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33 Title: Examining memory performances in a sample of cognitively healthy illiterate older adult population in India
- Sonakshi Arora
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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. 445-446
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Objective:
Despite the rise in literacy, 773 million of the global population is estimated to be illiterate. The rate of illiteracy is even higher among women and older adults (OA). Literacy has been well documented to impact cognitive skills, and most neuropsychological tests developed are for individuals with higher education. Moreover, there is sparse research on cognitive process and performance of illiterate individuals across cognitive domains.
Per a 2011 census, the illiteracy rate in the Indian older adult population was as high as 56%, and within this group, women and older adults in rural regions were especially vulnerable. Thus, it is important to understand cognitive performance of illiterate Indian older adult population, especially when they are being assessed for neurodegenerative disorders.
Participants and Methods:This study used subset of data from Harmonized Longitudinal Aging Study of India, Diagnostic Assessment of Dementia (LASI DAD), which was developed by the Gateway to Global Aging Data. A sample of cognitive healthy OA (n = 715) was selected based on Hindi Mental Status Exam score of >19 and a Clinical Dementia Rating Scale of 0 (literate = 419, illiterate = 296). Given the heterogeneity of the population, adapted cognitive instruments were used. This study compared memory performances, using word list and constructional praxis with delayed recall tasks, of OA based on their literacy status (illiterate vs. literate).
Results:Literate cognitive healthy OA (M = 15.27, SD = 3.9) learned more words over three trials than illiterate OA (M = 12.17, SD = 3.7) on a world list task, a statistically significant difference (M = 3.1, 95% CI [2.5, 3.6], t (713) = 10.62, p<0.05. Literate OA (M = 8.7, SD = 2.2) had higher scores on task of copy of simple geometrical figures than illiterate OA (M = 5.3, SD = 2.8), a statistically significant difference (M = 3.3, 95% CI [2.9, 3.7], t (713) = 7.1, p<0.05. Literate OA (M = 4.5, SD = 1.8) also recalled more words than illiterate OA (M = 3.6, SD = 2.1) after a delay. Recall of geometric figures after a delay was higher for literate OA (M = 5, SD = 2.9) as well compared to illiterate OA (M = 2.4, SD = 2.5).
Conclusions:Conclusion: In a sample of cognitively healthy Indian older adults, literate OA consistently performed better than illiterate OA on both verbal and nonverbal memory measures. This is consistent with past literature which shows that illiterate individuals take longer to learn verbal information and have lower recall. Additionally, use of geometric figure may be complicated for these individuals. These are important considerations when assessing an OA for memory problems with low or no education. Next steps would be to look at differences across other cognitive domains and also examining if cognitive differences exist in illiterate OA based on gender.
46 Comparison of Anxiety Measures in a Memory Clinic Sample
- Raelynn Mae de la Cruz, Jessica Rodrigues, Rachel M. Butler-Pagnotti, Filippo Cieri, Shehroo B. Pudumjee, Sonakshi Arora, Kimberly L. Cobos, Jessica Z. K. Caldwell, Lucille Carriere, Christina G. Wong
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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. 725-726
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- Article
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Objective:
As the presentation of anxiety may differ between younger and older adults, it is important to select measures that accurately capture anxiety symptoms for the intended population. The 21-item Beck Anxiety Inventory (BAI) is widely used; however, its high reliance on somatic symptoms may result in artificial inflation of anxiety ratings among older adults, particularly those with medical conditions. The 30-item Geriatric Anxiety Scale (GAS) was specifically developed for older adults and has shown strong psychometric properties in community-dwelling and long-term care samples. The reliability and validity of the GAS in a memory clinic setting is unknown. The present study aimed to compare the psychometric properties of the GAS and the BAI in a memory disorder clinic sample.
Participants and Methods:Participants included 35 older adults (age=73.3±5.0 years; edu=15.3±2.8 years; 42% female; 89% non-Hispanic white) referred for a neuropsychological evaluation in a memory disorders clinic. In addition to the GAS and BAI, the Geriatric Depression Scale (GDS) and Montreal Cognitive Assessment (MoCA) were included. Cutoffs for clinically significant anxiety were based on published data for each measure. A dichotomous anxiety rating (yes/no) was created to examine inter-measure agreement; minimal anxiety was classified as “no” and mild, moderate and severe anxiety were classified as “yes.” Internal scale reliability was examined using Cronbach’s alpha. Convergent and discriminant validity were examined using Spearman rank correlation coefficients. Frequency distributions determined the proportion of yes/no anxiety ratings, and a McNemar test compared the proportion of anxiety classifications between the two measures.
Results:Both measures had excellent internal consistency (BAI: a=.88; GAS: a=.94). The BAI and GAS were highly correlated with each other (r=.79, p<.001) and positively correlated with a depression measure (BAI-GDS: r=.51, p=.002; GAS-GDS: r=.53, p=.001). Discriminant validity was supported by lower correlations between the anxiety measures and cognition (BAI-MoCA: r=.38, p=.061; GAS-MoCA: r=.34, p=.098). The BAI classified 14 participants as having anxiety (40%) and 21 participants as not having anxiety (60%), whereas the GAS classified 21 participants as having anxiety (60%) and 14 participants as not having anxiety (40%). The proportion of anxiety classifications were significantly different between the two measures (p =.016). For 28 participants (80%), there was agreement between the anxiety ratings. Seven participants (20%) were classified as having anxiety by the GAS, but not by the BAI; GAS items related to worry about being judged or embarrassed may contribute to discrepancies, as they were frequently endorsed by these participants and are unique to the GAS.
Conclusions:Results support that both anxiety measures have adequate psychometric properties in a clinical sample of older adult patients with memory concerns. It was expected that the BAI would result in higher classification of anxiety due to reliance on somatic symptoms; however, the GAS rated more participants as having anxiety. The GAS may be more sensitive to detecting anxiety in our sample, but formal anxiety diagnoses were not available in the current dataset. Future research should examine the diagnostic accuracy of the GAS in this population. Overall, preliminary results support consideration of the GAS in memory disorder evaluations.