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Cognitive Reserve (CR) reflects acquired knowledge, skills, and abilities throughout life, and it is known for modulating cognitive efficiency in healthy and clinical populations. CR, which was initially proposed to explain individual differences in the clinical presentation of dementia, has subsequently been extended to healthy ageing, showing its role in cognitive efficiency also during middle age. Recently, CR has been linked to affective processes in psychiatric conditions such as schizophrenia, major depressive and anxiety symptoms, and psychological distress, suggesting its potential role in emotional expression and regulation. Whether the role of CR in mental health extends to non-pathological adults, and whether this is only relevant in older age is not yet clear. The aim of this work was therefore to explore the relationship between CR and mental health in healthy adults, with a focus on middle adulthood (40-60). In a sample of 96 participants, we found a positive association between CR and mental health outcomes, such that a higher cognitive reserve index corresponded to fewer mental health reported symptoms. Specifically, a higher CR reflecting professional activities was associated with lower stress levels, especially in middle agers. Taken together, these data therefore suggest that engaging occupations may help maintain a robust mental health, especially by reducing stress symptoms during middle age. These results broaden previous findings suggesting that CR relates to affective components of mental health in middle aged and older adults.
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Reserva Cognitiva , Saúde Mental , Humanos , Reserva Cognitiva/fisiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estresse Psicológico/psicologia , Envelhecimento/psicologia , Envelhecimento/fisiologiaRESUMO
BACKGROUND: Cognitive reserve (CR) has not been studied in people with Intellectual Developmental Disability, a population with a high incidence of dementia. Commonly adopted CR proxies should be adapted to reflect more specifically the experiences of people with Intellectual Developmental Disability. METHOD: This scoping review intended to identify CR proxies relevant to people with this condition. RESULTS: Some of these were the same already detected in a population without intellectual disabilities (education, occupation, physical activity, leisure, community and social activities); others were found to be specifically relevant for this population: type of schooling, parental educational level, environmental stimulation and living place. CONCLUSIONS: These proxies need to be considered in studies on CR and Intellectual Developmental Disability and in clinical practice. Research on the protective effect of CR aims to encourage policies promoting lifestyle-based educational and preventive interventions and overcome participation barriers for people with Intellectual Developmental Disability.
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Reserva Cognitiva , Deficiência Intelectual , Humanos , Criança , Reserva Cognitiva/fisiologia , Deficiências do Desenvolvimento , Atividades de Lazer , Exercício FísicoRESUMO
OBJECTIVES: Aging of the population encourages research on how to preserve cognition and quality of life. Many studies have shown that Physical Activity (PA) positively affects cognition in older adults. However, PA carried out throughout the individual's lifespan may also have an impact on cognition in old age. We hypothesize the existence of Motor Reserve (MR), a flexible and dynamic construct that increases over time and compensates for age-related motor and cognitive loss. METHODS: Two questionnaires were developed and validated to estimate MR (Physical Activity carried out throughout the individual's lifespan) and Current Physical Activity (CPA, PA carried out in the previous 12 months). They were administered to 75 healthy individuals over 50 to verify the relation with cognition. MR and CPA include physical exercise (i.e., structured activities to improve or maintain physical fitness) and incidental PA, which we consider as any movement that leads to a metabolic cost above baseline (e.g., housekeeping, walking). In addition, the Cognitive Reserve Index questionnaire (CRI), a reliable predictor of cognitive performance, was used to measure each participant's Cognitive Reserve. RESULTS: The factors that most influenced performance are Age and Cognitive Reserve, but also MR and CPA together and MR when it is the only factor. CONCLUSIONS: Cognitive variability in adult and elderly populations is explained by both MR and CPA. PA training could profitably be included in new preventive and existing interventions.
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Reserva Cognitiva , Qualidade de Vida , Humanos , Idoso , Cognição , Envelhecimento/psicologia , Exercício FísicoRESUMO
Nonagenarians and centenarians, also called oldest-old, are a very heterogeneous population that counts a limited number of individuals as it is a real challenge to reach this goal. Even if it is well known that cognitive reserve can be considered a factor in maintaining good cognitive functioning in ageing, only very few studies have been carried out on the role of cognitive reserve (CR) in the oldest-old people. The aim of this study is to investigate the relationship between cognitive reserve and cognitive functioning in a population living in a specific region of Italy, the Blue Zone in Sardinia. This population is characterised by extreme longevity and distinctive historical, geographic, social, linguistic and nutritional features. The cognitive Reserve Index questionnaire (CRIq) and the short cognitive Esame Neuropsicologico Breve-2 (ENB-2, Brief Neuropsychological Examination) were administered to 67 participants, all aged between 90 and 105 years old. The CRIq was a predictor of neuropsychological performance for the global score of the battery of tests, ENB-2 (ENB-tot) and also for 7 out of 16 of its sub-tests. All except one (Token) tapped executive functions (Interference memory at 10 and 30 s, TMT-B, Overlapping figures, Abstraction, Fluency). Results highlight that also in the oldest-old population CR has a positive effect on cognition, especially on executive functioning.
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Reserva Cognitiva , Idoso de 80 Anos ou mais , Humanos , Encéfalo , Cognição , Função Executiva , Testes NeuropsicológicosRESUMO
BACKGROUND: This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. METHODS: The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. RESULTS: The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). DISCUSSION: The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.
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Transtornos Cognitivos , Transtornos do Desenvolvimento da Linguagem , Humanos , Transtornos Cognitivos/diagnóstico , Sensibilidade e Especificidade , Reprodutibilidade dos Testes , Telefone , Padrões de Referência , Testes NeuropsicológicosRESUMO
(i) Background: Cognitive impairment in people with multiple sclerosis (MS) has been studied in relation to certain clinical variables (e.g., motor disability and disease duration) and lifestyle factors such as cognitive reserve (CR). However, only very few studies have considered the interaction of clinical variables and cognitive reserve in preserving the integrity of the neuropsychological profile. In this paper, we hypothesised that a higher level of CR might predict good cognitive efficiency by modulating the clinical outcome of the disease. (ii) Methods: A sample of 100 participants with MS (age range 30-74), was recruited and assessed remotely with a questionnaire to measure CR and a cognitive screening test. Data were analysed through generalized additive models. (iii) Results: We found that the model analysing the interaction between CR and disease duration, and between CR and motor disability, was able to explain a significant percentage of cognitive performance. In particular, higher levels of CR predicted a better cognitive performance despite a long disease duration, unless the motor disability was severe. (iv) Conclusion: This study highlights the crucial role of CR in modulating cognitive efficiency in people with MS.
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BACKGROUND: The wide use of the term Cognitive Reserve (CR) is in need of a clear and shared definition of its concept and of the development of new tools, quick and easy to use and updated for the people of today. This study describes the online short CRIq (s-CRIq), the new shorter version of the CRIq, following an item analysis revision, and compares the data distribution of different samples. METHODS: The s-CRIq was administered online to 435 people while another 440 filled out the s-CRIq in self-administration. A further 588 participants had been administered the original paper-and-pencil long CRIq and 344 the online long CRIq. RESULTS: The major difference in the databases of s-CRIq versus the long versions is an increased score in education and in leisure activity. However, the density distributions of the total score of CRI in the 4 databases share 64% of their areas, and at least two of them share 84%. CONCLUSION: The s-CRIq proved to be a simple and easy-to-administer tool. Similarly, to the original version, the s-CRIq is freely available on the web, and it is our hope that it will be of fruitful use for researchers and clinicians alike.
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Reserva Cognitiva , Humanos , Testes Neuropsicológicos , Inquéritos e Questionários , Escolaridade , Atividades de LazerRESUMO
Cognitive reserve (CR) represents the adaptive response of the cognitive system responsible for preserving normal functioning in the face of brain damage. Experiential factors such as education, occupation, and leisure activities influence the development of CR. Theoretically, such factors build up from childhood and across adulthood. Thus, appropriate tools to define and measure CR as early as adolescence are essential to understand its developmental processes. To this aim, we introduce the construct of "Cognitive Reserve Potential" (CRP) and its corresponding index of experiential factors tailored to youth. We investigated prototypical youth exposures potentially associated with the lifelong development of CR (e.g., sport practice, musical experiences, cultural activities, and relationships with peers and family). Principal component analysis and confirmatory factor analysis identified and replicated the CRP factor structure on two independent samples of Italian students: N = 585 (295 F) and N = 351 (201 F), ages 11 to 20. CRP was associated mainly with family socio-cultural status (i.e., socioeconomic status [SES], Home Possessions, and Books at Home). Results confirmed the strength of the factorial model and warranted the proposal of the CRP-questionnaire as an innovative tool for understanding CR evolutionary dynamics.
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Cognitive impairment and sexual dysfunction are common symptoms in persons with Multiple Sclerosis (MS). The present study focuses on the relationship between these two dimensions by means of a specific assessment commonly used in clinical practice with this population. Fifty-five persons with a diagnosis of MS underwent specific cognitive tests and answered clinical questionnaires. Two cognitive tests, one for memory (the Selective Reminding Test), and one for attention (the Symbol Digit Modalities Test), were administered together with two tests for executive functions (the D-KEFS Sorting Test and Stroop Test). Two self-report questionnaires to investigate clinical, psychological and sexual features (the Beck Depression Inventory-II and Self-perception of Cognition in Multiple Sclerosis and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19), were also administered. The main result highlights that sexual difficulties are associated with cognitive deficits, particularly with executive disorders, but not with memory and attention. Furthermore, sexual difficulties are better explained when depression symptoms are also taken into account. This study disentangles the interaction between sexual dysfunction, cognitive impairment and depression in persons with MS by emphasising the role of very high cognitive processing (i.e., executive functioning) in determining human behaviour.
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Tele-neuropsychology, i.e., the application of remote audio-visual technologies to neuropsychological evaluation or rehabilitation, has become increasingly popular and widespread during and after the COVID-19 pandemic. New tools with updated normative data and appropriate methodological developments are necessary. We present Tele-GEMS, a telephone-based cognitive screening developed on N = 601 Italian participants. It yields a global score tapping on orientation, memory, spatial representation, language, and pragmatic abilities. Its administration lasts about 10 min. Clinical cut-offs are provided, accounting for demographic variables (age, education, and sex) and also for a comprehensive index taking into account cognitively stimulating life experiences that can build up a cognitive reserve. Tele-GEMS shows good internal consistency and a good inter-rater agreement. The test includes the thresholds for estimating a significant change after repeated measurements. Tele-GEMS has a good construct validity as assessed with MoCA and a suitable criterion validity assessed with its in-person version (GEMS). All the materials and the instructions, including scripts and an online Application for the automatic calculation of cut-offs, are accessible on OSF at https://osf.io/t3bma/ under a Creative Commons license.
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Testes Neuropsicológicos , Psicometria , Telemedicina , Humanos , Masculino , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Telefone , Psicometria/métodosRESUMO
In a recent study we showed that Cognitive Reserve (CR) did not significantly predict the neuropsychological outcomes of patients with severe Acquired Brain Injury (sABI), after a rehabilitation program. The present study aims to extend the previous results by assessing the role of CR on long-term neuropsychological outcomes of a subgroup (N = 27) of that same population. Patients took part in a telephone interview, where Tele-Global Examination Mental State (Tele-GEMS) and Glasgow Outcome Scale Extended (GOS-E) were administered. A linear regression model was conducted considering Tele-GEMS and GOS-E as dependent variables, while the scores on Cognitive Reserve Index questionnaire (CRIq), Disability Rating Scale (DRS), and Level of Cognitive Functioning (LCF), administered at discharge, were considered as predictors. Results show that higher levels of CR and LCF, significantly predicted cognitive performance 4 years later. However, in the same follow-up, CR did not predict functional outcome, which was only predicted by lower disability scores at discharge. Thus, even if CR seems not showing an effect on cognitive efficiency when tested after the first rehabilitation intervention, current results show that CR has significant effects on long-term cognitive outcomes.
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OBJECTIVE: Psychomotor slowdown was observed in individuals with Obstructive Sleep Apnea Syndrome (OSAS). Previous studies evaluated separately cognitive and motor reaction times, finding that OSAS individuals show a specific impairment in the latter. The present study investigates whether eye-to-hand coordination (EHC), a specific psychomotor ability, is compromised in OSAS. METHOD: The EHC was measured in 30 OSAS individuals who were matched with 30 healthy controls by the Two-Hand Coordination Test analyzing the speed, accuracy, and coordination; the role of these variables was investigated in predicting the group they belonged to. RESULTS: The OSAS participants showed poorer performance in the execution accuracy (t(55) = -3.36, d'Cohen = -0.89, p ≤ .001), which was also found to be the only predictor of the belonging to group (ß = 0.43 (0.18), p < .05). CONCLUSIONS: The OSAS individuals show impairments in EHC and in correcting their error (executive slowdown). This is the first investigation exploring EHC coordination in this population and contributes in understanding the psychomotor slowness characterizing OSAS.
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Apneia Obstrutiva do Sono , Humanos , Testes Neuropsicológicos , Tempo de Reação , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Desempenho PsicomotorRESUMO
Introduction: With the rapid increase in the population over 65 years old, research on healthy aging has become one of the priorities in the research community, looking for a cost-effective method to prevent or delay symptoms of mild cognitive disorder or dementia. Studies indicate that cognitive reserve theory could be beneficial in this regard. The aim of this study was to investigate the potential relationship between lifestyle socio-behavioral proxies of cognitive reserve and cortical regions in adults with no subjective cognitive decline. Methods: Overall, 58 participants, aged 65-85 years, were included in the data analysis (M = 71.83, SD = 5.02, 20.7% male). Cognitive reserve proxies were measured using the Cognitive Reserve Index questionnaire, while cortical volumes were obtained with the Siemens 1.5 T Avanto MRI scanner and further mapped using the Desikan-Killiany-Tourville (DKT) Atlas. Estimated intracranial volume and age were used as covariates. Results: The results indicated that higher occupational complexity was associated with larger cortical volume in the left middle temporal gyrus, the left and right inferior temporal gyrus, and the left inferior parietal lobule, while a combined proxy (the total CRI score) showed a positive relationship with the volume of left middle temporal gyrus and inferior parietal lobule, and pars orbitalis in the right hemisphere. Discussion: These results might indicate that more complex occupational activities and overall more intellectually and socially active life-style could contribute to better brain health, especially in regions known to be more vulnerable to Alzheimer's disease.
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Gliomas are commonly characterized by neurocognitive deficits that strongly impact patients' and caregivers' quality of life. Surgical resection is the mainstay of therapy, and it can also cause cognitive impairment. An important clinical problem is whether patients who undergo surgery will show post-surgical cognitive impairment above and beyond that present before surgery. The relevant rognostic factors are largely unknown. This study aims to quantify the cognitive impairment in glioma patients 1-week after surgery and to compare different pre-surgical information (i.e., cognitive performance, tumor volume, grading, and lesion topography) towards predicting early post-surgical cognitive outcome. We retrospectively recruited a sample of N = 47 patients affected by high-grade and low-grade glioma undergoing brain surgery for tumor resection. Cognitive performance was assessed before and immediately after (â¼1 week) surgery with an extensive neurocognitive battery. Multivariate linear regression models highlighted the combination of predictors that best explained post-surgical cognitive impairment. The impact of surgery on cognitive functioning was relatively small (i.e., 85% of test scores across the whole sample indicated no decline), and pre-operative cognitive performance was the main predictor of early post-surgical cognitive outcome above and beyond information from tumor topography and volume. In fact, structural lesion information did not significantly improve the accuracy of prediction made from cognitive data before surgery. Our findings suggest that post-surgery neurocognitive deficits are only partially explained by preoperative brain damage. The present results suggest the possibility to make reliable, individualized, and clinically relevant predictions from relatively easy-to-obtain information.
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Neoplasias Encefálicas , Glioma , Humanos , Estudos Retrospectivos , Qualidade de Vida , Testes Neuropsicológicos , Glioma/complicações , Glioma/cirurgia , Glioma/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/patologia , Cognição , Encéfalo/patologiaRESUMO
Background: This study aimed at standardizing and providing preliminary evidence on the clinical usability of the Italian telephone-based Verbal Fluency Battery (t-VFB), which includes phonemic (t-PVF), semantic (t-SVF) and alternate (t-AVF) verbal fluency tasks. Methods: Three-hundred and thirty-five Italian healthy participants (HPs; 140 males; age range = 18-96 years; education range = 4-23 years) and 27 individuals with neurodegenerative or cerebrovascular diseases were administered the t-VFB. Switch number and cluster size were computed via latent semantic analyses. HPs underwent the telephone-based Mental State Examination (MMSE) and Backward Digit Span (BDS). Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability and equivalence with the in-person Verbal Fluency tasks were assessed. Norms were derived via Equivalent Scores. Diagnostic accuracy against clinical populations was assessed. Results: The majority of t-VFB scores correlated among each other and with the BDS, but not with the MMSE. Switch number correlated with t-PVF, t-SVF, t-AVF scores, whilst cluster size with the t-SVF and t-AVF scores only. The t-VFB was underpinned by a mono-component structure and was internally consistent (Cronbach's α = 0.91). Test-retest (ICC = 0.69-0.95) and inter-rater reliability (ICC = 0.98-1) were optimal. Each t-VFB test was statistically equivalent to its in-person version (equivalence bounds yielding a p < 0.05). Education predicted all t-VFB scores, whereas age t-SVF and t-AVF scores and sex only some t-SVF scores. Diagnostic accuracy against clinical samples was optimal (AUC = 0.81-0.86). Discussion: The t-VFB is a valid, reliable and normed telephone-based assessment tool for language and executive functioning, equivalent to the in-person version; results show promising evidence of its diagnostic accuracy in neurological populations.
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BACKGROUND: The aim of this paper is to present a freely accessible new instrument for the evaluation of cognition: the Global Examination of Mental State (GEMS). METHODS: It is made up of 11 items tapping into a range of skills, such as Orientation in time and space, Memory, Working memory, Visuo-spatial, Visuo-constructional and Planning abilities, Perceptual and visual Attention, Language (Naming, Comprehension, and Verbal fluency), and Pragmatics. RESULTS: The psychometric strengths of this screening are: (1) extensive and updated normative data on the adult Italian population (from 18 to 100 years old); (2) absence of ceiling effect in healthy individuals, which allows to better detect interindividual variability; (3) comparison of the global scores with normative data taking into account Cognitive Reserve rather than only education, thus increasing diagnostic accuracy; (4) thresholds for significant change over time and the possibility to use parallel versions (GEMS-A/GEMS-B) for test-retest; (5) solid psychometric properties and data on discriminant validity; and (6) free access to all materials (record forms, instructions, and cut-off scores) on the web under a Creative Common License. CONCLUSIONS: With all these characteristics, GEMS could be a very useful paper-and-pencil instrument for cognitive screening.
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Transtornos Cognitivos , Cognição , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Humanos , Idioma , Pessoa de Meia-Idade , Testes Neuropsicológicos , Psicometria , Adulto JovemRESUMO
BACKGROUND: Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). METHODS: The t-FAB (ranging 0-12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18-96 years; education range = 4-23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test-retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. RESULTS: In HPs, t-FAB measures yielded high inter-rater/test-retest reliability (ICC = .78-.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43-.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). DISCUSSION: The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.
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Função Executiva , Doenças do Sistema Nervoso , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Doenças do Sistema Nervoso/diagnóstico , Testes Neuropsicológicos , Padrões de Referência , Reprodutibilidade dos Testes , TelefoneRESUMO
The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists' Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement (about three quarters and above) on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research (a little over half), and even fewer to skills related to management, administration, and advocacy (fewer than half). European expert clinical neuropsychologists were in agreement with previous studies (including those conducted in the United States, Australia, and other countries) regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others.
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BACKGROUND: The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. METHODS: Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18-96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. RESULTS: With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. DISCUSSION: The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative.