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23 Subjective Cognition in African American and White Older Adults: Interactions with Psychosocial Factors
- Kemaria Avery, Ross Divers, Eathan Breaux, Erika Pugh, Lauren Rasmussen, Matthew Calamia
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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. 436-437
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Objective:
Given that African American older adults are disproportionately at risk for the development of dementia, identifications of sensitive risk and protective factors are of high importance. Subjective decline in cognition is a potentially easy to assess clinical marker, as it has been previously associated with increased risk of converting to MCI and/or dementia. Subjective decline in cognition is complex though, in that it has also been associated with psychosocial factors. Given this, and the fact that the bulk of research on subjective decline in cognition has been conducted in older white adults, research in diverse samples is needed. The present study sought to address these gaps by examining interactions between race and psychosocial risk (dysphoria) and protective (social activity) factors in the prediction of subjective cognition.
Participants and Methods:Older white (n = 350) and African American (n = 478) participants completed questionnaires via Qualtrics Panels (m age = 65.9). Subjective decline in cognition was assessed via the Multifactorial Memory Questionnaire (MMQ). Dysphoria was assessed via the Inventory of Depression and Anxiety Symptoms-II Dysphoria subscale (IDAS). Frequency of late life social activity was assessed via a validated series of questions used by the Rush Alzheimer’s Disease Center. Race, dysphoria, late life social activity, and interactions between race and dysphoria and race and social activity were analyzed as predictors of subjective decline in cognition via linear regression.
Results:The overall model accounted for a significant portion of the variance in subjective decline in cognition, F(6, 713) = 38.38, p < .01, with an R2 of .24. The interaction between race and dysphoria was significant, such that the relationship between dysphoria and subjective decline in cognition was stronger for older adults who are African American. Race, dysphoria, social activity, and the interaction between race and social activity were not significant predictors.
Conclusions:While dysphoria and related negative affect variables have been previously associated with subjective cognition, interactions with race are rarely analyzed. Our results show that the relationship between dysphoria and subjective decline in cognition were stronger for African American older adults. This result is of clinical importance, as dysphoria is central to many internalizing disorders, which have been associated with subjective cognition and the development of MCI and dementia. Future research should seek to analyze drivers for this associations and if interventions for dysphoria may reduce subjective decline in cognition for African American older adults.
63 Longitudinal Decline in Everyday Functioning: Exploring the Incremental Validity of Neuropsychiatric Symptoms in Dementia
- Ross Divers, Matthew Calamia, Christopher Reed, Eathan Breaux, Ashlyn Runk, Lauren Rasmussen
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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, p. 268
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Objective:
Decline in everyday function is a hallmark of dementia and is associated with increased caregiver burden, medical spending, and poorer quality of life. Neuropsychiatric symptoms (e.g., apathy, hallucinations) can also occur in those with dementia and have been associated with worse everyday functioning cross-sectionally. However, research on which neuropsychiatric symptoms are most associated with everyday functioning in those with dementia longitudinally has been more limited. Further, it is unknown which neuropsychiatric symptoms may add incremental validity beyond cognition in predicting everyday function longitudinally. The current study aimed to address both of these gaps in the literature by identifying which neuropsychiatric symptoms are most associated with everyday function over time and if symptoms add incremental validity in predicting everyday function beyond cognition in those with dementia.
Participants and Methods:Older adult participants (N = 4525), classified as having dementia at baseline by the National Alzheimer's Coordinating Center, were examined. Severity of neuropsychiatric symptoms were measured via the Neuropsychiatric Symptoms Questionnaire-Informant. Everyday function was assessed via the Functional Activities Questionnaire-Informant. Memory (Logical Memory immediate and delayed) and executive function (Digit Symbol Test, TMT-A and TMT-B) composites were created to assess cognition. Severity of neuropsychiatric symptoms at baseline were analyzed as predictors of everyday functioning beyond demographic factors and cognition at baseline and over the course of five years using multilevel modeling.
Results:At baseline, severity of the majority of symptoms, excluding irritability, manic symptoms, and changes in appetite, were associated with everyday function (all p < .05). When examining everyday functioning longitudinally, only severity of hallucinations, apathy, motor dysfunction, and sleep dysfunction were associated with differences in everyday function over time (all p < .01).
Conclusions:There is heterogeneity in the degree to which neuropsychiatric symptoms are associated with everyday functioning over time in those with dementia. Additionally, our results show that some neuropsychiatric symptoms are associated with longitudinal changes in everyday function beyond domains of cognition show to be associated with function. Clinicians should pay particular attention to which neuropsychiatric symptoms individuals with dementia and their families are reporting to aid with treatment planning and clinical decision making related to autonomy. Future research would benefit from examining pathways through which neuropsychiatric symptoms are associated with everyday functioning over time in this population, and if treatments of neuropsychiatric symptoms may improve everyday function in this population.
78 Utility of the D-KEFS Color Word Interference Test as a Measure of Performance Validity in Adults Referred for a Psychoeducational Evaluation
- Anthony Robinson, Eathan Breaux, Marissa Huber, Matthew Calamia
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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. 752-753
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Objective:
Previous investigations have demonstrated the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Color Word Interference Test (CWIT) as an embedded validity indicator in mixed clinical samples and traumatic brain injury. The present study sought to cross-validate previously identified indicators and cutoffs in a sample of adults referred for psychoeducational testing.
Participants and Methods:Archival data from 267 students and community members self-referred for a psychoeducational evaluation at a university clinic in the South were analyzed. Referrals included assessment for attention-deficit hyperactivity disorder, specific learning disorder, autism spectrum disorder, or other disorders (e.g., anxiety, depression). Individuals were administered subtests of the D-KEFS including the CWIT and several standalone and embedded performance validity indicators as part of the evaluation. Criterion measures included The b Test, Victoria Symptom Validity Test, Medical Symptom Validity Test, Dot Counting Test, and Reliable Digit Span. Individuals who failed 0 criterion measures were included in the credible group (n = 164) and individuals failing 2 or more criterion measures were included in the non-credible group (n = 31). Because a subset of the sample were seeking external incentives (e.g., accommodations), individuals who failed only 1 of the criterion measures were excluded (n = 72). Indicators of interest included all test conditions examined separately, the inverted Stroop index (i.e., better performance on the interference trial than the word reading or color naming trials), inhibition and inhibition/switching composite, and sum of all conditions.
Results:Receiver Operating Characteristics (ROC) curves were significant for all four conditions (p < .001) and the inverted stroop index (p = .032). However, only conditions 2, 3 and 4 met minimal acceptable classification accuracy (AUC = .72 - 81). ROC curves with composite indicators were also significant (p < .001), with all three composite indicators meeting minimal acceptable classification accuracy (AUC = .71- .80). At the previously identified cutoff of age corrected scale score of 6 for all four conditions, specificity was high (.88 -.91), with varying sensitivity (.23 - .45). At the previously identified cutoff of .75 for the inverted stroop index, specificity was high (.87) while sensitivity was low (.19). Composite indicators yielded high specificity (.88 - .99) at previously established cutoffs with sensitivity varying from low to moderate (.19 - .48). Increasing the cutoffs (i.e., requiring higher age corrected scale score to pass) for composite indicators increased sensitivity while still maintaining high specificity. For example, increasing the total score cutoff from 18 to 28 resulted in moderate sensitivity (.26 vs .52) with specificity of .91.
Conclusions:While a cutoff of 6 resulted in high specificity for most conditions, the sum of all four conditions exhibited the strongest classification accuracy and appears to be the most robust indicator which is consistent with previous research (Eglit et al., 2019). However, a cutoff of 28 as opposed to 18 may be most appropriate for psychoeducational samples. Overall, the results suggest that the D-KEFS CWIT can function as a measure of performance validity in addition to a measure of processing speed/executive functioning.