7 results
95 Examining the Utility of Demographically Adjusted Scores on the Community Screening Instrument for Dementia in Congolese Older Adults
- Anny Reyes, Liselotte De Wit, Molly R. Winston, Dustin B. Hammers, Alvaro Alonso, Jean Ikanga
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 294-295
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Given the lack of comprehensive neuropsychological tools and neuropsychological services in Sub-Saharan Africa (SSA), cognitive screeners for dementia can be useful tools to screen for suspected dementia at the population level. However, most available screeners have not been developed or validated in SSA populations. The Community Screening Instrument for Dementia (CSID) was developed for cross-cultural use, and it has a cognitive testing component and informant interview. We have previously demonstrated that lower years of education and female sex are associated with lower scores on the CSID. Here, we examine the utility of demographically adjusted CSID scores in a community sample of Congolese older adults.
Participants and Methods:354 participants (mean age=73.6±6.7, mean education (years) =7.3±4.7; 50% female) were randomly recruited in Kinshasa, Democratic Republic of the Congo, and completed the CSID and the Alzheimer's Questionnaire (AQ) to examine functional abilities. Raw scores were demographically adjusted for education and sex by adding 1 point for <12 years of education and 1 point for female. Cognitive impairment was classified as a total score below 25.5. Rates of impairment were compared between raw scores and demographically-adjusted scores. Demographic profiles were examined between both classifications
Results:Average raw CSID scores were 25.23 (SD=4.19) and average demographically-adjusted scores were 26.59 (SD= 4.09). Approximately 43.1% of the sample was impaired based on the raw CSID scores compared to 30.4% with the demographically-adjusted scores (x2= 12.334, p<.001). There was a higher proportion of females (n=95; 26.8%) classified as impaired with the raw SCID scores compared to the demographically-adjusted scores (n=62; 17.5%; x2= 8.87, p=0.003). Approximately 27.4% (n=97) of the participants classified as impaired with the raw SCID scores had primary education or less (i.e., 1-6 years) compared to 18.9% with the demographically-adjusted scores (n=67; (x2= 107.77, p<.001). Forty-five participants were re-classified as not impaired with the demographically-adjusted scores with the majority of these participants being female (73.3%), having primary education (66.7%), and being functionally unimpaired on the AQ (91.1% unimpaired).
Conclusions:We demonstrate that raw scores on the CSID can lead to misclassification of impairment in females and in individuals with lower years of education. Demographically-adjusted scores on the CSID can help properly capture those with suspected dementia while reducing false positives. Given the effects of education and sex on performance, future studies should examine if demographically adjusted scores improve the sensitivity and specificity of the CSID in Congolese populations and compare its performance to other screening tools to determine the most appropriate screener for this population.
96 Health Factors and Psychosocial Factors as Predictors of Depressive Symptoms and the Association of Depressive Symptoms and Cognitive Functioning in Congolese Older Adults
- Liselotte De Wit, Molly R. Winston, Anny Reyes, Sabrina Hickle, Suzanne Penna, Jean Ikanga
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 295-296
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Late-life depression is a complex condition impacted by both mental and physical health outcomes and psychosocial factors. Psychosocial predictors of depression are reliant on cultural factors including socioeconomic variables, stigmas, and cultural values. Most research on late-life depression and its effect on cognitive functioning has been completed in so-called Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations and findings may not generalize to older adults living in other areas of the world. The current study explored predictors of depressive symptoms as well as the association between depressive symptoms and neuropsychological functioning in Congolese older adults.
Participants and Methods:A total of 319 participants (mean age=72.7±6.15, mean education in years=7.6±4.56; 47% female) were randomly recruited. Depressive symptoms were assessed with the Geriatric Depression Scale. Given the exploratory nature of the current study, forward stepwise linear regression models were run to assess predictors of depressive symptoms. The independent variables assessed as potential predictors included age, years of education, gender, participant income, parental income, living arrangement (i.e., alone or with others), functional abilities (FAQ), fragility, and self-rated overall health. Analyses were run in the overall sample as well as stratified by gender. The association between depressive symptoms and performance on the Community Screening Instrument for Dementia (SCID) was also explored.
Results:Higher depressive symptoms were found in women (ß=.228, p=0.036), those with lower parental income (ß=-.156, p=.005), higher fragility (ß=-.237, p<.001), and worse overall health (ß=-.311, p=.020). Among women, lower parental income, (ß=-.230, p=.002), higher fragility (ß=-.312, p<.001), and lower overall health (ß=-.235, p=.004) predicted higher depressive symptoms, while in men only higher fragility (ß=-.164, p=.041) and living alone (ß=-.184, p=.022) predicted higher depressive symptoms. There was also a significant association between depressive symptoms and lower scores on the CSID (ß=-.189, p=.001)
Conclusions:Similar to results in WEIRD populations, general health and fragility predicted depressive symptoms in Congolese older adults. However, parental income (more so than participant income) also predicted depressive symptoms in Congolese older adults, particularly in women, while living alone was a predictor in Congolese older men. It is possible that the difference in depressive symptoms between men and women is driven by underreporting of depressive symptoms among men. Our results also showed that there was an association between depressive symptoms and global cognitive functioning similar to prior findings in WEIRD populations. Our results are important for clinicians assessing depressive symptoms in patients in or from Congo or sub-Saharan Africa.
5 Examining the Cognitive, Vascular, and Lifestyle Profiles of Older Adults with Late-Onset Epilepsy
- Anny Reyes, Emily L. Johnson, Carrie R. McDonald
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 793-794
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Older adults represent the fastest-growing population of individuals with epilepsy with an incidence that peaks after age 65. Patients with late-onset epilepsy (LOE) have a multitude of risk factors for accelerated cognitive and brain aging, including vascular and metabolic risk factors. Despite this, there are few studies investigating the cognitive profiles of older adults with LOE, a neglected area in aging research. We examine the cognitive profiles of older adults with LOE and determine the contribution of demographic and vascular risk factors to impairment.
Participants and Methods:Participants were part of the Atherosclerosis Risk in Communities Study (ARIC) and the incidence of epilepsy was identified using ARIC hospitalization records and Centers for Medicare and Medicaid Services claims data from 1991 to 2015. Approximately 1.8% of the participants with sufficient Medicare coverage data were classified as having LOE (LOE n=281; Non-LOE n=9808). Vascular, lifestyle, and cognitive data were obtained from the ARIC Neurocognitive Study (ARIC-NCS) which consisted of three visits since 2011. Participants with ARIC-NCS visits completed after the onset of seizures were included in the final sample. Non-LOE participants with normal cognition (Black: n=603 and White: n=2543 participants independently) were used to generate z-scores across tests of language, memory, executive function, and processing speed/attention. Impairment was defined as <1.5 standard deviations below the mean of the normative sample. Stepwise regressions were conducted to examine the contribution of demographic (age, race, sex, education) and vascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, smoking) to cognitive performance.
Results:Average age of first seizure of all LOE participants (n=281) was 76.23 (SD=6.24), 55.9% female, 30.7% Black/African American, and the majority had either a college (28.1%) or high school degree (26%). Fifty-six LOE participants had ARIC-NCS visits after the onset of seizures (average age=79.84, SD=5.17, 57.1% female, 32.1% Black). Approximately 67.9% of the sample had at least one vascular risk factor with 81.5% having hypertension, 37% diabetes, 26.4% hyperlipidemia, 20.4% obesity (BMI>30), and 4.5% current smoker. The most frequently impaired domains were language (naming=29.7%; animal fluency=20%; letter fluency=30%) and memory (prose immediate recall=18.4%; prose delayed recall=44.7%; word delayed recall=19.4%). Higher education was associated with better naming (b=0.801, p=0.040). Female sex (b=-0.799, p=0.017) and lower education levels (b=0.418, p=0.050) were associated with poorer immediate prose recall. Older age was associated with poorer delayed prose recall (b=-0.191, p=0.036). Hypertension was associated with worse digit span backward (b=-0.942, p=0.002).
Conclusions:In older adults with LOE, language and memory were the most commonly impaired cognitive domains, similar to studies in early onset epilepsy. Vascular risk factors were prevalent among LOE and hypertension was associated with worse working memory. Further, important demographic factors (sex, education, and age) were associated with the extent of cognitive impairment. Characterizing cognitive profiles in LOE and determining the contribution of demographic and vascular factors to impairment could help to identify patients at risk for future cognitive decline and/or the development of LOE itself, as well as interventions aimed at reducing the risk of further decline.
2 Cross Cultural Application of the International Classification of Cognitive Disorders in Epilepsy (IC CoDE) Cognitive Phenotypes in People with Temporal Lobe Epilepsy in India
- Urvashi Shah, Shivani Rajeshree, Anny Reyes, Aparna Sahu, Mayuri Kalika, Sangeeta Ravat, Robyn Busch, Mayu Fujikawa, Victoria Ives-Deliperi, Sallie Baxendale, Bruce Hermann, Carrie McDonald
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 307-308
-
- Article
-
- You have access Access
- Export citation
-
Objective:
To apply the new IC-CoDE cognitive diagnostic taxonomy (Norman et al., 2020) to a large cohort of people with temporal lobe epilepsy (TLE) in India. The IC-CoDE taxonomy of cognitive diagnoses for 1,409 Englishspeaking adults with TLE from seven epilepsy centres in the U.S. has been published (McDonald et al., 2022). Initial results suggest that the IC-CoDE produces stable cognitive phenotypes across centres; however, its international applicability, including the suggested impairment cut-off needs to be considered across cultures and languages to avoid misclassification. The aim of this study was to apply the IC-CoDE to a population, outside of the U.S., diverse in language representation (i.e., bi/multi-lingual), assessment tools, normative data, and educational and cultural backgrounds to determine whether the same cognitive phenotypes and their relative frequencies would emerge.
Participants and Methods:Data from 549 adults with TLE (mean age=27.14 (8.04), 60.47% males) from a tertiary referral hospital in Mumbai, India who had undergone a comprehensive neuropsychological evaluation (minimum two tests in at least 4 of the 5 cognitive domains: memory, language, executive function, attention/processing speed and visuospatial) were analysed using the ICCoDE criteria. The base rate of impairment for individual tests was calculated using a cutoff of 1.5 standard deviations (S.D.) below the normative mean. The cognitive diagnostic criteria were applied, and the distribution and base rate of cognitive phenotypes was compared to the published taxonomy data from the U.S. (McDonald et al., 2022).
Results:In comparison to the U.S. cohort, the India group was relatively younger, lower in the education level, had a younger age at seizure onset and a shorter duration of the epilepsy. Application of the IC-CoDE taxonomy using a 1.5 S.D. cutoff revealed an Intact cognitive profile in 48% of patients, Single Domain impairment in 32%, Bi Domain impairment in 15% and Generalised impairment in 5%. These findings were mostly comparable to percentages reported in the U.S. cohorts with Intact profile (47%; c2= 0.158, p=0.690), Single Domain (29%; c2= 46.26, p<0.01), Bi Domain (16%; c2= 0.298, p=0.585) and Generalised (8%; c2= 5.347, p=0.021) impairment. However, the most common impairment in the Single Domain group for the bi/multilingual India population was Memory (38%) followed by Attention (20%) and then Language (13%), diverging from the distribution in the U.S. data with maximum impairment in Language (49%) followed by Memory (32%) in the Single Domain Group.
Conclusions:These findings demonstrate that the IC-CoDE can be applied internationally, and the broad taxonomy of cognitive diagnosis holds even in a culturally, linguistically diverse population. Differences in rates of impairments across specific domains emerged with language relatively preserved in the India bi/multilingual population, and memory more frequently impaired than observed in the multi-centre U.S. sample. These findings may reflect differences in demographics, rates of bi/multilingualism, normative data, language tools, or underlying neuropathology, which should be further explored to determine their impact on cognitive profiles.
4 Preoperative International Classification of Cognitive Disorder in Epilepsy (IC-CoDE) Phenotype is Associated with Postoperative Memory Decline Following Temporal Lobectomy
- Kayela Arrotta, Bruce P Hermann, Carrie R McDonald, Anny Reyes, Sallie Baxendale, Robyn Busch
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 310-311
-
- Article
-
- You have access Access
- Export citation
-
Objective:
The International Classification of Cognitive Disorder in Epilepsy (IC-CoDE) is a new consensus-based taxonomy that classifies patients into one of four cognitive phenotypes (i.e., cognitively intact, single-domain impairment, bi-domain impairment, generalized impairment). The IC-CoDE has been effectively applied to patients with temporal lobe epilepsy (TLE), but little is known about the relationship between pre-operative cognitive phenotype and post-operative cognitive outcome following epilepsy surgery. The purpose of this study was to examine whether the IC-CoDE classifications are related to memory decline following surgery for TLE.
Participants and Methods:347 patients (ages 16-66; 57% female) with pharmacoresistant TLE completed comprehensive pre- and post-surgical neuropsychological assessments. Patients were classified into IC-CoDE phenotypes based on pre-surgical pattern of cognitive impairment using a threshold of >1.5 standard deviations (SD) below the normative mean. Change scores were calculated from delay trial scores of the following memory tests: Rey Auditory Verbal Learning Test (RAVLT), and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from the Wechsler Memory Scale - Third Edition (WMS-III). Cutoffs were applied using epilepsy-specific reliable change indices and patients were classified within the ‘decline’ group if they experienced significant decline on any of the three memory measures.
Results:The distribution of IC-CoDE phenotypes in our sample were as follows: 57% intact, 29% single-domain, 10% bi-domain, and 5% generalized impairment. 108 patients (31%) demonstrated post-surgical memory decline. Patients who underwent dominant temporal lobectomy were more likely to show post-surgical memory decline compared to non-dominant temporal lobectomy. However, there was no significant difference in phenotype distribution between patients who underwent left versus right-sided resections; thus, analyses were conducted on the entire sample to increase power. Chi-square analyses revealed unique patterns of post-surgical memory decline across phenotypes, X2 = 8.79, p = .032. There was a significantly higher proportion of patients with memory decline in the single-domain phenotype (39%) and this was followed by the bi-domain phenotype (33%) and the intact phenotype (29%). In contrast, patients with generalized impairment were unlikely to show memory decline (.06%). Within the single domain impaired phenotype, there were no differences between the specific domains impaired and memory decline. Logistic regression model was also significant; after controlling for surgery side, the IC-CoDE phenotypes significantly predicted the likelihood of a patient experiencing post-surgical memory decline; X2 = 8.18, p = .043.
Conclusions:In addition to the IC-CoDE providing a useful cognitive classification scheme in epilepsy, the IC-CoDE phenotypes appear helpful in identifying those at risk for post-operative memory decline. Previous literature has suggested that those with better pre-surgical cognition are generally at highest risk for cognitive decline. Our results generally follow this trend, but interestingly, patients with single domain impairment were at the highest risk of memory decline, even above those in the cognitively intact group. Future studies are important to confirm this pattern in other samples and examine additional contributing factors and underlying mechanisms that may influence risk of memory decline across these cognitive phenotypes.
Impaired Behavioral Pattern Separation in Refractory Temporal Lobe Epilepsy and Mild Cognitive Impairment
- Sanam J. Lalani, Anny Reyes, Erik Kaestner, Shauna M. Stark, Craig E.L. Stark, David Lee, Leena Kansal, Jerry J. Shih, Christine N. Smith, Brianna M. Paul, Carrie R. McDonald
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 6 / July 2022
- Published online by Cambridge University Press:
- 03 June 2021, pp. 550-562
-
- Article
- Export citation
-
Objective:
Episodic memory impairment and hippocampal pathology are hallmark features of both temporal lobe epilepsy (TLE) and amnestic mild cognitive impairment (aMCI). Pattern separation (PS), which enables the distinction between similar but unique experiences, is thought to contribute to successful encoding and retrieval of episodic memories. Impaired PS has been proposed as a potential mechanism underling episodic memory impairment in aMCI, but this association is less established in TLE. In this study, we examined behavioral PS in patients with TLE and explored whether profiles of performance in TLE are similar to aMCI.
Method:Patients with TLE, aMCI, and age-matched, healthy controls (HCs) completed a modified recognition task that relies on PS for the discrimination of highly similar lure items, the Mnemonic Similarity Task (MST). Group differences were evaluated and relationships between clinical characteristics, California Verbal Learning Test—Second Edition scores, and MST performance were tested in the TLE group.
Results:Patients with TLE and aMCI demonstrated poorer PS performance relative to the HCs, but performance did not differ between the two patient groups. Neither the side of seizure focus nor having hippocampal sclerosis affected performance in TLE. However, TLE patients with clinically defined memory impairment showed the poorest performance.
Conclusion:Memory performance on a task that relies on PS was disrupted to a similar extent in TLE and aMCI. The MST could provide a clinically useful tool for measuring hippocampus-dependent memory impairments in TLE and other neurological disorders associated with hippocampal damage.
Central Nervous System Manifestations of COVID-19: A Critical Review and Proposed Research Agenda
- Kelsey C. Hewitt, David E. Marra, Cady Block, Lucette A. Cysique, Daniel L. Drane, Michelle M. Haddad, Emilia Łojek, Carrie R. McDonald, Anny Reyes, Kara Eversole, Dawn Bowers
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 3 / March 2022
- Published online by Cambridge University Press:
- 16 April 2021, pp. 311-325
-
- Article
- Export citation
-
Objective:
On March 11, 2020, the World Health Organization declared an outbreak of a new viral entity, coronavirus 2019 (COVID-19), to be a worldwide pandemic. The characteristics of this virus, as well as its short- and long-term implications, are not yet well understood. The objective of the current paper was to provide a critical review of the emerging literature on COVID-19 and its implications for neurological, neuropsychiatric, and cognitive functioning.
Method:A critical review of recently published empirical research, case studies, and reviews pertaining to central nervous system (CNS) complications of COVID-19 was conducted by searching PubMed, PubMed Central, Google Scholar, and bioRxiv.
Results:After considering the available literature, areas thought to be most pertinent to clinical and research neuropsychologists, including CNS manifestations, neurologic symptoms/syndromes, neuroimaging, and potential long-term implications of COVID-19 infection, were reviewed.
Conclusion:Once thought to be merely a respiratory virus, the scientific and medical communities have realized COVID-19 to have broader effects on renal, vascular, and neurological body systems. The question of cognitive deficits is not yet well studied, but neuropsychologists will undoubtedly play an important role in the years to come.