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74 The Role of Executive Functioning in Predicting Health Numeracy in a Memory Disorders Clinic.
- Ayesha Arora, Matthew S Phillips, Veronica Koralewski, Neil H Pliskin, Jason R Soble, Zachary J Resch, Kyle J Jennette
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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. 276-277
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Objective:
Health numeracy is the understanding and application of information conveyed with numbers, tables and graphs, and probabilities in order to effectively manage one's own healthcare. Health numeracy is a vital aspect of communicating with healthcare providers and participating in one's own medical decision making, which is especially important in aging populations. Current literature indicates that assessing and establishing one's health numeracy abilities is among the first steps in providing necessary resources and accommodating patients' individual needs. Additionally, older adults with diffuse cognitive impairment often have issues with facets of executive functioning; however, the extant literature does not discuss the role of executive functioning in relation to health numeracy in this population. The purpose of this study was to explore the relationship between performance on tasks of executive functioning and objectively-measured health numeracy abilities in older adult patients.
Participants and Methods:This study included a sample of 42 older adult patients referred for neuropsychological evaluation for memory complaints who were administered the Test of Premorbid Functioning (TOPF), Trail Making Test - Part B (TMT-B), and Stroop Color and Word Test (SCWT Color Word Interference [CWI]) as part of a larger standardized battery. Patients were also administered the Numerical Understand in Medicine Instrument - Short Form (NUMI-SF). All included patients had <2 performance validity test failures. The sample was racially diverse (47.6% Black, 35.7% White, 14.3% Hispanic, 2.4% Asian) and 54.8% female. Average age was 62.95 (SD= 8.6) and average education was 14.1 (SD=2.7). Diagnostically, 47.6% of the sample were cognitively normal, 33.3% had mild cognitive impairment, and 19.0% had dementia. Average NUMI-SF score was 4.79 (SD= 1.7). Two multiple regressions were conducted to evaluate the extent to which executive functioning, as measured by the TMT-B and SCWT CWI predicted NUMI-SF, and the additive predictive power of premorbid IQ and demographics via the TOPF on the relationship between executive functioning and NUMI-SF.
Results:The first regression, which measured the relationship between the TMT-B and SCWT CWI upon NUMI-SF scores, was not significant (p=.616). The model was significant with the addition of the TOPF (ß=.595, p<.001) and TOPF alone predicted ∼60% of the variance in NUMI-SF score, while TMT-B and SCWT CWI remained non-significant.
Conclusions:These results indicate that common measures of executive functioning are not reliable predictors of health literacy with or without the moderating of premorbid intellectual functioning taken into consideration. This suggests that health numeracy is likely to be minimally affected by deficits in executive functioning and rather may be better accounted for by premorbid intellectual functioning and/or other sociodemographic factors (e.g. socioeconomic status, education quality, occupation). Future studies will benefit from elucidating the contributions of other social determinant factors on predicting health numeracy.
15 The Role of Race and Adverse Childhood Experiences on Predicting Cognitive Ability on the Montreal Cognitive Assessment (MoCA).
- Veronica Koralewski, Matthew S. Phillips, Ayesha Arora, Woojin Song, Neil Pliskin, Jason R. Soble, Zachary J. Resch, Kyle Jennette
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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. 532-533
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Objective:
Awareness of risk factors associated with any form of impairment is critical for formulating optimal prevention and treatment planning. Millions worldwide suffer from some form of cognitive impairment, with the highest rates amongst Black and Hispanic populations. The latter have also been found to achieve lower scores on standardized neurocognitive testing than other racial/ethnic groups. Understanding the socio-demographic risk factors that lead to this discrepancy in neurocognitive functioning across racial groups is crucial. Adverse childhood experiences (ACEs), are one aspect of social determinants of health. ACES have been linked to a greater risk of future memory impairment, such as dementia. Moreover, higher instances of ACEs have been found amongst racial minorities. Considering the current literature, the purpose of this exploratory research is to better understand how social determinants, more specifically, ACEs, may play a role in the development of cognitive impairment.
Participants and Methods:This cross-sectional study included data from an urban, public Midwestern academic medical center. There was a total of 64 adult clinical patients that were referred for a neuropsychological evaluation. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA) as well as a 10-item ACE questionnaire, which measures levels of adverse childhood experiences. The sample was 73% Black and 27% White. The average age was 66 (SD=8.6) and average education was 12.6 years (SD=3.4). A two-way ANOVA was conducted to evaluate the interaction of racial identity (White; Black) and ACE score on MoCA total score. An ACE score >4 was categorized as “high”; ACE <4 was categorized as “low.”
Results:There was not a significant interaction of race and ACE group on MoCA score (p=.929) nor a significant main effect of ACE score (p=.541). Interestingly, there was a significant main effect of Race on MoCA (p=.029). White patients had an average MoCA score of 21.82 (sd=4.77). Black patients had an average MoCA score of 17.54 (sd=5.91).
Conclusions:Overall, Black patients demonstrated statistically lower scores on the MoCA than White patients. There was no significant difference on MoCA score between races when also accounting for ACE scores. Given this study’s findings, one’s level of adverse childhood experiences does not appear to impact one’s cognitive ability later in life. There is a significant difference in cognitive ability between races, specifically Black and White people, which suggests there may be social determinants other than childhood experiences to be explored that influence cognitive impairment.
45 Relationship Between Degree of Cognitive Impairment and Performance on Measures of Health Numeracy and Literacy in a Memory Disorders Clinic
- Matthew S Phillips, Veronica Koralewski, Ayesha Arora, Woojin Song, Neil H Pliskin, Jason R Soble, Zachary J Resch, Kyle J Jennette
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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. 353-354
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- Article
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Objective:
Understanding healthcare information is an important aspect in managing one’s own needs and navigating a complex healthcare system. Health numeracy and literacy reflect the ability to understand and apply information conveyed numerically (i.e., graphs, statistics, proportions, etc.) and written/verbally (i.e., treatment instructions, appointments, diagnostic results) to communicate with healthcare providers, understand one’s medical condition(s) and treatment plan, and participate in informed medical decision-making. Cognitive impairment has been shown to impact one’s ability to understand complex medical information. The purpose of this study is to explore the relationship between the degree of cognitive impairment and one’s ability to perform on measures of health numeracy and literacy.
Participants and Methods:This cross-sectional study included data from 38 adult clinical patients referred for neuropsychological evaluation for primary memory complaints at an urban, public Midwestern academic medical center. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA), as well as measures of both health numeracy (Numeracy Understanding of Medicine Instrument-Short Version [NUMI-SF]) and health literacy (Short Assessment of Health Literacy-English [SAHL-E]). The sample was 58% female and 60% Black/40% White. Mean age was 65 (SD=9.4) and mean education was 14.4 years (SD=2.5). The sample was further split into three groups based on cognitive diagnosis determined by comprehensive neuropsychological assessment (i.e., No Diagnosis [34%]; Mild Cognitive Impairment [MCI; 29%]; Dementia [34%]).Groups were well matched and did not statistically differ in premorbid intellectual functioning (F=1.96, p=.157; No Diagnosis, M=100, SD=7.92; MCI, M=99, SD=8.87; Dementia, M=94, SD=7.72) ANOVAs were conducted to evaluate differences between clinical groups on the MoCA, NUMI-SF, and SAHL-E. Multiple regressions were then conducted to determine the association of MoCA scores with NUMI-SF and SAHL-E performance.
Results:As expected, the Dementia group performed significantly below both the No Diagnosis and MCI groups on the MoCA (F=19.92, p<.001) with a large effect (ηp2=.540). Significant differences were also found on the NUM-SF (F=5.90, p>.05) and on the SAHL-E (F=6.20, p>.05) with large effects (ηp2=.258 and ηp2=.267, respectively). Regression found that MoCA performance did not predict performance on the NUMI-SF and SAHL-E in the No Diagnosis group (F=2.30, p=.809) or the MCI group (F=1.31, p=.321). Conversely, the MoCA significantly predicted performance on the NUMI-SF and SAHL-E for the Dementia (F=15.59, p=.001) group.
Conclusions:Degree of cognitive impairment is associated with understanding of health numeracy and literacy information, with patients diagnosed with dementia performing most poorly on these measures. Patients with normal cognitive functioning demonstrated a significantly better understanding of health numeracy and health literacy. This study supports the notion that as cognitive functioning diminishes, incremental support is necessary for patients to understand medical information pertaining to their continued care and medical decision-making, particularly as it relates to both numerical and written information.