. Chinese showed fewer gender differences than Americans.

Validating the Structure of the Depression and Somatic Symptoms Scale.

BACKGROUND: Depressed primary care patients may present with somatic symptoms first, complicating differential diagnosis. Clinicians have few instruments for assessing this comorbidity. OBJECTIVE: To evaluate the psychometrics of the translated Chinese Depression and Somatic Symptoms Scale (DSSS) in Americans. PROCEDURES: A total of 491 nonclinical but symptomatic ethnically-diverse individuals completed the DSSS and Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Factor analysis yielded 2 distinct factors: depression and somatic symptoms. DSSS and subscales showed internal consistency, reliability, and convergent validity with CES-D and subscales. CONCLUSIONS: These results support DSSS's trustworthiness for US populations. Using DSSS for patient assessment may assist diagnosis and inform interventions.

The Dot Counting Test adds up: Validation and response pattern analysis in a mixed clinical veteran sample.

OBJECTIVE: This study cross-validated the Dot Counting Test (DCT) as a performance validity test (PVT) among a mixed clinical veteran sample. Completion time and error patterns also were examined by validity group and cognitive impairment status. METHOD: This cross-sectional study included 77 veterans who completed the DCT during clinical evaluation. Seventy-four percent (N = 57) were classified as valid and 26% as noncredible (N = 20) via the Word Memory Test (WMT) and Test of Memory Malingering (TOMM). Among valid participants, 47% (N = 27) were cognitively impaired, and 53% (N = 30) were unimpaired. RESULTS: DCT performance was not significantly associated with age, education, or bilingualism. Seventy-five percent of the overall sample committed at least one error across the 12 stimulus cards; however, valid participants had a 27% higher rate of 0 errors, while noncredible participants had a 35% higher rate of ≥4 errors. Overall, noncredible individuals had significantly longer completion times, more errors, and higher E-scores. Conversely, those with cognitive impairment had longer completion times, but comparable errors to their unimpaired counterparts. Finally, DCT E-scores significantly predicted group membership with 83.1% classification accuracy and an area under the curve of .87 for identifying invalid performance. The optimal cut-score of 15 was associated with 70% sensitivity and 88% specificity. CONCLUSION: The DCT demonstrated good classification accuracy and sensitivity/specificity for identifying noncredible performance in this mixed clinical veteran sample, suggesting utility as a non-memory-based PVT with this population. Moreover, cognitive impairment significantly contributed to slower completion times, but not reduced accuracy.

An Evaluation of the Texas Functional Living Scale's Latent Structure and Subscales.

OBJECTIVE: Performance-based functional assessment is a critical component of neuropsychological practice. The Texas Functional Living Scale (TFLS) has promise given its brevity, nationally representative norms, and co-norming with Wechsler scales. However, its subscale structure has not been evaluated. The purpose of this study was to evaluate the TFLS in a mixed clinical sample (n = 197). METHOD: Reliability and convergent and discriminant validity coefficients were calculated with neurocognitive testing and collateral reports and factor analysis was performed. RESULTS: The Money and Calculation subscale had the best psychometric properties of the subscales. The evidence did not support solitary interpretation of the Time subscale. A three-factor latent structure emerged representing memory and semantic retrieval, performance and visual scanning, and financial calculation. CONCLUSIONS: This study added psychometric support for interpretation of the TFLS total score and some of its subscales. Study limitations included sample characteristics (e.g., gender ratio) and low power for collateral report analyses.

Corticobasal syndrome due to sporadic Creutzfeldt-Jakob disease: a review and neuropsychological case report.

OBJECTIVE: Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive, and fatal neurodegenerative disease with neuropsychological sequelae. This study highlighted a rare presentation of CJD (e.g. corticobasal syndrome [CBS]), reviewed updated diagnostic criteria and procedures for CJD (e.g. diffusion weighted imaging [DWI], real-time quaking-induced conversion [RT-QuIC]), and discussed differential diagnoses. METHOD: Case report methodology focused on a 68-year-old, Hispanic, right-handed man with 11 years of education. He presented with a 1-2-month history of gait and motor difficulties (e.g. rigidity, myoclonus). RESULTS: After evaluation, a 'cortical ribboning' pattern on DWI and positive RT-QuIC was integrated with performance on neurobehavioral exam (i.e. alien limb phenomenon, unilateral ideomotor apraxia) and neuropsychological testing (i.e. frontal-parietal dysfunction pattern) to reach a diagnosis of sCJD-CBS. The patient expired 3 months after onset of symptoms. CONCLUSIONS: This literature review and case report highlighted the importance of staying abreast of developments in neurological literature and the added value of neuropsychology, when integrated with newer procedures, for confirming and excluding diagnostic considerations.

Slow and Steady Does Not Always Win the Race: Investigating the Effect of Processing Speed across Five Naming Tests.

OBJECTIVE: This retrospective study investigated the effect of processing speed on confrontation naming performance via five naming tests with varying time components. METHOD: The effect of processing speed, as measured by the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index (PSI), and cognitive impairment were examined using Boston Naming Test, Neuropsychological Assessment Battery Naming Test, Visual Naming Test (VNT), Auditory Naming Test (ANT), and Woodcock-Johnson III Rapid Picture Naming (RPN) performance among a mixed clinical sample of 115 outpatient veterans. RESULTS: PSI scores accounted for 5%-26% of the total variance in naming test performances. Comparison of cognitively impaired versus unimpaired participants found significant differences and medium to large effect sizes (η2 = .08-.20) for all naming measures except ANT tip-of-the-tongue responses. After controlling for the effect processing speed, VNT tip-of-the-tongue responses also became non-significant, whereas significant group differences remained present for all other naming test scores, albeit with notably smaller effects sizes (η2 = .06-.10). CONCLUSIONS: Confrontation naming test performance is related to cognitive processing speed, although the magnitude of this effect varies by the demands of each naming test (i.e., largest for RPN; smallest for VNT). Thus, results argue that processing speed is important to consider for accurate clinical interpretation of naming tests, especially in the context of cognitive impairment.

The effect of perceptual reasoning abilities on confrontation naming performance: An examination of three naming tests.

INTRODUCTION: Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual-perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy. METHOD: A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation. RESULTS: Multiple regression indicated that PRI accounted for 23%, 13%, and 15% of the variance in BNT, VNT, and NAB scores, respectively, but dropped out as a significant predictor once VCI was added. Follow-up bootstrap mediation analyses revealed that PRI had a significant indirect effect on naming performance after controlling education, primary language, and severity of cognitive impairment, as well as the mediating effect of general verbal abilities for the BNT (B = 0.13; 95% confidence interval, CI [.07, .20]), VNT (B = 0.01; 95% CI [.002, .03]), and NAB (B = 0.03; 95% CI [.01, .06]). CONCLUSIONS: Findings revealed a complex relationship between perceptual reasoning abilities and confrontation naming that is mediated by general verbal abilities. However, when verbal abilities were statistically controlled, perceptual reasoning abilities were found to have a significant indirect effect on performance across all three confrontation naming measures with the largest effect noted with the BNT relative to the VNT and NAB Naming Test.