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64 Validity and Stability of Objective Measures of Subtle Functional Difficulties in Older Adults
- Sophia L Holmqvist, Moira Mckniff, Marina Kaplan, Giuliana Vallecorsa, Riya Chaturvedi, Molly Tassoni, Stephanie Simone, Katherine Hackett, Rachel Mis, Tania Giovannetti
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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. 370
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Objective:
Self-reported mild functional difficulties are one of the most salient predictors of future cognitive decline in older adults. However, few measures of objective assessment of mild functional difficulties are available. This study explored the validity and stability of novel, performance-based measures of subtle functional difficulties in older adults without dementia using an objective and standardized test, called the Naturalistic Action Test (NAT), which has been used for people with dementia.
Participants and Methods:40 older adults (Healthy Controls (HC), Mild Cognitive Impairment (MCI)) completed the NAT at baseline and again after one-month. The NAT requires participants to make a breakfast and a lunch using objects presented on a table. Standard cognitive tests (memory, language, etc.) also were administered at baseline only and were used to compute intraindividual cognitive variability (IIV), a sensitive measure of cognitive ability level. NAT scores reflecting micro-errors and completion time were obtained from video recordings. Micro-errors are inefficient actions that include misreaching toward the wrong object and moving objects around the table without a clear purpose. Validity of the NAT measures was evaluated in correlations with IIV, and the stability of NAT performance was evaluated using within-sample t-tests and correlations between measures at baseline and one-month.
Results:In the full sample (N =40), greater micro errors were significantly correlated with greater IIV at baseline (r=.512, p<.001) and one month followup (r=.327, p=.039). Among HC, paired t tests showed that there were no significant differences in micro-errors over one month; however, completion time was significantly slower at baseline (Md=16.06, SD=24; t(32)=3.76, p<.001). MCI participants showed a significant decrease in micro-errors (M=3.86, SD=4.4; t(6)=2.33, p=.029), but no difference in completion time. Among HC and MCI, micro errors (r=.506, p<.001), and completion time (r=.899, p<.001) were significantly correlated across time points.
Conclusions:Results show promise for novel NAT measures (time, micro-errors) as valid, objective indicators of subtle cognitive difficulties that affect everyday function. Analyses of stability of scores over time showed evidence of practice effects over time, which along with predictive validity, should be explored in future work.
68 Associations between within-domain intraindividual variability and functional abilities in cognitively healthy older adults
- Stephanie M Simone, Sophia Holmqvist, Molly B Tassoni, Moira McKniff, Emma Pinsky, Tania Giovannetti
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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. 373-374
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Objective:
Cognitive performance, particularly in the domains of memory and executive functioning (EF), have been shown in previous research to predict decline in everyday functioning in older adults. The goal-control model posits that episodic memory difficulties cause weak or decaying task goals that lead to the omission of every day task steps (low accomplishment). EF difficulties preclude control over the execution of task goals that lead to inefficient and error-prone performance (high errors). Intraindividual variability (IIV) in neuropsychological test performance has been proposed as a noninvasive early marker of dementia and has utility in cognitively healthy older adults. In this study we examined cross-sectional relations between within-domain IIV in memory and attention/EF with performance of everyday tasks in the lab. We expected greater memory IIV to be associated with task accomplishment (goal decay), and greater attention/EF IIV to be associated with errors (poor control over goals).
Participants and Methods:40 cognitively normal (CN) older adult (65+) participants (M age=71.44, SD=10.62; 73.8% women; 85.7% White; M education=18.55, SD=8.38) completed the Naturalistic Action Test (NAT), requiring completion of standardized, everyday tasks (i.e., breakfast, lunch) and scored for accomplishment of steps and various errors (micro-errors - misreach to distractor object, extra actions; overt -sequence, perseverative behaviors, etc.; motor errors). Within-domain IIV measures were calculated for 6 memory measures (HVLT-R, BVMT-R) and 6 attention/EF measures (Digit Span, Trail Making Test, Salthouse Letter/Pattern Comparison). First, raw scores for each test were z-transformed, then the intraindividual standard deviation of all z-scores was calculated. Bivariate Spearman’s rank-order correlations were used to examine associations between NAT performance and within-domain IIV, as well as mean performance. Linear regressions were used to examine the associations of IIV score with NAT scores, adjusting for age, sex, and mean cognitive performance.
Results:Among CN participants, higher memory IIV was significantly associated with lower NAT accomplishment (r=-.329, p=.038), and better mean memory performance was significantly associated with fewer errors (micro-errors r=-.509, p=.003; overt r=-.438, p=.012; motor errors r=-.463, p=.008). Regression models revealed that memory IIV, after controlling for mean memory performance, age, and sex, did not significantly predict NAT performance. High attention/EF IIV was significant associated with more errors (overt r=.377, p=.016), whereas mean attention/EF performance was not significantly correlated with any NAT measures. Attention/executive function IIV significantly predicted errors (micro-errors B=4.15, p=.03; Overall model: R2=0.285, F(4, 24)=2.393, p=.079; overt B=.562, p=.032; Overall model: R2=0.371, F(4, 24)=3.543, p=.021) after adjusting for mean attention/executive function performance, age, and sex.
Conclusions:Consistent with the goal-control model framework, greater variability in memory was associated with lower task accomplishment, whereas greater variability in attention/EF was associated with more errors. However, only attention/EF IIV predicted NAT performance, specifically errors (micro-errors, overt errors), after adjusting for age, sex, and mean attention/EF performance. Within-domain IIV can be used to predict mild functional difficulties in cognitively healthy older adults. Future research should examine within-domain IIV in a larger sample with more diversity to maximize generalizability, and in a longitudinal design to evaluate within-domain IIV predictive validity for cognitive/functional impairment.
50 Examining the Utility of a Performance-Based Test of Everyday Function for Assessing Cognition in Older Adults Who Speak English as a Second Language
- Moira Mckniff, Sophia Holmqvist, Marina Kaplan, Giuliana Vallecorsa, Riya Chaturvedi, Molly Tassoni, Stephanie Simone, Katherine Hackett, Rachel Mis, Tania Giovannetti
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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. 358-359
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Objective:
Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.
Participants and Methods:Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as <1.5 SD.
Results:Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.
Conclusions:Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.
32 Associations between Childhood Attention Deficit Hyperactivity Disorder and Learning Disabilities and Cognition in Late Adulthood.
- Giuliana Vallecorsa, Marina Kaplan, Moira McKniff, Emma Pinksky, Molly Tassoni, Stephanie Simone, Sophia Holmqvist, Rachel Mis, Katherine Hackett, Tania Giovannetti
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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. 640
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Objective:
There has been relatively little research on the effect of childhood attention difficulties/weaknesses and learning disabilities/differences on cognitive aging. This study examined associations between self-reported symptoms and diagnoses/concerns of childhood attention deficit hyperactivity disorder (ADHD) and reading or math learning disabilities (LD) and cognitive abilities in older adulthood. We hypothesized that cognitive weaknesses in childhood would be associated with cognitive abilities later in life.
Participants and Methods:The 25 individuals with healthy cognition or MCI were recruited from the greater Philadelphia area (Mage= 74.4; SD= 5.34; 40% men; 84%white) and completed a self-report questionnaire of childhood ADHD and LD. Specifically, participants rated their experience of ADHD symptoms of inattention and hyperactivity/impulsivity and indicated whether they had a past diagnosis of (or concerns regarding past) ADHD, math LD or language/reading LD Participants also completed tests of language, attention, episodic memory, executive function, and processing speed. Pearson or point-biserial correlation coefficients (r-values) indicating a medium effect size (.30 or greater) were interpreted as meaningful.
Results:On average, participants reported 3.48 symptoms of inattention and 2.56 symptoms of hyperactivity/impulsivity (i.e., at least six symptoms from either category are consistent with diagnostic criteria for ADHD). 16% of the sample reported childhood ADHD/attention difficulties, 48% reported childhood math LD/math difficulties, and 32% reported childhood language LD/difficulties. On cognitive tests, the sample performed in the average range, with considerable variability (i.e., norm-based, demographically adjusted T-scores ranged from 20-74). The relation between cognitive scores and report of childhood ADHD symptoms was weak and non-significant correlation (r<.18). By contrast, report of childhood ADHD/attention difficulties was associated with lower scores attention tests (r=.33). Report of childhood language LD/difficulties was associated with a worse overall cognitive composite (r=-.35) and executive function ability (r=-.35). Childhood math LD/difficulties was not meaningfully associated with lower scores on any of the cognitive tests administered. Unexpectedly, report of childhood cognitive difficulties also were associated with higher scores on cognitive tests, such that childhood ADHD/attention difficulties was associated with better performance on tests of episodic memory (r=.39), and childhood math LD/difficulties were associated with better performance on tests of language (r=-.37).
Conclusions:Current cognitive abilities in older adults may be influenced by lifelong cognitive weakness and academic difficulties. A history of ADHD and LD/difficulties should be considered in clinical neuropsychological assessment and future research on cognitive aging should consider ADHD/LD from a lifespan, developmental framework.
85 Evaluating the Improvement on the Naturalistic Action Task After the Virtual Kitchen Intervention: A Case Study
- Molly B. Tassoni, Moira McKniff, Emma Pinsky, Ross Divers, Stephanie M Simone, Sophia Holmqvist, Rachel Mis, Katherine Hackett, Marina Kaplan, Giuliana Vallecorsa, Mijail Serruya, Takehiko Yamaguchi, Tania Giovannetti
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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. 186-187
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Objective:
The goal-control model of the functional impairment in dementia posits two different underlying mechanisms: decay of task goals (reduced task accomplishment) and poor control over goal execution (high error rates). Here we present a case series in which we explore the effects of a performance-based, functional intervention on two participants. Outcomes were evaluated using the goal-control framework.
Participants and Methods:Two participants with dementia (CS: age 70, 14 years of education; EM: age 93, 18 years of education) completed neuropsychological tests (scored using age, education, and IQ-adjusted norms) and baseline testing with the Naturalistic Action Task (NAT; a validated performance-based task of everyday function including a Breakfast and Lunch task). The Virtual Kitchen (VK) was used to train, through repeated performance, either the Breakfast (CS) or Lunch (EM) tasks for 30 minutes (or 10 total repetitions) per day over 5 days. After VK training, participants performed the NAT Breakfast and Lunch tasks again to evaluate improvement on the trained and untrained tasks. Baseline and post-training NATs were scored for task accomplishment and errors by two coders observing video recordings. Z scores were derived by calculating accomplishment and error change scores for each participant relative to the mean and standard deviations of change scores from a cohort of 36 healthy controls (mean age: 73.3, SD: 6.44; mean education: 17.42, SD: 2.17).
Results:Both participants exhibited similar cognitive profiles: high estimated IQ; low MMSE (total = 19 for both CS and EM; 1st percentile); anterograde amnesia, slowed processing speed and impaired executive function; average scores on tests of attention, language, and self-reported depression. Informant report of daily functioning (FAQ) suggested that EM (FAQ=28) exhibited greater functional impairment than CS (FAQ=9). Both participants completed all VK training sessions. Z scores of the change from pre- to post-training showed significant increases in task accomplishment on the trained task (trained condition change z scores: EM = +27.69; CS =+ 6.06), but significantly less improvement or worse task accomplishment on the untrained task (untrained condition change z scores: EM = +4.06; CS = -13.69). The training did not reduce errors, as error rates increased for both participants on the trained task.
Conclusions:The participants presented in this case study exhibited comparable cognitive profiles, including marked anterograde amnesia. Our results suggest that repeated training in a virtual context can improve specific aspects of functioning on real, life everyday tasks. Further, according to the goal-control framework, repeated practice reduces the decay of the task goal, as represented by greater task accomplishment, but does not improve executive control over the task execution. Important future directions are to determine if people with different cognitive profiles will demonstrate different benefits from VK training and to examine if virtual training of personally relevant, everyday tasks can promote independent living and improve quality of life.
43 Mood and Everyday Function in Older Adults: Analyses of Self-report and Performance-based Measures of Everyday Function
- Marina Kaplan, Moira McKniff, Emma Pinksy, Molly Tassoni, Stephanie M Simone, Katherine Hackett, Rachel Mis, Giuliana Vallecorsa, Sophia Holmqvist, Tania Giovannetti
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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. 352
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Objective:
The relation between depressed mood and functional difficulties in older adults has been demonstrated in studies using self-report measures and has been interpreted as evidence for low mood negatively impacting everyday functional abilities. However, few studies have directly examined the relation between mood and everyday function using performance-based tests. This study included a standardized, performance-based measure of everyday action (Naturalistic Action Task, NAT) to test the prediction that report of depression symptoms are associated with self-report and performance-based tests of everyday function. Associations with anxiety symptoms and motivation/grit and everyday function also were explored.
Participants and Methods:68 older adults without dementia were screened and recruited (n = 55, M age = 74.21, SD= 6.80, age range = 65 to 98) from the community and completed self-report measures of depression symptoms (GDS), anxiety (GAI), motivation (Short Grit-S), and everyday functioning (FAQ). Participants also performed the NAT, which requires completion of a breakfast and lunch task and is scored for task accomplishment, errors (micro-errors, overt, motor), and total time. Additionally, an informant also reported on the participant’s everyday function. Spearman correlations were performed and results showing a medium effect size or greater are reported.
Results:Participant mood (GDS) was associated with self-reported function (FAQ; r =.45) but not performance-based measures of everyday function (NAT). Self-reported anxiety and motivation were not meaningfully associated with either self-reported or performance-based everyday function. Participant self-report (FAQ) and informant report of participant’s function (IFAQ) supported the validity of performance-based assessment as both were meaningfully associated with NAT performance (FAQ x NAT overt errors r = .34; I-FAQ x NAT micro-errors r = .34; I-FAQ x NAT motor errors r = .49).
Conclusions:Mood, but not anxiety or motivation, was associated with self-reported everyday function but not performance-based function. When considered alongside the meaningful relations between self/informant-report of function and everyday task performance, results suggest mood does not impact everyday function abilities in community-dwelling older adults without dementia. We suggest that frameworks to be reconceptualized to consider the potential for mild functional difficulties to negatively impact mood in older adults without dementia. Additionally, interventions and compensatory strategies designed to improve everyday function should examine the impact on mood outcomes.
3 Smartphone Digital Phenotyping for Unobtrusive and Continuous Assessment of Everyday Cognition and Movement Trajectories in Older Adults
- Katherine Hackett, Shiyun Xu, Moira McKniff, Emma Pinsky, Sophia Holmqvist, Giuliana Vallecorsa, Ian Barnett, Tania Giovannetti
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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. 207-208
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Objective:
To evaluate the feasibility, usability, and preliminary validity of a digital phenotyping protocol to capture everyday cognition and activities in vivo among older adults.
Participants and Methods:Eight participants (M age=69.1 + 2.6; M education=18.0 + 1.4; 50% female; 88% non-Hispanic White) with normal cognition or mild cognitive impairment used an open-source smartphone application (mindLAMP) to passively and continuously capture sensor data including global positioning system (GPS) trajectories for a 4-week study period. Baseline neuropsychological tests and measures of depression, self-reported cognitive decline and mobility patterns were collected as external validators for digital data. Participants downloaded mindLAMP onto their smartphones and resumed their daily routines for 4 weeks before removing mindLAMP and completing a debriefing questionnaire. A cognitive composite was derived by averaging T-scores across domains of attention, executive functioning, processing speed, memory, and language. GPS raw data were processed to generate monthly average and standard deviation mobility metrics for each participant, including time spent at home, distance travelled, radius of gyration, flight length, and circadian routine. Feasibility and usability findings are presented along with correlation coefficients >.4 between GPS metrics and external validators.
Results:100% of enrolled participants completed the 4-week study without requesting to withdraw. Usability ratings ranged from poor to excellent. 75% of participants agreed that mindLAMP was easy to use, whereas only 1 participant enjoyed using mindLAMP. 100% of participants were satisfied with the study team’s explanation of procedures, privacy safeguards, data encryption methods and risks/benefits, reflected in an average score of 98.8% on the comprehension of consent quiz. No participants reported feeling uncomfortable, suspicious, or paranoid due to the study application running on their smartphone. No participants endorsed new problems using their smartphone, though 75% reported charging it more frequently during the study period. On average each day, participants spent 1121 + 227 minutes at home, travelled 38727 + 36210 geodesic units, and had 201 + 149 minutes of missing GPS data. Overall, greater amounts of activity (monthly average) and higher variability (monthly standard deviation) in GPS metrics were associated with better outcomes. Specifically, less time spent at home, greater distance travelled, larger radius of gyration, greater flight length, and greater variability in home time, distance travelled, radius of gyration and flight length were associated with less depression, less self-reported cognitive decline, better cognition, and greater self-reported mobility (.40< |r| <.69). On the other hand, greater circadian routine was associated with more self-reported cognitive decline (r=.66) and less self-reported mobility (r=-.43).
Conclusions:Smartphone digital phenotyping is a feasible and acceptable method to capture everyday activities in older adults. Continuous collection of data from personal devices warrants caution; however, participants denied privacy concerns and expressed an overall positive experience. High frequency GPS data collection impacts battery life and should be considered among relative risks and confounds to naturalistic assessment. Patterns of behavior from passive smartphone data show promise as an unobtrusive method to identify cognitive risk and resilience in older adults. Subsequent analyses will evaluate additional sensor metrics across a larger and more heterogeneous cohort.
Cognitive dispersion is elevated in amyloid-positive older adults and associated with regional hypoperfusion
- Sophia L. Holmqvist, Kelsey R. Thomas, Emily C. Edmonds, Amanda Calcetas, Lauren Edwards, Katherine J. Bangen, for the Alzheimer’s Disease Neuroimaging Initiative
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 7 / August 2023
- Published online by Cambridge University Press:
- 12 September 2022, pp. 621-631
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Objective:
Cognitive dispersion across neuropsychological measures within a single testing session is a promising marker predictive of cognitive decline and development of Alzheimer’s disease (AD). However, little is known regarding brain changes underlying cognitive dispersion, and the association of cognitive dispersion with in vivo AD biomarkers and regional cerebral blood flow (CBF) has received limited study. We therefore examined associations among cognitive dispersion, amyloid-beta (Aβ) positivity, and regional CBF among older adults free of dementia.
Method:One hundred and forty-eight Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants underwent neuropsychological testing and neuroimaging. Pulsed arterial spin labeling (ASL) magnetic resonance imaging (MRI) was acquired to quantify CBF. Florbetapir positron emission tomography (PET) imaging determined Aβ positivity.
Results:Adjusting for age, gender, education, and mean cognitive performance, older adults who were Aβ+ showed higher cognitive dispersion relative to those who were Aβ-. Across the entire sample, higher cognitive dispersion was associated with reduced CBF in inferior parietal and temporal regions. Secondary analyses stratified by Aβ status demonstrated that higher cognitive dispersion was associated with reduced CBF among Aβ+ individuals but not among those who were Aβ-.
Conclusions:Cognitive dispersion may be sensitive to early Aβ accumulation and cerebrovascular changes adjusting for demographics and mean neuropsychological performance. Associations between cognitive dispersion and CBF were observed among Aβ+ individuals, suggesting that cognitive dispersion may be a marker of brain changes among individuals on the AD continuum. Future studies should examine whether cognitive dispersion predicts brain changes in diverse samples and among those with greater vascular risk burden.