The Relationship Between Older Adults' Subjective Age and Perceived Effort on Cognitive Tasks.

BACKGROUND: Although engagement in cognitively-demanding activities is beneficial for older adults, research suggests that older adults may be less motivated to engage in these types of activities because of the increased age-related costs associated with task engagement and their perceptions of the task demands. METHODS: Across three studies, we investigated if older adults' subjective age predicted their perceptions of effort over the course of a working memory task. Younger and older adults reported their subjective age and then completed an increasingly difficult series of working memory trials, indicating perceived task demands and effort after each trial. RESULTS: Results from all three studies showed that there was no age difference in performance or in perceptions of task difficulty, contrary to previous results. Also, there was no significant association between older adults' subjective age and perceived effort, suggesting that subjective age may not be a reliable predictor of perceptions of task demands in older adults. DISCUSSION: Participant characteristics and the testing environment may play a role in determining the relationship between subjective age and perceived effort.

Low-Performing Students Confidently Overpredict Their Grade Performance throughout the Semester.

When asked to predict how they will perform on an upcoming exam, students are often poorly calibrated, typically in the direction of overpredicting their performance. Research shows that low-performing students' calibration tends to remain poor across multiple tests over the course of a semester. We tested whether these students remain confident in these erroneously high grade predictions across the semester or whether their confidence wanes, suggesting some degree of metacognitive awareness. In two studies, students made grade predictions prior to taking four in-class exams and then rated their level of confidence in their predictions. Results from both studies showed that miscalibration and confidence remained stable across tests, suggesting that low-performing students continued to believe that they would perform well on upcoming exams despite prior evidence to the contrary.

Reducing Surgical Complications in Spine Patients Through a Medication Management Support Program.

STUDY DESIGN: A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We analyzed complications before and during the implementation of this program. OBJECTIVE: The goal of the study was to determine if a medication management support program was effective for reducing perioperative complications, including hemorrhage, myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis. DATA AND METHODS: Using data from the National Surgical Quality Improvement Program database, we examined the presence of 5 complications before and during the implementation of a medication management support program. There were 9732 patients in the clinic population who underwent elective spine surgery between 2011 and 2020 and were included in this analysis. Of those 9732 patients, 7205 had surgery before the introduction of the program, whereas 2527 had surgery at some point after the program was introduced. We conducted a series of Pearson's χ 2 tests to determine the relative frequencies of the complications before and during the program. RESULTS: Results showed that during the implementation of the program, patients were relatively less likely to experience hemorrhage (3.16% vs. 1.11%; P <0.001). The reductions in thrombotic complications were clinically significant: myocardial infarction (0.12% vs. 0.00%), stroke (0.10% vs. 0.04%), pulmonary embolism (0.33% vs. 0.28%), and deep vein thrombosis (0.36% vs. 0.28%). These P values ranged from P =0.08 for myocardial infarction to P =0.67 for pulmonary embolism. CONCLUSIONS: The use of this medication management support program appears effective for reducing the need for blood transfusions and thrombotic complications. While promising, the results should be interpreted with caution as we do not know whether this type of program will be effective for other hospital systems.

Metacognitive errors in the classroom: The role of variability of past performance on exam prediction accuracy.

Students often make incorrect predictions about their exam performance, with the lowest-performing students showing the greatest inaccuracies in their predictions. The reasons why low-performing students make inaccurate predictions are not fully understood. In two studies, we tested the hypothesis that low-performing students erroneously predict their exam performance in part because their past performance varies considerably, yielding unreliable data from which to make their predictions. In contrast, high-performing students tend to have consistently high past performance that they can rely on to make relatively accurate predictions of future test performance. Results showed that across different exams (Study 1) and different courses (Study 2), low-performing students had more variable past performance than high-performing students. Further, results from Study 2 showed that variability in past course performance (but not past exam performance) was associated with poor calibration. Results suggest that variability in past performance may be one factor that contributes to low-performing students' erroneous performance predictions.

Statistical Model of Dynamic Markers of the Alzheimer's Pathological Cascade.

Objectives: Alzheimer's disease (AD) is a progressive disease reflected in markers across assessment modalities, including neuroimaging, cognitive testing, and evaluation of adaptive function. Identifying a single continuum of decline across assessment modalities in a single sample is statistically challenging because of the multivariate nature of the data. To address this challenge, we implemented advanced statistical analyses designed specifically to model complex data across a single continuum. Method: We analyzed data from the Alzheimer's Disease Neuroimaging Initiative (ADNI; N = 1,056), focusing on indicators from the assessments of magnetic resonance imaging (MRI) volume, fluorodeoxyglucose positron emission tomography (FDG-PET) metabolic activity, cognitive performance, and adaptive function. Item response theory was used to identify the continuum of decline. Then, through a process of statistical scaling, indicators across all modalities were linked to that continuum and analyzed. Results: Findings revealed that measures of MRI volume, FDG-PET metabolic activity, and adaptive function added measurement precision beyond that provided by cognitive measures, particularly in the relatively mild range of disease severity. More specifically, MRI volume, and FDG-PET metabolic activity become compromised in the very mild range of severity, followed by cognitive performance and finally adaptive function. Conclusion: Our statistically derived models of the AD pathological cascade are consistent with existing theoretical models.

Successful aging: The role of cognitive gerontology.

This commentary explores the relationships between the construct of successful aging and the experimental psychology of human aging-cognitive gerontology. What can or should cognitive gerontology contribute to understanding, defining, and assessing successful aging? Standards for successful aging reflect value judgments that are culturally and historically situated. Fundamentally, they address social policy; they are prescriptive. If individuals or groups are deemed to be aging successfully, then their characteristics or situations can be emulated. If an individual or a group is deemed to be aging unsuccessfully, then intervention should be considered. Although science is never culture-free or ahistorical, cognitive gerontology is primarily descriptive of age-related change. It is not prescriptive. It is argue that cognitive gerontology has little to contribute to setting standards for successful aging. If, however, better cognitive function is taken as a marker of more successful aging-something not universally accepted-then cognitive gerontology can play an important assessment role. It has a great deal to contribute in determining whether an individual or a group evidences better cognitive function than another. More importantly, cognitive gerontology can provide tools to evaluate the effects of interventions. It can provide targeted measures of perception, attention, memory, executive function, and other facets of cognition that are more sensitive to change than most clinical measures. From a deep understanding of factors affecting cognitive function, cognitive gerontology can also suggest possible interventions. A brief narrative review of interventions that have and have not led to improved cognitive function in older adults. Finally, the enormous range is addressed in the estimates of the proportion of the population that meets a standard for aging successfully, from less than 10% to more than 90%. For research purposes, it would be better to replace absolute cutoffs with correlational approaches (e.g., Freund & Baltes, 1998, Psychology and Aging, 13, 531-543). For policy purposes, cutoffs are necessary, but we propose that assessments of successful aging be based not on absolute cutoffs but on population proportions. An example of one possible standard is this: Those more than 1 standard deviation above the mean are aging successfully; those more than 1 standard deviation below the mean are aging unsuccessfully; those in between are aging usually. Adoption of such a standard may reduce the wide discrepancies in the incidence of successful aging reported in the literature.

Alzheimer's Disease Assessment: A Review and Illustrations Focusing on Item Response Theory Techniques.

Alzheimer's disease (AD) affects neurological, cognitive, and behavioral processes. Thus, to accurately assess this disease, researchers and clinicians need to combine and incorporate data across these domains. This presents not only distinct methodological and statistical challenges but also unique opportunities for the development and advancement of psychometric techniques. In this article, we describe relatively recent research using item response theory (IRT) that has been used to make progress in assessing the disease across its various symptomatic and pathological manifestations. We focus on applications of IRT to improve scoring, test development (including cross-validation and adaptation), and linking and calibration. We conclude by describing potential future multidimensional applications of IRT techniques that may improve the precision with which AD is measured.

The effect of cognitive testing and feedback on older adults' subjective age.

Subjective age, or how old a person feels, is an important measure of self-perception that is associated with consequential cognitive and health outcomes. Recent research suggests that subjective age is affected by certain situations, including cognitive testing contexts. The current study examined whether cognitive testing and positive performance feedback affect subjective age and subsequent cognitive performance. Older adults took a series of neuropsychological and cognitive tests and subjective age was measured at various time points. Participants also either received positive or no feedback on an initial cognitive task, an analogies task. Results showed that participants felt older over the course of the testing session, particularly after taking a working memory test, relative to baseline. Positive feedback did not significantly mitigate this subjective aging effect. Results suggest that subjective age is malleable and that it can be affected by standard cognitive and neuropsychological test conditions.

Metacognition in the classroom: The association between students' exam predictions and their desired grades.

Students are overconfident when making grade predictions, and worse, the lowest-performing students are generally the most overconfident. Because metacognitive accuracy is associated with academic performance, multiple studies have attempted to improve metacognitive accuracy with mixed results. However, these studies may be of limited use because we do not understand the types of information university students use to make performance predictions. The current studies examined the possibility that university students' predictions are associated with their desires-the grade they want to receive. Studies 1-4 demonstrated that students' desired grades were strongly associated with their grade predictions across different courses, universities, and measurement strategies. Study 4 also showed that, if warned about the previous results, students could reduce their reliance on their desired grades and improve the accuracy of their predictions relative to control. Together, results demonstrated that students' exam predictions are associated with their desired grades.

The Effect of Prior Task Success on Older Adults' Memory Performance: Examining the Influence of Different Types of Task Success.

BACKGROUND/STUDY CONTEXT: Negative aging stereotypes can lead older adults to perform poorly on memory tests. Yet, memory performance can be improved if older adults have a single successful experience on a cognitive test prior to participating in a memory experiment (Geraci & Miller, 2013, Psychology and Aging, 28, 340-345). The current study examined the effects of different types of prior task experience on subsequent memory performance. METHODS: Before participating in a verbal free recall experiment, older adults in Experiment 1 successfully completed either a verbal or a visual cognitive task or no task. In Experiment 2, they successfully completed either a motor task or no task before participating in the free recall experiment. RESULTS: Results from Experiment 1 showed that relative to control (no prior task), participants who had prior success, either on a verbal or a visual task, had better subsequent recall performance. Experiment 2 showed that prior success on a motor task, however, did not lead to a later memory advantage relative to control. CONCLUSION: These findings demonstrate that older adults' memory can be improved by a successful prior task experience so long as that experience is in a cognitive domain.

The influence of retrieval practice on metacognition: The contribution of analytic and non-analytic processes.

People may change their memory predictions after retrieval practice using naïve theories of memory and/or by using subjective experience - analytic and non-analytic processes respectively. The current studies disentangled contributions of each process. In one condition, learners studied paired-associates, made a memory prediction, completed a short-run of retrieval practice and made a second prediction. In another condition, judges read about a yoked learners' retrieval practice performance but did not participate in retrieval practice and therefore, could not use non-analytic processes for the second prediction. In Study 1, learners reduced their predictions following moderately difficult retrieval practice whereas judges increased their predictions. In Study 2, learners made lower adjusted predictions than judges following both easy and difficult retrieval practice. In Study 3, judge-like participants used analytic processes to report adjusted predictions. Overall, the results suggested non-analytic processes play a key role for participants to reduce their predictions after retrieval practice.

How Do Scores on the ADAS-Cog, MMSE, and CDR-SOB Correspond?

OBJECTIVE: Clinicians and researchers who measure cognitive dysfunction often use the Alzheimer's Disease Assessment Scale--Cognitive Subscale (ADAS-Cog), the Mini-Mental State Examination (MMSE), or the Clinical Dementia Rating scale (CDR-SOB). But, the use of different measures can make it difficult to compare data across patients or studies. What is needed is a simple chart that shows how scores on these three important measures correspond to each other. METHODS: Using data from 1709 participants from the Alzheimer's Disease Neuroimaging Initiative and item response theory-based statistics, we analyzed how scores on each measure, the ADAS-Cog, the MMSE, and the CDR-SOB, correspond. RESULTS: Results indicated multiple inflections in CDR-SOB and ADAS-Cog scores within a given MMSE score, suggesting that the CDR-SOB and ADAS-Cog are more precise in measuring the severity of cognitive dysfunction than the MMSE. CONCLUSIONS: This study shows how scores on these three popular measures of cognitive dysfunction correspond to each other, which is very useful information for both researchers and clinicians.

Age Effects in Implicit Memory: The Role of Response Competition Induced by Relative Word Frequency.

BACKGROUND/STUDY CONTEXT: This study examined the effect of age and response competition on implicit memory performance. METHODS: Younger and older adults studied high- and low-frequency words and took a word stem completion test that could be completed with multiple solutions. To manipulate response competition, the test list consisted of word stems that could be completed with target low-frequency words, as well as multiple other solutions with higher frequencies than the target (the high response competition condition) and word stems that could be completed with target high-frequency words, as well as multiple other solutions with lower frequencies than the target (the low response competition condition). RESULTS: Relative to younger adults, older adults showed reduced levels of priming only under conditions of high response competition (low-frequency targets with high-frequency competitors). CONCLUSION: In support of a response competition mechanism, older adults were more likely to complete stems with nonstudied high-frequency solutions than were younger adults. Results demonstrate that older adults have reduced priming compared with younger adults under some conditions of high response competition.

Improving metacognitive accuracy: how failing to retrieve practice items reduces overconfidence.

People often exhibit inaccurate metacognitive monitoring. For example, overconfidence occurs when people judge that they will remember more information on a future test then they actually do. The present experiments examined whether a small number of retrieval practice opportunities would improve participants' metacognitive accuracy by reducing overconfidence. Participants studied Lithuanian-English paired associates and predicted their performance on an upcoming memory test. Then they attempted to retrieve one or more practice items (or none in the control condition) and made a second prediction. Experiment 1 showed that failing to retrieve a single practice item lead to improved subsequent performance predictions - participants became less overconfident. Experiment 2 directly manipulated retrieval failure and showed that again failure to retrieve a single practice item significantly improved subsequent predictions, relative to when participants successfully retrieved the practice item. Finally, Experiment 3 showed that additional retrieval practice opportunities reduced overconfidence and improved prediction accuracy.

Aging 5 years in 5 minutes: the effect of taking a memory test on older adults' subjective age.

How old one feels-one's subjective age-has been shown to predict important psychological and health outcomes. The current studies examined the effect of taking a standard memory test on older adults' subjective age. Study 1 showed that older adults felt older after taking a standard neuropsychological screening test and participating in a free-recall experiment than they felt at baseline. Study 2 showed that the effect was selective to older adults: Younger adults' subjective age was not affected by participating in the memory experiment. Study 3 showed that the subjective-aging effect was specific to memory, as taking a vocabulary test for a similar amount of time did not affect older adults' subjective age. Finally, Study 4 showed that simply expecting to take a memory test subjectively aged older adults. The results indicate that being in a memory-testing context affects older adults' self-perception by making them feel older.

The bizarreness effect: evidence for the critical influence of retrieval processes.

People show better memory for bizarre sentences relative to common sentences, a finding referred to as the bizarrness effect. Interestingly, this effect is typically only obtained using a mixed-list design, in which participants study common and bizarre sentences in the same list. This bizarreness effect in mixed-list designs has been explained as the result of both enhanced encoding processes and efficient retrieval processes. The present experiment was designed to isolate the unique contributions of the retrieval context to the bizarreness effect. Participants studied common sentences in one room under one set of instructions, and bizarre sentences in another room under another set of instructions. At test, participants recalled the common and bizarre sentences either together or separately. The results showed that the bizarreness effect was only obtained when participants recalled the common and bizarre items together; no bizarreness advantage emerged when participants were required to recall the common and bizarre items separately. These results suggest that differential encoding processes are not necessary for explaining the bizarreness effect in memory. Rather, retrieval of the mixed-list context appears to be critical for obtaining the effect.

Improving older adults' memory performance using prior task success.

Holding negative aging stereotypes can lead older adults to perform poorly on memory tests. We attempted to improve older adults' memory performance by giving them task experience that would counter their negative performance expectations. Before participating in a memory experiment, younger and older adults were given a cognitive task that they could either successfully complete, not successfully complete, or they were given no prior task. For older adults, recall was significantly higher and self-reported anxiety was significantly lower for the prior task success group relative to the other groups. There was no effect of prior task experience on younger adults' memory performance. Results suggest that older adults' memory can be improved with a single successful prior task experience.

Gaining precision on the Alzheimer's Disease Assessment Scale-cognitive: a comparison of item response theory-based scores and total scores.

BACKGROUND: The Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) is a commonly used measure for assessing cognitive dysfunction in patients with Alzheimer's disease (AD). The measure has 11 subscales, each of which captures an important aspect of cognitive dysfunction in AD. Traditional scoring of the ADAS-cog involves adding up the scores from the subscales without regarding their varying difficulty or their strength of relationship to AD-associated cognitive dysfunction. The present article analyzes problems associated with this approach and offers solutions for gaining measurement precision by modeling how the subscales function. METHODS: We analyzed data collected at the Baylor College of Medicine Alzheimer's Disease and Memory Disorders Clinic from 1240 patients diagnosed with varying degrees of dementia. Item response theory was used to determine the relationship between total scores on the ADAS-cog and the underlying level of cognitive dysfunction reflected by the scores. RESULTS: Results revealed that each total score corresponded to a spectrum of cognitive dysfunction, indicating that total scores were relatively imprecise indicators of underlying cognitive dysfunction. Furthermore, it was common for two individuals with the same total score to have significantly different degrees of cognitive dysfunction. CONCLUSIONS: These findings suggest that item response theory scoring of the ADAS-cog may measure cognitive dysfunction more precisely than a total score method.

Neuropsychological status in older adults influences susceptibility to false memories.

In 2 experiments we examined the influence of frontal lobe function on older adults' susceptibility to false memory in a categorized list paradigm. Using a neuropsychological battery of tests developed by Glisky, Polster, and Routhieaux (1995), we designated older adults as having high- or low-frontal function. Young and older adults studied and were tested on categorized lists using free report cued recall and forced report cued recall instructions, with the latter requiring participants to produce responses even if they had to guess. Under free report cued recall instructions, frontal lobe function was a strong predictor of false memories in older adults: Older adults who scored low on tests of frontal functioning demonstrated much higher levels of false recall than younger adults, whereas levels of false recall in high-frontal older adults were more similar to those of young adults. However, after forced report cued recall, high- and low-frontal older adults performed similarly to each other, and both demonstrated higher levels of false recall than young adults. On a final recognition test, high-frontal older adults in both the free report cued recall and forced report cued recall conditions were more successful than low-frontal older adults in using source information to reduce memory errors. The results indicate that older adults show higher levels of false recall than younger adults, but type of test (free report or forced report) and neuropsychological status of older adults mediate these effects. Low-frontal older adults are particularly susceptible to producing false memories on free report tests that entail source monitoring.

On the validity of remember-know judgments: evidence from think aloud protocols.

The use of remember-know judgments to assess subjective experience associated with memory retrieval, or as measures of recollection and familiarity processes, has been controversial. In the current study we had participants think aloud during study and provide verbal reports at test for remember-know and confidence (i.e., sure-probably) judgments. Results indicated that the vast majority of remember judgments for studied items were associated with recollection from study (87%), but this correspondence was less likely for high-confidence judgments (72%). Instead, high-confidence judgments were more likely than remember judgments to be associated with incorrect recollection and a lack of recollection. Know judgments were typically associated with a lack of recollection (62%), but still included recollection from the study context (33%). Thus, although remember judgments provided fairly accurate assessments of retrieval including contextual details, know judgments did not provide accurate assessments of retrieval lacking contextual details.