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2 The Vietnamese Montreal Cognitive Assessment: An Evaluation of Construct Validity and Recommended Cut-off for Cognitive Impairment after TBI
- Halle Quang, Ashley Nguyen, Cardinal Do, Skye McDonald, Chris Nguyen
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 592-593
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Objective:
Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) play an essential role in the clinical evaluation of neuropsychological functions. Despite the extensive investigations of the MoCA in English speaking countries as well as emerging adaptation work in a few Asian cultures, evidence base for the utility of the Vietnamese MoCA (MoCA-V) is lacking. This has posed a huge challenge for current and future clinical practice in Vietnam, as the country continues to assume a large burden of brain-related disorders. This study examined the construct validity of the MoCA-V and identified a cut-off score for the determination of cognitive impairment in a prevalent neurological condition in Vietnam - traumatic brain injury (TBI).
Participants and Methods:Participants included 129 neurologically healthy individuals and 80 patients with moderate-to-severe TBI. All participants completed the MoCA-V, along with other common neurocognitive measures such as the Trail Making Test (TMT) Parts A and B, Vietnamese Verbal Fluency Test, and Digit Span.
Results:Pearson’s correlations revealed significant, moderate correlations between performance on the MoCA-V subdomains and more comprehensive cognitive measures. Performance on the MoCA-V Attention domain was correlated with both Digit Span Forward, r(110) = .453, p < .001] and Digit Span Backward, r(110) = .303, p = .001; performance on the MoCA Language domain was correlated with the Vietnamese Verbal Fluency Test, r(107) = .334, p < .001; and performance on the MoCA Executive Function domain was correlated with the TMT-B, r(108) = -.479, p = .022. Performance on the MoCA-V was also associated with age, r(127) = -.659, p < .001, and education, r(127) = .769, p < .001, consistent with the general effects of age and education in cognitive abilities. Finally, a cut-off score of 22.5 was identified for the detection of cognitive impairment in Vietnamese people with TBI (AUC = 0.811; 95% CI = .75-.87, p < .001).
Conclusions:This study provides the first evidence for the construct validity and clinical utility of the MoCA-V. Future research is necessary to cross-validate study findings among other clinical populations. Lessons learned from neuropsychological test translation and adaptation process will be discussed, particularly in the development of the administration materials and test instructions (e.g., considerations for individuals with limited formal education, influences of colonialism in the development of test stimuli).
2 Examining Gender Differences in the Serial Position Effect and its Relationship to Memory Outcomes
- Cardinal Do, Julie Suhr
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 861-862
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Objective:
There are gender-related disparities in age of diagnosis of Mild Cognitive Impairment (MCI) or dementia, with women often receiving delayed diagnoses compared to men. These delays may be related to the general female advantage in episodic verbal memory across aging. Thus, it is important to identify methods of examining memory performance that can help to reduce disparities in diagnosis. The serial position effect, a pattern where individuals tend to remember more words at the beginning (primacy) and end (recency) of a list, is predictive of dementia and may provide an avenue for this endeavor. Whereas healthy adults tend to exhibit a prototypical U-shaped serial position profile, those with MCI or dementia tend to show reduced primacy relative to recency (i.e., a J-shaped profile). To date, few studies have examined gender differences in the serial position effect. There is some evidence to suggest that older, cognitively healthy women perform better than men on middle and recency, but more research is needed to clarify the relationship between gender and the serial position effect, which was the focus of this study.
Participants and Methods:We utilized data across three archival datasets, which included a total of 338 participants (67.5% female; Mage=66.9, SDage=9.4) divided into three age groups (50-64, 65-75, 76+). Scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) immediate and delayed memory indices (IMI and DMI, respectively) were used to assess verbal episodic memory abilities. Performances across learning trials of the List Learning task were utilized to examine the serial position effect. ANCOVA analyses were conducted and utilized regional scoring of list learning performance, which examined the percentage of correctly recalled words in each portion of the list (primacy, middle, and recency). We also calculated the relative strength of primacy to list learning to examine the relationship between J-curve performance and gender. Years of education was included as a covariate in all analyses.
Results:Consistent with prior literature, men performed worse performance on both IMI F(1, 331)=17.20, p<.001, and DMI, F(1, 331)=6.87, p=.009, across aging. Repeated measured GLM showed that the serial position effect was seen across the full sample, F(1.93, 639.874)=5.66, p=.004, and interacted with gender, F(1.933, 639.874)=5.70, p=.004, and education, F(1.933, 639.874)=6.13, p = .003. Although men and women did not differ in primacy, p = .67, women performed better in middle, p < .001, and recency, p = .03, performance. Higher education was associated with better primacy, but not middle or recency, performance. Additionally, 23.1% of the sample exhibited a J-curve pattern, and there was a main effect of J-curve pattern for both IMI, F(1, 334)=12.33, p<.001, and DMI, F(1, 334)=15.62, p<.001, with those showing a J=curve having worse memory performance.
Conclusions:Our finding of no gender difference in primacy suggests that focusing on primacy performance in verbal list learning may help to address gender-related disparities in MCI or dementia diagnosis. Additionally, given evidence of education being associated with primacy, but not middle or recency, performance, future research should investigate the development of education-based normative data for primacy performance.
1 Examining Gender Invariance in Repeatable Battery for the Assessment of Neuropsychological Status Learning Ratio
- Claire Alexander, Cardinal Do, Julie Suhr
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 860-861
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Objective:
Process-based measures of verbal learning, such as the recently described learning ratio (LR; Hammers et al., 2022) may add valuable data to neuropsychological assessment. Women tend to have higher episodic verbal memory ability compared to men at all ages, including older adulthood (Golchert et al., 2019; Maitland et al., 2004). However, it is unclear whether gender is related to the process of learning, as quantified through measures of learning slope and ratio. To date only one study has examined this, with Hammers et al. (2021) finding no gender differences on LR in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); therefore, further study is necessary. We examined whether men and women differed in LR, learning over time (LOT), and raw learning slope (RLS) in a healthy older adult sample, as well as whether these learning process variables predicted delayed memory equally for men and women.
Participants and Methods:203 cognitively healthy community-dwelling adults aged 50 and above (mean age 67.7; 133 women) were taken from a larger archival database; all were administered the RBANS in the context of other studies. LR, LOT, and RLS were calculated from the List Learning task. We examined whether men and women differed in these learning process measures. We then examined whether process measures differentially predicted performance on list recall and delayed memory index (DMI) of the RBANS for men and women.
Results:Men and women did not differ in age or years of education. After accounting for age and education, there were no gender differences on LR (p=.455) or RLS (p=.502) but LOT was lower in women (p=.013).
LR was equally predictive of list recall across genders (p<.001 for LR; p=.21 for gender). Correlations between LR and list recall were r=.65 (p<.001) for men and r=.56 (p<.001) for women. Both LR (p<.001) and gender (p=.008) predicted DMI but the interaction was nonsignificant. Correlations between LR and DMI were r=.52 for men (p<.001) and r=.46 for women (p<.001).
RLS predicted list recall equally across genders (p<.001 for RLS; p=.07 for gender; p=.18 for interaction). Correlations between RLS and list recall were r=.43 for men (p<.001) and r=.23 for women (p=.008). RLS (p<.001) and gender (p=.002; p=.19 for interaction) predicted DMI scores. Correlations between RLS and DMI were r=.31 for men (p=.008) and r=.21 for women (p=.015).
LOT predicted list recall equally across genders (p<.001; p=.97 for gender; p=.80 for interaction). Correlations between LOT and list recall were r=-.50 for men (p<.001) and r=-.60 for women (p<.001). LOT also predicted DMI equally across genders (p<.001; p=.084 for gender; p=.159 for interaction). Correlations between LOT and DMI were r=-.46 for men (p<.001) and r=-.49 for women (p<.001).
Conclusions:Of the three process variables, LR was the only one that did not show gender differences and was related to delayed memory outcomes with medium to large effect across both genders. Results suggest that LR can be used consistently across genders. As this sample consisted of healthy, independently-living older adults, future study should examine LR by gender in MCI and dementia samples.