"Cognitive" Criteria in Older Adults With Slow Gait Speed: Implications for Motoric Cognitive Risk Syndrome.

BACKGROUND: Motoric cognitive risk syndrome (MCR) is a predementia condition that combines slow gait speed and subjective cognitive concerns (SCC). The SCC criterion is presently unstandardized, possibly limiting risk detection. We sought to (a) characterize SCC practices through MCR literature review; (b) investigate the ability of SCC in slow gait individuals in predicting the likelihood of cognitive impairment in a demographically diverse sample of community-dwelling, nondemented older adults. METHODS: First, we comprehensively reviewed the MCR literature, extracting information regarding SCC measures, items, sources, and cognitive domain. Next, Einstein Aging Study (EAS) participants (N = 278, Mage = 77.22 ±â€…4.74, %female = 67, Meducation = 15 ±â€…3.61, %non-Hispanic White = 46.3) completed gait, Clinical Dementia Rating Scale (CDR), and SCC assessment at baseline and annual follow-up (Mfollow-up = 3.5). Forty-two participants met slow gait criteria at baseline. Generalized linear mixed-effects models examined baseline SCC to predict cognitive impairment on CDR over follow-up. RESULTS: We reviewed all published MCR studies (N = 106) and documented ambiguity in SCC criteria, with a prevalent approach being use of a single self-reported memory item. In EAS, high SCC endorsement on a comprehensive, validated screen significantly affected the rate of cognitive impairment (CDR; ßinteraction = 0.039, p = .018) in slow gait individuals. CONCLUSIONS: An assessment approach that queries across numerous SCC domains was found to predict future decline in clinical dementia status in slow gait older adults. Current SCC practices in MCR, which tend to utilize a single-memory item, may not be the optimal approach. We discuss the implications of SCC criteria validation and standardization to enhance early dementia detection in MCR.

Does the Cognitive Change Index Predict Future Cognitive and Clinical Decline? Longitudinal Analysis in a Demographically Diverse Cohort.

Background: The Cognitive Change Index (CCI) is a widely-used measure of self-perceived cognitive ability and change. Unfortunately, it is unclear if the CCI predicts future cognitive and clinical decline. Objective: We evaluated baseline CCI to predict transition from normal cognition to cognitive impairment in nondemented older adults and in predementia groups including, subjective cognitive decline, motoric cognitive risk syndrome, and mild cognitive impairment. Different versions of the CCI were assessed to uncover any differential risk sensitivity. We also examined the effect of ethnicity/race on CCI. Methods: Einstein Aging Study participants (N = 322, Mage = 77.57±4.96, % female=67.1, Meducation = 15.06±3.54, % non-Hispanic white = 46.3) completed an expanded 40-item CCI version (CCI-40) and neuropsychological evaluation (including Clinical Dementia Rating Scale [CDR], Montreal Cognitive Assessment, and Craft Story) at baseline and annual follow-up (Mfollow - up=3.4 years). CCI-40 includes the original 20 items (CCI-20) and the first 12 memory items (CCI-12). Linear mixed effects models (LME) and generalized LME assessed the association of CCI total scores at baseline with rate of decline in neuropsychological tests and CDR. Results: In the overall sample and across predementia groups, the CCI was associated with rate of change in log odds on CDR, with higher CCI at baseline predicting faster increase in the odds of being impaired on CDR. The predictive validity of the CCI broadly held across versions (CCI-12, 20, 40) and ethnic/racial groups (non-Hispanic black and white). Conclusions: Self-perception of cognitive change on the CCI is a useful marker of dementia risk in demographically/clinically diverse nondemented samples. All CCI versions successfully predicted decline.

Examining the role of participant and study partner report in widely-used classification approaches of mild cognitive impairment in demographically-diverse community dwelling individuals: results from the Einstein aging study.

Objective: The role of subjective cognitive concerns (SCC) as a diagnostic criterion for MCI remains uncertain and limits the development of a universally (or widely)-accepted MCI definition. The optimal MCI definition should define an at-risk state and accurately predict the development of incident dementia. Questions remain about operationalization of definitions of self- and informant-reported SCCs and their individual and joint associations with incident dementia. Methods: The present study included Einstein Aging Study participants who were non-Hispanic White or Black, free of dementia at enrollment, had follow-up, and completed neuropsychological tests and self-reported SCC at enrollment to determine MCI status. Informant-reported SCC at baseline were assessed via the CERAD clinical history questionnaire. Self-reported SCC were measured using the CERAD, items from the EAS Health Self-Assessment, and the single memory item from the Geriatric Depression Scale. Cox proportional hazards models examined the association of different operationalizations of SCC with Petersen and Jak/Bondi MCI definitions on the risk of dementia, further controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at specific time points for each definition, and Youden's index were calculated as an accuracy measure. Cox proportional hazards models were also used to evaluate the associations of combinations of self- and informant-reported SCC with the risk of incident dementia. Results: 91% of the sample endorsed at least one SCC. Youden's index showed that not including SCC in either Jak/Bondi or Petersen classifications had the best balance between sensitivity and specificity across follow-up. A subset of individuals with informants, on average, had a lower proportion of non-Hispanic Blacks and 94% endorsed at least one self-reported SCC. Both informant-reported and self-reported SCC were significantly associated with incident dementia. Conclusion: Our findings suggest that the SCC criterion may not improve the predictive validity for dementia when included in widely-employed definitions of MCI. Consistent with some prior research, informant-reported SCC was more related to risk of incident dementia than self-reported SCC. Given that requiring informant report as a diagnostic criterion may unintentionally exclude health disparate groups, additional consideration is needed to determine how best to utilize informant-report in MCI diagnosis.

Measurement precision across cognitive domains in the Alzheimer's Disease Neuroimaging Initiative (ADNI) data set.

OBJECTIVE: To demonstrate measurement precision of cognitive domains in the Alzheimer's Disease Neuroimaging Initiative (ADNI) data set. METHOD: Participants with normal cognition (NC), mild cognitive impairment (MCI), and Alzheimer's disease (AD) were included from all ADNI waves. We used data from each person's last study visit to calibrate scores for memory, executive function, language, and visuospatial functioning. We extracted item information functions for each domain and used these to calculate standard errors of measurement. We derived scores for each domain for each diagnostic group and plotted standard errors of measurement for the observed range of scores. RESULTS: Across all waves, there were 961 people with NC, 825 people with MCI, and 694 people with AD at their most recent study visit (data pulled February 25, 2019). Across ADNI's battery there were 34 memory items, 18 executive function items, 20 language items, and seven visuospatial items. Scores for each domain were highest on average for people with NC, intermediate for people with MCI, and lowest for people with AD, with most scores across all groups in the range of -1 to +1. Standard error of measurement in the range from -1 to +1 was highest for memory, intermediate for language and executive functioning, and lowest for visuospatial. CONCLUSION: Modern psychometric approaches provide tools to help understand measurement precision of the scales used in studies. In ADNI, there are important differences in measurement precision across cognitive domains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Linking self-perceived cognitive functioning questionnaires using item response theory: The subjective cognitive decline initiative.

OBJECTIVE: Self-perceived cognitive functioning, considered highly relevant in the context of aging and dementia, is assessed in numerous ways-hindering the comparison of findings across studies and settings. Therefore, the present study aimed to link item-level self-report questionnaire data from international aging studies. METHOD: We harmonized secondary data from 24 studies and 40 different questionnaires with item response theory (IRT) techniques using a graded response model with a Bayesian estimator. We compared item information curves to identify items with high measurement precision at different levels of the self-perceived cognitive functioning latent trait. Data from 53,030 neuropsychologically intact older adults were included, from 13 English language and 11 non-English (or mixed) language studies. RESULTS: We successfully linked all questionnaires and demonstrated that a single-factor structure was reasonable for the latent trait. Items that made the greatest contribution to measurement precision (i.e., "top items") assessed general and specific memory problems and aspects of executive functioning, attention, language, calculation, and visuospatial skills. These top items originated from distinct questionnaires and varied in format, range, time frames, response options, and whether they captured ability and/or change. CONCLUSIONS: This was the first study to calibrate self-perceived cognitive functioning data of geographically diverse older adults. The resulting item scores are on the same metric, facilitating joint or pooled analyses across international studies. Results may lead to the development of new self-perceived cognitive functioning questionnaires guided by psychometric properties, content, and other important features of items in our item bank. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Tracking cognition with the T-MoCA in a racially/ethnically diverse older adult cohort.

Introduction: We investigated the utility of the Telephone-Montreal Cognitive Assessment (T-MoCA) to track cognition in a diverse sample from the Einstein Aging Study. Methods: Telephone and in-person MoCA data, collected annually, were used to evaluate longitudinal cognitive performance. Joint models of T-MoCA and in-person MoCA compared changes, variance, and test-retest reliability measured by intraclass correlation coefficient by racial/ethnic group. Results: There were no significant differences in baseline performance or longitudinal changes across three study waves for both MoCA formats. T-MoCA performance improved over waves 1-3 but declined afterward. Test-retest reliability was lower for the T-MoCA than for the in-person MoCA. In comparison with non-Hispanic Whites, non-Hispanic Blacks and Hispanics performed worse at baseline on both MoCA formats and showed lower correlations between T-MoCA and in-person versions. Conclusions: The T-MoCA provides valuable information on cognitive change, despite racial/ethnic disparities and practice effects. We discuss implications for health disparity populations. Highlights: We assessed the comparability of Telephone-Montreal Cognitive Assessment (T-MoCA) and in-person MoCA for tracking cognition.Changes within 3 years in T-MoCA were similar to that for the in-person MoCA.T-MoCA is subject to practice effects and shows difference in performance by race/ethnicity.Test-retest reliability of T-MoCA is lower than that for in-person MoCA.

Measuring Memory Lapses and Their Impact on Daily Life: Results From Two Daily Diary Studies.

Memory lapses (e.g., forgetting a medication) are common for most people, yet past methods of assessment relied upon retrospective reports from long recall windows. Recently, researchers have incorporated daily diary methods to capture memory lapse frequency closer to the experience in real-world environments. This study describes the utility of the Daily Memory Lapses Checklist using data from two 14-day diary studies (Combined Sample = 467; 66% women). Frequency and impact (i.e., irritation and interference) of prospective and retrospective memory lapses were assessed at both individual- and daily levels. Across studies, memory lapses occurred on more than one-third of assessment days. Retrospective lapses were reported more frequently than prospective; however, both lapses had a similar impact. The Daily Memory Lapses Checklist represents a flexible measure that separates the occurrence of a memory lapse from its impact on daily life: metrics that will enhance our understanding of daily experiences of cognitive functioning.

Development and psychometric evaluation of the Test of Practical Judgment alternate form (Form B).

The Test of Practical Judgment (TOP-J) is increasingly used by neuropsychologists to measure everyday judgment ability in older adulthood. In the present study, we developed an alternate TOP-J Form B, which may be used to reduce practice effects for repeat assessment situations or in place of the original Form A. In developing the measure, special attention was given to limiting cultural bias and making items similar in content and difficulty to Form A. The TOP-J Form B was piloted in a clinical geriatric sample (N = 77) in the Midwestern U.S. Subsequently, older adults (N = 130) were recruited from several boroughs of New York City and surrounding areas (mean age = 77; mean years of education = 16; 69% female; 28% Black/African-American, 11% Hispanic). In this validation sample, both the 9-item and 15-item versions of the TOP-J Form B showed strong psychometric properties, including good unidimensional model fit in confirmatory factor analysis, preliminary convergent/divergent and criterion validity evidence, and strong inter-rater reliability, ICC (2, 1) = .93. The means and standard deviations for the TOP-J Form A and Form B were highly similar, particularly for the 9-item forms in which there was less than a one-point mean difference. Preliminary normative data for cognitively intact participants (n = 73) were established. We present means and standard deviations that will allow for the calculation of z scores as Form B scores were normally distributed. The newly developed TOP-J Form B should be useful in diverse clinical and research settings.

Concordance Between Logical Memory and Craft Story 21 in Community-Dwelling Older Adults: The Role of Demographic Factors And Cognitive Status.

OBJECTIVE: Episodic memory loss, a hallmark symptom of Alzheimer's Disease, is frequently quantified by story memory performance. The National Alzheimer's Coordinating Center Uniform Data Set Neuropsychological Battery (UDSNB) replaced Logical Memory with Craft Story 21 in UDSNB Version 3. The concordance between these story memory tasks is poorly characterized in demographically diverse older adults, possibly jeopardizing the integrity of longitudinal data in aging cohorts. METHOD: Einstein Aging Study participants (n = 298; Mage = 76.6; Meducation = 15; 66.4% women; 43.3% Non-Hispanic White) completed UDSNB measures, including Craft Story and Logical Memory. Classification as normal cognition (n = 206) or mild cognitive impairment (n = 90) was based on Jak/Bondi criteria. Analyses included correlations, linear regression, and equipercentile equating methods to characterize the relationship between Logical Memory and Craft Story. Multivariate linear mixed effects models explored the association of covariates and practice effects over follow-up, stratified by cognitive status and race/ethnicity. RESULTS: Immediate (r = 0.54) and delayed (r = 0.56) versions of Logical Memory and Craft Story were moderately correlated. Age, education, depression, and female sex were associated with Logical Memory, while age, education, cognitive status, and male sex were associated with Craft Story. Significant differential effects of sex on story memory were observed. CONCLUSIONS: We demonstrated that Logical Memory and Craft Story may be used largely interchangeably; however, memory may be enhanced for stories with a protagonist of the same sex as the participant. Craft Story was somewhat more associated with mild cognitive impairment in the overall sample, but especially in non-Hispanic Black participants. We discuss how results inform test selection considerations.

Mental health literacy questionnaire-short version for adults (MHLq-SVa): validation study in China, India, Indonesia, Portugal, Thailand, and the United States.

BACKGROUND: Mental Health Literacy (MHL) has become a focus of research in recent decades, as a prerequisite for early identification and intervention for mental health problems. Although several instruments have been developed for assessing MHL, there is a need for brief and psychometrically sound measures to capture important aspects of MHL in large and diverse adult samples. The present study aimed to: (1) provide a revised and shorter version of a previously validated questionnaire for assessing MHL; and (2) examine the psychometric properties of the MHLq-SVa in student samples from six different countries (China, India, Indonesia, Portugal, Thailand, and United States). METHODS: The study involved 2180 senior school and undergraduate students, aged between 17 and 25 years old, from China, India, Indonesia, Portugal, Thailand, and the United States. Participants responded to the Mental Health Literacy Questionnaire for young adults (MHLq-ya), in their native language, following its translation and adaptation for each culture. The MHLq-ya comprises 29 items, organized into four dimensions: Knowledge of mental health problems; Erroneous beliefs/stereotypes; First-aid skills and help-seeking behavior; Self-help strategies. Confirmatory factor analyses and internal consistency analyses were performed on the combined data. RESULTS: Data from the different countries supported a shorter version of the questionnaire (MHLq-SVa), composed of 16 items that fit with previously defined dimensions. Internal consistency and between-factor correlations further supported the adequacy of the instrument's psychometric properties. CONCLUSION: The study provided preliminary support for the construct validity and reliability of the MHLq-SVa as a measure for assessing MHL in young adults from six different countries and languages. Future studies are needed to further validate the measure and undertake multicultural comparisons of MHL in diverse samples from around the globe.

Daily Memory Lapses and Affect: Mediation Effects on Life Satisfaction.

Memory lapses are a type of daily challenge that are common to most people and are associated with negative mood outcomes. How daily challenges are associated and linked to broad domains, like life satisfaction and well-being, has been underexamined. Life satisfaction is often assessed from a macro-level that emphasizes average differences over longer timeframes, yet daily experiences (i.e., micro-level) may accumulate to shape these characteristics. In the current study, we examined if daily memory lapses (e.g., difficulties with word-finding or forgetting a meeting) were associated with life satisfaction, and whether this relationship was mediated by the associated changes in positive and negative affect due to daily memory lapses. In a coordinated analysis of two datasets (N = 561, ages 25-93 years), we used multilevel structural equation modeling to assess how daily memory lapses may influence the broader outcome of global life satisfaction. The pattern of results was similar across datasets: memory lapses were associated with reduced positive affect and increased negative affect. Further, the daily affect associated with daily memory lapses significantly mediated the relationship between lapses and life satisfaction, while the direct relationship between memory lapses and life satisfaction was non-significant. This study provides support for the role of daily challenges, specifically memory lapses, influencing broader constructs such as psychological well-being by identifying the key factor of affective responses. Future work should identify other salient daily challenges, as well as explore if reducing the affective response to challenges through targeted interventions would mitigate impacts on distal functioning.

Retrospective metamemory monitoring of semantic memory in community-dwelling older adults with subjective cognitive decline and mild cognitive impairment.

In neurodegenerative conditions, better memory/cognitive awareness, indexed by greater "metamemory monitoring accuracy", is linked to stronger cognitive remediation outcomes. Differences in metamemory monitoring accuracy in predementia conditions, which could inform treatment effectiveness, have not been systematically investigated. We utilized a retrospective confidence judgment (RCJ) task for general knowledge recognition in community-dwelling older adults: 106 cognitively healthy (HC), 68 subjective cognitive decline (SCD) despite intact neuropsychological function, 14 amnestic mild cognitive impairment (aMCI), and 31 non-amnestic mild cognitive impairment (naMCI). Participants gave confidence ratings after making recognition responses to general knowledge questions. Recognition accuracy, confidence levels, and absolute and relative RCJ accuracy (i.e., metamemory monitoring accuracy) were analysed. Compared to HC and SCD, absolute RCJ accuracy was significantly poorer in both MCI groups but relative RCJ accuracy was significantly poorer in naMCI, but not aMCI. This novel result may be driven by lower confidence for correct recognition responses in naMCI and suggests that poorer RCJ accuracy in naMCI may be attributable to poorer performance monitoring. We discuss results in relation to the possibility that individuals in distinct preclinical dementia conditions, who have different levels of memory/cognitive awareness, may differentially benefit from cognitive remediation strategies tailored to their levels of memory/cognitive awareness.

Re-evaluation of psychometric evidence and update of normative data for the Test of Practical Judgment.

ObjectiveThe Test of Practical Judgment (TOP-J) has shown utility in inpatient and outpatient settings in older adults who present with mild cognitive impairment and various dementia subtypes. The TOP-J has two versions (i.e. 9 items and 15 items), and was initially validated within a small rural non-Hispanic White sample. In the current study, we re-evaluated the psychometric evidence and refined scoring criteria and administration guidelines in older adults with more diverse demographic characteristics than the original validation sample. Method: Participants (N = 348) were recruited from several boroughs of New York City and surrounding areas (mean/median age = 79; mean years education = 15, median = 15.5; 68% female; 30% Black/African-American, 8% Hispanic). Results: Reliability and validity were comparable to original findings. Based on confirmatory factor analysis, one item was replaced on the 9-item version, now called TOP-J Form A. Normative data for cognitively intact participants (n = 261) were updated and stratified by two education groups. Conclusions: The TOP-J is increasingly used in clinical and research settings in the U.S. and abroad, and the current study provides improved normative data and administration and scoring guidelines for use with demographically diverse older individuals.

Informant report of practical judgment ability in a clinical sample of older adults with subjective cognitive decline, mild cognitive impairment, and dementia.

Despite the importance of capturing problems with judgment and decision-making during neuropsychological evaluations of older adults, there are a limited number of validated measures and no informant rating scales. We developed an informant measure that captures compromised judgment related to safety, medical, financial, and social-ethical issues After item refinement and piloting in a memory disorders clinic, we utilized the Test of Practical Judgment-Informant (TOP-J-Informant) at two clinics in the Midwestern U.S., including 189 patient/informant dyads (mean age = 79.0, median years of education = 13, % female = 67.7) with various preclinical and clinical dementia conditions. We found psychometric support, including evidence for convergent, divergent, and criterion-related validity, and internal consistency. Importantly, we were able to discriminate between diagnostic groups in the expected direction. The TOP-J-Informant is brief (<5 minutes), easy to administer, and can reveal areas of concern related to poor judgment when administered in the context of a neuropsychological evaluation or clinic visit.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia.

Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions. OBJECTIVE: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both. METHODS: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer's disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br). RESULTS: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82. CONCLUSION: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

Julgamento é a capacidade de tomar decisões acertadas, após considerar informações relevantes disponíveis, soluções possíveis, resultados prováveis ​​e fatores contextuais. A perda de julgamento é comum em pacientes com comprometimento cognitivo leve (CCL) e demência. O Teste de Julgamento Prático (TOP-J) avalia o julgamento prático em adultos e idosos, em versões de 15 e 9 itens, que exigem que os indivíduos ouçam cenários sobre problemas cotidianos e relatem suas soluções. OBJETIVO: Adaptação do TOP-J para amostra brasileira, elaboração de uma versão reduzida e verificação da acurácia de ambas. MÉTODOS: Oitenta e cinco idosos, incluindo 26 com CCL, 20 com doença de Alzheimer (DA), 15 com variante comportamental de demência frontotemporal (DFTvc) e 24 controles, foram submetidos à avaliação neuropsicológica, incluindo a adaptação brasileira do TOP-J (TOP-J-Br). RESULTADOS: Nas duas versões do TOP-J-Br, os controles superaram os CCL, DA e DFTvc (p<0,001) e o grupo CCL superou os grupos DA e DFTvc (p<0,001). Para o grupo TOP-J/15-Br, o melhor ponto de corte para diferenciação entre controles e pacientes apresentou sensibilidade de 91,7, especificidade de 59,0 e área sob a curva de 0,8. Para o TOP-J/9-Br, o melhor ponto de corte para diferenciação entre controles e pacientes teve sensibilidade de 79,9, especificidade de 72,1 e área sob a curva de 0,82. CONCLUSÃO: O TOP-J/15-Br, e particularmente o TOP-J/9-Br, mostraram propriedades psicométricas robustas e o potencial de utilidade clínica em idosos brasileiros em vários estágios de declínio cognitivo neurodegenerativo.

UDSNB 3.0 Neuropsychological Test Norms in Older Adults from a Diverse Community: Results from the Einstein Aging Study (EAS).

BACKGROUND: The Uniform Data Set, Version 3 Neuropsychological Battery (UDSNB3.0), from the database of the University of Washington's National Alzheimer's Coordinating Center (NACC), is widely used to characterize cognitive performance in clinical and research settings; however, norms for underrepresented community-based samples are scarce. OBJECTIVE: We compared UDSNB 3.0 test scores between the Einstein Aging Study (EAS), composed of racially/ethnically diverse, community-dwelling older adults aged≥70 and the NACC, and report normative data from the EAS. METHODS: Analyses included 225 cognitively normal EAS participants and comparable data from 5,031 NACC database participants. Linear regression models compared performance between the samples, adjusting for demographics (sex, age, education, race/ethnicity), depressive symptoms, and whether English was the first language. Linear regression models to examine demographic factors including age, sex, education and race/ethnicity as predictors for the neuropsychological tests were applied in EAS and NACC separately and were used to create a demographically adjusted z-score calculator. RESULTS: Cognitive performance across all domains was worse in the EAS than in the NACC, adjusting for age, sex, education, race/ethnicity, and depression, and the differences remained in visuo-construction, visuospatial memory, confrontation naming, visual attention/processing speed, and executive functioning after further adjusting for whether English was the first language. In both samples, non-Hispanic Whites outperformed non-Hispanic Blacks and more education was associated with better cognitive performance. CONCLUSION: Differences observed in demographic, clinical, and cognitive characteristics between the community-based EAS sample and the nationwide NACC sample suggest that separate normative data that more accurately reflect non-clinic, community-based populations should be established.

Prospective Metamemory Monitoring of Episodic Visual Memory in Community-Dwelling Older Adults with Subjective Cognitive Decline and Mild Cognitive Impairment.

OBJECTIVE: Metamemory tasks have been utilized to investigate anosognosia in older adults with dementia, though previous research has not systematically compared memory self-awareness in prodromal dementia groups. This represents an important oversight given that remedial and interventional efforts may be most beneficial before individuals' transition to clinical dementia. We examine differences in memory self-awareness and memory self-monitoring between cognitively healthy elderly controls and prodromal dementia groups. METHODS: Participants with subjective cognitive decline despite intact objective neuropsychological functioning (SCD; n = 82), amnestic mild cognitive impairment (aMCI; n = 18), nonamnestic mild cognitive impairment (naMCI; n = 38), and normal cognitive functioning (HC; n = 120) were recruited from the Einstein Aging Study for a cross-sectional study. Participants completed an experimental visual memory-based global metamemory prediction task and subjective assessments of memory/cognition and self-awareness. RESULTS: While, relative to HC, memory self-awareness and memory self-monitoring were preserved for delayed memory performance in SCD and aMCI, these processes were impaired in naMCI. Furthermore, results suggest that poor metamemory accuracy captured by our experimental task can be generalized to everyday memory problems. CONCLUSIONS: Within the framework of the Cognitive Awareness Model, our findings provide preliminary evidence that poor memory self-awareness/self-monitoring in naMCI may reflect an executive or primary anosognosia, with implications for tailored rehabilitative interventions.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c).

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia / Avaliação da capacidade de julgamento em uma amostra brasileira de pacientes com comprometimento cognitivo leve e demência

ABSTRACT. Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions. Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both. Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer's disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br). Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82. Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

RESUMO. Julgamento é a capacidade de tomar decisões acertadas, após considerar informações relevantes disponíveis, soluções possíveis, resultados prováveis ​​e fatores contextuais. A perda de julgamento é comum em pacientes com comprometimento cognitivo leve (CCL) e demência. O Teste de Julgamento Prático (TOP-J) avalia o julgamento prático em adultos e idosos, em versões de 15 e 9 itens, que exigem que os indivíduos ouçam cenários sobre problemas cotidianos e relatem suas soluções. Objetivo: Adaptação do TOP-J para amostra brasileira, elaboração de uma versão reduzida e verificação da acurácia de ambas. Métodos: Oitenta e cinco idosos, incluindo 26 com CCL, 20 com doença de Alzheimer (DA), 15 com variante comportamental de demência frontotemporal (DFTvc) e 24 controles, foram submetidos à avaliação neuropsicológica, incluindo a adaptação brasileira do TOP-J (TOP-J-Br). Resultados: Nas duas versões do TOP-J-Br, os controles superaram os CCL, DA e DFTvc (p<0,001) e o grupo CCL superou os grupos DA e DFTvc (p<0,001). Para o grupo TOP-J/15-Br, o melhor ponto de corte para diferenciação entre controles e pacientes apresentou sensibilidade de 91,7, especificidade de 59,0 e área sob a curva de 0,8. Para o TOP-J/9-Br, o melhor ponto de corte para diferenciação entre controles e pacientes teve sensibilidade de 79,9, especificidade de 72,1 e área sob a curva de 0,82. Conclusão: O TOP-J/15-Br, e particularmente o TOP-J/9-Br, mostraram propriedades psicométricas robustas e o potencial de utilidade clínica em idosos brasileiros em vários estágios de declínio cognitivo neurodegenerativo.

T-MoCA: A valid phone screen for cognitive impairment in diverse community samples.

INTRODUCTION: There is an urgent need to validate telephone versions of widely used general cognitive measures, such as the Montreal Cognitive Assessment (T-MoCA), for remote assessments. METHODS: In the Einstein Aging Study, a diverse community cohort (n = 428; mean age = 78.1; 66% female; 54% non-White), equivalence testing was used to examine concordance between the T-MoCA and the corresponding in-person MoCA assessment. Receiver operating characteristic analyses examined the diagnostic ability to discriminate between mild cognitive impairment and normal cognition. Conversion methods from T-MoCA to the MoCA are presented. RESULTS: Education, race/ethnicity, gender, age, self-reported cognitive concerns, and telephone administration difficulties were associated with both modes of administration; however, when examining the difference between modalities, these factors were not significant. Sensitivity and specificity for the T-MoCA (using Youden's index optimal cut) were 72% and 59%, respectively. DISCUSSION: The T-MoCA demonstrated sufficient psychometric properties to be useful for screening of MCI, especially when clinic visits are not feasible.