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1 Subjective Cognitive Concerns, Neuropsychological Test Performances, and Frontoparietal Thickness and Connectivity in High-Functioning Older Adults
- Justin E. Karr, Jonathan G. Hakun, Daniel B. Elbich, Cristina N. Pinheiro, Frederick A. Schmitt, Suzanne C. Segerstrom
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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. 102-103
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Objective:
Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults, in whom substantially greater neurological change may need to occur before performance on cognitive tests are low enough to indicate cognitive impairment. For high-functioning older adults, subjective cognitive concerns (SCC) may indicate decline that is not detected by the presence of low cognitive test scores but may be related to the absence of high scores and the presence of latent neurological changes. We hypothesized that high-functioning older adults with SCC would have fewer high scores than those without concerns, but a comparable number of low scores. These findings would indicate that objective decline has occurred but would not be detected by a traditional focus on low scores. We also hypothesized that SCC would be associated with lower frontoparietal network volume, thickness, and connectivity, indicating latent neurological change underlying subjective cognitive concerns.
Participants and Methods:Participants from an imaging sub-study of an ongoing longitudinal aging study were selected if they had high estimated premorbid functioning, defined as either (a) estimated intelligence >75th percentile on the North American Adult Reading Test (n=48) or (b) having a college degree (n=62). This resulted in 68 participants subdivided based on SCC, defined as one or more self-reported SCC on the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog). Participants with SCC (n=35; 73.9 years-old, SD=9.6, range: 60-95; 62.9% female; 94.3% White) and without SCC (n=33; 71.0 years-old, SD=7.2, range: 61-85, 75.8% female; 100% White) completed a neuropsychological test battery of memory and executive functions, including the Rey Auditory Verbal Learning Test, Trail Making Test Parts A and B, Controlled Oral Word Association Test, Digit Span, and Letter-Number Sequencing, and underwent structural MRI. MR images were analyzed for frontoparietal network volume, thickness, and connectivity.
Results:Participants with and without SCC were compared on the number of low test scores (i.e., at or below the 16th percentile) and high test scores (i.e., at or above the 75th percentile), finding a comparable number of low scores, t=1.66, p=.103, d=.40, but a lower number of high scores among participants with SCC, t=2.95, p=.004, d=.71. Participants with SCC had lower bilateral mean frontoparietal network volumes (left: t=2.98, p=.004, d=.74; right: t=2.63, p=.011, d=.66) and cortical thickness (left: t=2.65, p=.010, d=.66; right: t=2.18, p=.033, d=.54), but did not differ from those without SCC in terms of network connectivity.
Conclusions:SCC have been reported as a potential risk factor for dementia in older adults. High-functioning older adults with SCC presented with fewer high scores than those without SCC but had a comparable number of low scores. Among high-functioning older adults, subjective cognitive decline may correspond with objective cognitive change not detected by the traditional emphasis on low scores, but rather the absence of high scores. SCC were also related to underlying changes in the volume and thickness of the frontoparietal network, but not connectivity. In high-functioning older adults, subjective cognitive decline may correspond with a reduction from high average functioning in some domains and underlying neurological changes.
84 Preliminary Psychometric Examination of a Short Questionnaire of Executive Functions
- Justin E. Karr
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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. 285-286
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Objective:
The behavioral assessment of executive functions has become increasingly common in clinical practice, with a self-report measure of executive functions becoming one of the most commonly administered assessment instruments of the construct in clinical practice. These subjective measurements serve as an alternative to objective tests of executive functions, which have been criticized for poor ecological validity. Many behavioral measures of executive functions are now available, but there are some issues with those currently in use, in that many are lengthy, proprietary, and/or do not measure executive functions that align with a theoretical framework of the multidimensional construct. This study aimed to examine the psychometric properties of a new short questionnaire of executive functions designed to be concise, theoretically based, and ultimately freely available for use in research and clinical practice.
Participants and Methods:Participants included 575 college undergraduate students who completed an online questionnaire to earn credit in psychology courses. They were, on average, 18.9 years-old (SD=1.0, range: 18-22), 82.4% female, and 78.8% White. All participants completed 20 self-report items on a four-point ordinal scale measuring five theorized executive function constructs of Planning, Inhibition, Working Memory, Shifting, and Emotional Control. The 20 items were analyzed using confirmatory factor analysis and factor reliabilities were estimated using omega. As a validity analysis, correlations between the total score with measures of subjective cognition and ADHD symptoms were compared to correlations between the total score with measures of anxiety and depression, hypothesizing stronger correlations of executive functions with cognition and ADHD than negative affect.
Results:The initial 20-item model did not fit well, x2=1560.10, df=160, p<.0001, CFI=0.822, TLI=0.788, RMSEA=0.130 (90% CI: 0.1240.136). The polychoric inter-item correlations were examined for high cross-factor correlations and low intra-factor correlations. This process resulted in the removal of one item from each factor, The modified model, inclusive of 15 items, presented with adequate fit to the data, X2=470.56, df=80, p<.0001, CFI=0.936, TLI=0.916, RMSEA=0.097 (90% CI: 0.0890.106). The total score has good reliability (Q=.82), whereas estimates for each factor ranged from .56 to .79. The total score showed a stronger correlation with ADHD symptoms (r=-.59) and subjective cognition (r=.59) than depression (r=.46, z=4.05, p<.001) and anxiety symptoms (r=.38, z=6.29, p<.001).
Conclusions:These preliminary findings provided modest psychometric support for this short 15-item self-report questionnaire of executive functions. The questionnaire had acceptable fit and evidence for validity, in that the total executive function score had a stronger correlation with subjective cognitive complaints and ADHD symptoms than negative affect. The reliability of some individual factors fell below conventional cutoffs for acceptable reliability, indicating a need for further refinement of this new questionnaire.
52 Developing and Calibrating a Sex-Specific Psychiatric Screener within the Post-Concussion Symptom Scale
- Brandon G Zuccato, Justin E Karr, Eric O Ingram, Isabelle L Messa, Kassandra Korcsog, Christopher A Abeare
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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. 157-158
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Objective:
Pre- and post-morbid mental health conditions can prolong recovery from concussion and are generally detrimental to athletic performance and quality of life. If psychiatric conditions can be identified in athletes at the time of baseline testing, psychological/psychiatric intervention can be implemented to prevent these complications. Given the time constraints on neuropsychological baseline testing, it is important to have time-efficient screening measures. As such, the purpose of this study was to develop and calibrate a psychiatric screening measure within the Post-Concussion Symptom Scale (PCSS) from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which is commonly administered to athletes at baseline, thereby “killing two birds with one stone”: (1) screening for psychiatric conditions and (2) obtaining a baseline measurement of concussion-like symptoms.
Participants and Methods:Participants were 278 undergraduate students from a Canadian university with a mean age of 21.87 years (SD=4.87, range=18 to 52) and a sex composition of 64% females (n=179, Age: M=21.29 years-old, SD=4.34, range: 18 to 52) and 36% males (n=179, Age: M=22.93 years-old, SD=5.57, range: 18 to 50). Participants were a convenience sample collected via online survey platform in exchange for bonus points toward courses through a participant pool system between January and July 2021. The psychiatric screener consisted of the affective subscale from the PCSS (irritability, sadness, feeling more emotional, nervousness) and the criterion measure was the Depression, Anxiety, and Stress Scales (DASS-42). Statistical analyses were conducted in R v.4.3 and included confirmatory factor analysis and receiver operating characteristic (ROC) curve analyses. Although a balance was sought between sensitivity and specificity, the former was prioritized given that this is intended as a screening measure. Males and females were analyzed separately as females tend to report more symptoms than males. Mild, moderate, and severe elevations were predicted for depression, anxiety, and stress, based on standard DASS cutoffs.
Results:The CFA analyses revealed good fit for both the PCSS (CFI=.992; TLI=.991; RMSEA=.053; SRMR=.066) and DASS (CFI=.995; TLI=.995; RMSEA=.053; SRMR=.065) models. Cutoffs of >3, >4, and >8 (SENS= .77-.80, SPEC= .52-.83) optimally classified males as having mild, moderate, and severe depression, respectively; and cutoffs of >8, >8, and >9 (SENS= .79-.83, SPEC= .63-.67) optimally classified females as having mild, moderate, and severe depression, respectively. A cutoff of >2 (SENS= .78-.81, SPEC= .35-.39) optimally classified males as having both mild and moderate anxiety (insufficient n in severe group); and >7, >8, and >9 (SENS= .80-.85, SPEC= .63-.68) optimally classified females as having mild, moderate, and severe anxiety. Cutoffs of >5and >8(SENS= .80-.86, SPEC= .70-.85) were optimal for detecting mild and moderate stress in males (insufficient n in severe group); and >8, >8, and >9 (SENS= .80.89, SPEC= .60-.75) were optimal in females.
Conclusions:The affective subscale within the PCSS operates well as a psychiatric screening measure. In general, females had higher cutoffs and the cutoffs for mild and moderate levels of the conditions tended to be similar. Males were less onsistent, with cutoffs varying widely depending on the construct and severity.
Detecting cognitive decline in high-functioning older adults: The relationship between subjective cognitive concerns, frequency of high neuropsychological test scores, and the frontoparietal control network
- Justin E. Karr, Jonathan G. Hakun, Daniel B. Elbich, Cristina N. Pinheiro, Frederick A. Schmitt, Suzanne C. Segerstrom
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- Journal:
- Journal of the International Neuropsychological Society / Volume 30 / Issue 3 / March 2024
- Published online by Cambridge University Press:
- 26 September 2023, pp. 220-231
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Objective:
Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults because greater neurological change must occur before cognitive performances are low enough to indicate decline or impairment. For high-functioning older adults, early neurological changes may correspond with subjective cognitive concerns and an absence of high scores. This study compared high-functioning older adults with and without subjective cognitive concerns, hypothesizing those with cognitive concerns would have fewer high scores on neuropsychological testing and lower frontoparietal network volume, thickness, and connectivity.
Method:Participants had high estimated premorbid functioning (e.g., estimated intelligence ≥75th percentile or college-educated) and were divided based on subjective cognitive concerns. Participants with cognitive concerns (n = 35; 74.0 ± 9.6 years old, 62.9% female, 94.3% White) and without cognitive concerns (n = 33; 71.2 ± 7.1 years old, 75.8% female, 100% White) completed a neuropsychological battery of memory and executive function tests and underwent structural and resting-state magnetic resonance imaging, calculating frontoparietal network volume, thickness, and connectivity.
Results:Participants with and without cognitive concerns had comparable numbers of low test scores (≤16th percentile), p = .103, d = .40. Participants with cognitive concerns had fewer high scores (≥75th percentile), p = .004, d = .71, and lower mean frontoparietal network volumes (left: p = .004, d = .74; right: p = .011, d = .66) and cortical thickness (left: p = .010, d = .66; right: p = .033, d = .54), but did not differ in network connectivity.
Conclusions:Among high-functioning older adults, subjective cognitive decline may correspond with an absence of high scores on neuropsychological testing and underlying changes in the frontoparietal network that would not be detected by a traditional focus on low cognitive test scores.
The Other Side of the Bell Curve: Multivariate Base Rates of High Scores on the Delis-Kaplan Executive Function System
- Justin E. Karr, Mauricio A. Garcia-Barrera, James A. Holdnack, Grant L. Iverson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 26 / Issue 4 / April 2020
- Published online by Cambridge University Press:
- 15 November 2019, pp. 382-393
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Objective:
Previous researchers have examined the frequency at which healthy participants obtain one or more low scores on neuropsychological test batteries, proposing five psychometric principles of multivariate base rates: (a) low scores are common, with their frequency contingent on (b) the low score cutoff used, (c) the number of tests administered/interpreted, and (d) the demographic characteristics and (e) intelligence of participants. The current study explored whether these principles applied to high scores as well, using the Delis-Kaplan Executive Function System (D-KEFS).
Method:Multivariate base rates of high scores (≥75th, ≥84th, ≥91st, ≥95th, and ≥98th percentiles) were derived for a three-test, four-test, and full D-KEFS battery, using the adult portion of the normative sample (aged 16–89 years; N = 1050) stratified by education and intelligence. The full D-KEFS battery provides 16 total achievement scores (primary indicators of executive function).
Results:High scores occurred commonly for all batteries. For the three-test battery, 24.1% and 12.4% had 1 or more scores ≥95th percentile and ≥98th percentile, respectively. High scores occurred more often for longer batteries: 61.6%, 72.9%, and 87.8% obtained 1 or more scores ≥84th percentile for the three-test, four-test, and full batteries, respectively. The frequency of high scores increased with more education and higher intelligence.
Conclusions:The principles of multivariate base rates also applied to high D-KEFS scores: high scores were common and contingent on the cutoff used, number of tests administered/interpreted, and education/intelligence of examinees. Base rates of high scores may help clinicians identify true cognitive strengths and detect cognitive deficits in high functioning people.