Cognitive measures in the Canadian Longitudinal Study on Aging

Objective: We describe the implementation of cognitive measures within the Canadian Longitudinal Study on Aging (CLSA), a nationwide, epidemiological study of aging, and relate CLSA Tracking cohort data (n over 20,000) to previous studies using these measures.Method: CLSA participants (aged 45–85, n over 50,000) provided demographic, social, physical/clinical, psychological, economic, and health service utilization information relevant to health and aging through telephone interviews (Tracking cohort, n over 20,000) or in-person (i.e. Comprehensive cohort, n over 30,000) in both official languages (i.e. English, French). Cognitive measures included: the Rey Auditory Verbal Learning Test (RAVLT) – Trial 1 and five-minute delayed recall; Animal Fluency (AF), the Mental Alternation Test (MAT) (both cohorts); Controlled Oral Word Association Test, Stroop Test, Prospective Memory Test, and Choice reaction times (Comprehensive Cohort).Results: Performance on the RAVLT Trial 1 and AF were very similar to comparable groups studied previously; CLSA sample sizes were far larger. Within the CLSA Tracking cohort, main effects of age and language were observed for all cognitive measures except RAVLT delayed recall. Interaction effects (language × age) were observed for AF.Conclusion: This preliminary examination of the CLSA Tracking cognitive measures lends support to their use in large studies of aging. The CLSA has the potential to provide the ‘best’ comparison data for adult Canadians generated to date and may also be applicable more broadly. Future studies examining relations among the psychological, biological, health, lifestyle, and social measures within the CLSA will make unique contributions to understanding aging.     

Dementia Rating Scale-2 normative data for middle-and older-aged Castilian speaking Spaniards

Abstract

Objectives: The Dementia Rating Scale-2 (DRS-2) is frequently used as a dementia screening tool in clinical and research settings in Spain. The present study describes DRS-2 Total and subscale scores in community-dwelling Spaniards, aged 50–71, and provides normative data for its use in Castilian Spanish-speaking individuals. Methods: The sample consisted of 798 individuals who participated in an observational study on essential hypertension. Mean age was 62.8 years (SD = 5.4), mean education was 8.6 years (SD = 3.4) with 47.9% females. Almost all of them were receiving blood pressure-lowering drugs (93%) and most of them had fairly well-managed blood pressure control (M systolic/diastolic blood pressure = 142.3/77.0 ± 16.0/9.2 mm Hg). We applied a previously described method of data normalization from the Mayo’s Older Americans Normative Studies to obtain the Castilian Spanish DRS-2 norms. Results: Worse performance on Total and subscale scores was associated with older age (p < .05) and fewer years of education (p < .001). Women obtained lower raw Total scores than men (131.68 ± 7.2 vs. 133.10 ± 6.90, p < .005), but had fewer years of education (7.96 ± 3.33 vs. 9.17 ± 3.45, p < .001). This gender difference disappeared after correcting for age and years of education. Total and subscale scores are presented adjusted by age, and normative data are shown for Total scores adjusted by age and years of education. Conclusions: These norms are useful for studying cognitive status and cognitive decline in research and clinical settings in Castilian Spanish-speaking populations.     

Psychometric properties of the Actual Week test: a naturalistic prospective memory task

Objective: Prospective memory is the ability to ‘remember to remember’ and a facet of memory important to everyday functioning. For older adults, prospective memory slips are a common concern. In the present study, we conducted an initial validation of a paper-and-pencil adaptation of the Actual Week test, and reported on internal consistency, inter-rater and test-retest reliability, convergent and divergent validity, as well as veridicality of the task. Method: Fifty-eight healthy, community-dwelling older adults were recruited from a larger randomized controlled trial and tested at baseline. The Actual Week test was a naturalistic five-day prospective memory task where participants were assigned eight hypothetical tasks to remember per day for five days. Tasks were either time-cued or event-cued and regular (i.e. occurring daily) or irregular (i.e. varied each day). The proportion of tasks that were recorded as on time and accurate was used as the primary measure of performance. Results: The Actual Week test had good internal consistency (Kuder–Richardson: r > .8), intra-test (intraclass correlation: α > .9) and test-retest reliability (r = .76). There was also evidence for convergent and divergent validity. Task performance was associated with age, but not years of education or sex. Conclusion: The Actual Week test demonstrated strong psychometric qualities and promising evidence for validity as a performance-based measure of everyday prospective memory in older adults. Avenues for future studies include extending the evidence for convergent validity and evaluating feasibility and utility with other clinical populations.     

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.     

Portable eyetracking-based assessment of memory decline

Introduction: Preferential viewing of novel stimuli in the Visual Paired Comparison task has provided a useful marker of memory and medial temporal lobe function. We created a portable version of the VPC (P-VPC) and contrasted P-VPC metrics against the Montreal Cognitive Assessment (MoCA) in healthy adults, to assess the validity and reliability of the P-VPC as an indicator of memory function across age. A supplementary case series was conducted with individuals diagnosed with Alzheimer’s disease (AD) and other dementias, to provide a preliminary illustration of the P-VPC’s use as a measure in clinical populations.

Method: Participants (n = 207) were tested using the P-VPC. Individuals were familiarized with a set of objects, which were each presented alongside a novel object in the test phase. Novelty viewing scores were compared to MoCA scores to index concurrent validity. Item analyses were conducted as a test of internal reliability of the P-VPC. A complementary clinical case series was conducted with AD (n = 4) and dementia (n = 5) participants, who were tested using the P-VPC and further compared to healthy age-matched participants.

Results: Preferential viewing decreased with age in healthy participants, and was positively correlated with MoCA scores. Compared to the MoCA, P-VPC scores did not differ based on education and/or whether English was spoken as the native language. Item analyses revealed acceptable internal consistency. P-VPC viewing percentiles of healthy participants were modeled as a function of age, and illustrated that individuals of the clinical case series diagnosed with AD scored in below-average percentiles, while those with dementia did not score below-average.

Conclusion: Good concurrent validity and acceptable internal reliability were observed, and P-VPC scores were not confounded by education or language experience. Low performance was observed in individuals with clinically diagnosed AD, suggesting that the P-VPC may be a potential tool for screening memory decline.     

Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE)

Abstract

Objective: Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. Method: HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. Results: Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31–.72, p = .877) and .70 (95% CI = .53–.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. Conclusions: Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.     

Predictors of WAIS–R vocabulary in late life: Differences by race

Background: Vocabulary scores tend to be significantly related to education in heterogeneous groups of older adults, even after controlling for confounding variables. However, there may be other factors that impinge on cognitive functioning for certain demographic groups, particularly those whose educational opportunities were limited, and who may have experienced considerable stress as a result of their minority status. Objectives: This study sought to explore possible predictors of vocabulary scores among African American and White older adults. Method: In this study, samples of African American (N = 165) and White (N = 146) community-dwelling older adults reported their level of education, perceived health status, and number of stressful life events, and were administered the Wechsler Adult Intelligence Scale–Revised (WAIS–R) Vocabulary subtest. Results: Among the White participants, level of education was the only significant predictor of vocabulary score after controlling for perceived health and exposure to stress. Among African American participants, education was also a significant predictor of vocabulary score. However perceived health and number of stressful life events were also significantly predictors of vocabulary score. Conclusions: Findings indicate that for certain cohorts of older adults, especially those who may have experienced stressful life circumstances and health disparities as a result of racial inequality, education may not be the only variable that predicts verbal intelligence. The importance of investigating cognitive functioning within a broader sociocultural context is discussed.     

Base rate comparison of suboptimal scores on the RBANS effort scale and effort index in Parkinson’s disease

Objective: The effort index (EI) and the effort scale are commonly used embedded effort indicators on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). This investigation examined the rates of suboptimal scores on the EI and effort scale in a Parkinson’s disease (PD) sample. Method: One hundred and sixty-three participants who have been diagnosed with PD by a board-certified neurologist were included in the study. The base rate of suboptimal scores on the EI and effort scale was calculated for the entire group. Results: On average, participants were 66.8 years of age (SD = 9.5) and had a mean education of 13.5 years (SD = 2.79). The mean Mini-Mental State Examination score was 27.0 (SD = 3.1). Overall, 8% of participants scored below the cut-off for optimal performance on the EI while 62.6% performed in the suboptimal range for the effort scale. Conclusion: The utility of the EI and the effort scale in PD populations warrants further examination. Additionally, results demonstrate the need for validation of embedded RBANS effort measures in various disease populations.     

Normative performance of healthy older individuals on the Modified Mini-Mental State (3MS) examination according to ethno-racial group,gender, age,and education level

Objective: To present normative performance data on the Modified Mini-Mental State (3MS) examination for healthy community-dwelling older individuals according to gender, age, education level, and ethno-racial group. Method: More than 19,000 generally healthy older men and women without a diagnosis of dementia were recruited from the general population in Australia and the U.S. for the ASPirin in Reducing Events in the Elderly (ASPREE) study. The 3MS exam was administered as part of the baseline screening and individuals scoring above 77 were eligible to participate. Results: The sample comprised 16,360 Australian whites, 1080 U.S. whites, 895 African-Americans and 316 Hispanic/Latinos. The median age of participants was 74 years (range 65–98), with an average of 12 years of education and 56% were female. Increasing age and fewer years of completed education were associated with lower scores on the 3MS. Women scored higher than men in most age and education categories. Differences across ethno-racial groups were found. With factor analysis, four factors were identified which accounted for 35% of the between-person variance in 3MS scores for white Australians. Conclusions: This large cohort of older individuals provides some of the most comprehensive 3MS normative data to be generated for whites (Australian and U.S.), Hispanic/Latinos and African-Americans, by age, gender, and educational attainment. These findings will serve as important reference standards for monitoring cognitive function in generally healthy older individuals, becoming increasingly important as this fraction of the population increases.     

The 15-item version of the Boston Naming Test as an index of English proficiency

Objective: The present study was designed to examine the potential of the Boston Naming Test – Short Form (BNT-15) to provide an objective estimate of English proficiency. A secondary goal was to examine the effect of limited English proficiency (LEP) on neuropsychological test performance.Method: A brief battery of neuropsychological tests was administered to 79 bilingual participants (40.5% male, M_Age = 26.9, M_Education = 14.2). The majority (n = 56) were English dominant (EN), and the rest were Arabic dominant (AR). The BNT-15 was further reduced to 10 items that best discriminated between EN and AR (BNT-10). Participants were divided into low, intermediate, and high English proficiency subsamples based on BNT-10 scores (≤6, 7–8, and ≥9). Performance across groups was compared on neuropsychological tests with high and low verbal mediation.Results: The BNT-15 and BNT-10 respectively correctly identified 89 and 90% of EN and AR participants. Level of English proficiency had a large effect (partial η² = .12–.34; Cohen’s d = .67–1.59) on tests with high verbal mediation (animal fluency, sentence comprehension, word reading), but no effect on tests with low verbal mediation (auditory consonant trigrams, clock drawing, digit-symbol substitution).Conclusions: The BNT-15 and BNT-10 can function as indices of English proficiency and predict the deleterious effect of LEP on neuropsychological tests with high verbal mediation. Interpreting low scores on such measures as evidence of impairment in examinees with LEP would likely overestimate deficits.     

Repetition priming in mild cognitive impairment and mild dementia: Impact of educational attainment

Objective: To examine the role of education on repetition priming performances in healthy aging, mild cognitive impairment (MCI), and mild dementia.

Method: A total of 72 participants (healthy = 27, with MCI = 28, with mild dementia = 17) took part in the present study. Priming was assessed using the Word Stem Completion Test, and delayed and recognition memory was assessed using the Rey Auditory Verbal Learning Test. A multinomial regression analysis was used to examine whether years of education moderated priming and declarative memory performances in predicting group membership.

Results: Priming performances discriminated between individuals with MCI and mild dementia but not between MCI and healthy. Additionally, this effect was most salient in individuals with low levels of education. Education did not moderate explicit memory performances in predicting group membership.

Conclusion: Little is known about the impact of education on priming in verbal memory. Our findings indicate that formal years of education impact priming performances in MCI and individuals with mild dementia, which may have implications for designing interventions targeting “intact” cognitive abilities in these groups.     

Clinimetric validity of the Trail Making Test Czech version in Parkinson’s disease and normative data for older adults

Abstract

Objective: The influence of demographic variables on the Trail Making Test (TMT) performance in older individuals and empirical findings on clinical validity in predementia states, such as Parkinson’s disease mild cognitive impairment (PD-MCI), are limited. The principal aim of this study was to add normative data for the Czech population of older adults and explore the clinimetric properties between PD-MCI and PD patients with normal cognition (PD-NC). Method: The study included 125 PD patients classified as 77 PD-MCI and 48 PD-NC and 528 older individuals (60–74 years, further subdivided for normative tables into 60–64, 65–69 and 70–74 age groups) and very old individuals (aged 75–96, further subdivided into 75–79, 80–84, 85–96) cognitively intact Czech adults. Results: Mostly age, to a lesser extent education but not gender, was associated with most TMT basic and derived indices (TMT-B – A). However, the ratio of TMT-B/TMT-A was independent of both age and education. We provide corresponding T-scores that minimize the effect of demographic variables. The results showed a high discriminative validity of TMT basic and derived indices for the differentiation of PD-MCI from PD-NC (all p < .05). The classification accuracy for the differentiation of PD-MCI from controls was optimal for the TMT-B only (80% area under the curve) based on norm adjusted scores. The classification accuracy of the TMT for PD-MCI vs. PD-NC was suboptimal. Conclusions: The cut-offs and normative standards are useful in clinical practice for those working with PD patients and very old adults.     

Assessing cognitive functioning in individuals with cocaine use disorder

Introduction: There have been mixed findings assessing the impact of regular cocaine use on cognitive functioning. This study employed a comprehensive cognitive battery to compare the performance of individuals diagnosed with a cocaine use disorder (N = 3 abusers, N = 17 dependent) against the performance of two control groups: (a) non-drug-users, and (b) marijuana users who report no cocaine use (N = 7 marijuana abusers, N = 0 dependent, N = 13 marijuana users with no Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, DSM–IV, diagnosis).

Method: This one-session, between-participants, outpatient study was conducted at the New York State Psychiatric Institute. Sixty research volunteers completed the study. Drug users in both groups had no signs of current intoxication, but had a positive urine toxicology—which indicated use within 72 hours in the cocaine use disorder group and within the past 30 days (depending on frequency of use) for the marijuana-using control group. The National Institutes of Health (NIH) Toolbox Cognition Battery was used to assess cognitive functioning across six domains: executive function, attention, episodic memory, working memory, processing speed, and language. Each participant’s score was also compared against a normative database adjusted for age.

Results: Although the mean cognitive scores for all groups fell within the normal range for all tests, marijuana-using control participants outperformed those with a cocaine use disorder on a cognitive flexibility and language measure.

Conclusions: Cognitive functioning of individuals diagnosed with cocaine use disorder was observed to be similar to that of control group participants on the majority of tasks and fell within the normal range when compared against normative data.     

Rouleau version of the Clock Drawing Test: age- and education-adjusted normative data from a wide Italian sample

Abstract

Objective: The Clock Drawing Test (CDT) is widely used as a screening tool for discriminating cognitively normal individuals from patients with mild dementia. The aim of present study was to provide normative values for a 10-point quantitative scoring system proposed by Rouleau and colleagues (1992), including CDT total score and subscales score assessing representation of clock face (RC), layout of numbers (LN), and position of hands (PH), in a large sample of Italian healthy individuals. Method: Eight hundred and seventy-two Italian healthy participants (483 women; age range 20–94 years) with educational level from primary school to university underwent CDT and Mini Mental State Examination (MMSE). Results: Multiple linear regression analysis revealed that age and education significantly influenced CDT total score and its subscale scores. Moreover, a significant effect of gender was found only in RC subscale. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-off values were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a weakly significant correlation between adjusted CDT total score and adjusted MMSE scores. Conclusions: The present study provided normative data for the Rouleau and colleagues version of CDT in an Italian sample, useful for clinical and research purposes.     

Normative data for phonemic and semantic verbal fluency test in the adult French–Quebec population and validation study in Alzheimer’s disease and depression

Objective: Verbal fluency tasks are principally used to assess lexical access and have shown usefulness for differential diagnosis. The purpose of Study 1 was to provide normative data in the adult French–Quebec population (Canada) for semantic verbal fluency (animals), for two sets of phonemic verbal fluency (TNP and PFL), and for letter P alone (60 seconds per category/letter). The objectives of Study 2 were to establish the diagnostic and predictive validity of the present tasks and normative data in Alzheimer’s disease (AD) and major depressive episode (MDE). Method: The normative sample consisted of 932 participants aged 19–91 years. Based on multiple linear regressions, equations to calculate Z-scores were provided. To assess validity, performance of 62 healthy participants was compared to 62 participants with AD and 41 with MDE aged over 50. Results: Age and education, but not gender, predicted performance on each verbal fluency task. Healthy adults aged 50 and younger had a better performance on semantic than phonemic verbal fluency. In comparison to MDE, AD participants had lower performance on animals and TNP, but not on letter P. Ninety percent of people with a Z-score ≤ ?1.50 on semantic verbal fluency had AD and the global accuracy was 76.6%. Test–retest reliability over one year was high for both animals (r = .711) and TNP (r = .790) in healthy older participants, but dropped for animals in people with AD (r = .493). Conclusions: These data will strengthen accurate detection of verbal fluency deficits in French–Quebec adults.     

Practice effects and longitudinal cognitive change in clinically normal older adults differ by Alzheimer imaging biomarker status

Objective: The objective of this study was to examine practice effects and longitudinal cognitive change in 190 clinically normal elderly classified according to a two-feature biomarker model for Alzheimer’s disease.Methods: All participants completed neuropsychological testing, MRI, FDG-PET, and PiB-PET at their baseline evaluation. We divided participants into four groups based on neuroimaging measures of amyloid (A+ or A?) and neurodegeneration (N+ or N?) and reexamined cognition at 15- and 30-month intervals.Results: The A?N? group showed significant improvements in the memory and global scores. The A+N? group also showed significant improvements in the memory and global scores as well as attention. The A?N+ group showed a significant decline in attention at 30 months. The A+N+ group showed significant improvements in memory and the global score at 15 months followed by a significant decline in the global score at 30 months.Conclusion: Amyloidosis in the absence of neurodegeneration did not have an adverse impact on practice effects or the 30-month cognitive trajectories. In contrast, participants with neurodegeneration (either A?N+ or A+N+) had worse performance at the 30-month follow-up. Our results show that neurodegeneration has a more deleterious effect on cognition than amyloidosis in clinically normal individuals.     

Sleep behaviours and multimorbidity occurrence in middle-aged and older adults: findings from the Canadian Longitudinal Study on Aging (CLSA)

ObjectivePoor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes, such as multiple chronic conditions (multimorbidity) and reduced longevity. Our objective was to examine the relationship between sleep behaviours and multimorbidity in Canada.MethodsWe analysed data from the Canadian Longitudinal Study on Aging (CLSA), a cross-sectional national health survey of community-dwelling adults over the age of 45 years. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: <6 h; normal: 6–8 h; long: >8 h) and sleep quality (dissatisfied/very dissatisfied; neutral; satisfied/very satisfied). Multimorbidity was defined using two definitions (public health and primary care) and two cut-points (2 or more and 3 or more chronic conditions).ResultsApproximately 70% were living with multimorbidity using the primary care definition (females: 67.9%; males 57.9%), whereas approximately 30% were living with multimorbidity using the public health definition (females: 30.9%; males: 24.0%). Adjusted analyses indicated that the odds of multimorbidity were higher for participants who selfreported either short or long sleep duration, as well as dissatisfaction with sleep quality. Associations were stronger among younger age groups (45–54 years and 55–64 years).ConclusionsDisrupted sleep may be a risk factor for multimorbidity across sexes and age groups. It is necessary to understand the potential impact of sleep on the risk of multimorbidity to inform both clinical and public health guidelines for the prevention and management of this major health issue.     

Effect of depression on cognition after mild traumatic brain injury in adults

Objective: The current study examined the effect of depression on cognitive test performance in a sample of adults seeking treatment for a mild traumatic brain injury (MTBI). We hypothesized that patients with greater depressive symptoms would perform worse on tasks of fluid cognition compared to those without depression, after controlling for potential confounds.

Method: Patients (N = 76) completed a brief cognitive test battery (NIH Toolbox Cognition Battery; NIHTB-CB) and a depression screening questionnaire (PHQ-9) at 11.7-weeks post injury (SD = 6.3 range 2–26). Cognitive scores were adjusted for age, education, gender, and race/ethnicity. Depressive symptoms were examined continuously and dichotomized as: (1) total PHQ-9 score of ≥ 10, the optimal cut-off for Major Depressive Disorder caseness from prior research, and (2) five or more symptoms of depression, including either depressed mood or anhedonia (i.e. DSM-5-based definition).

Results: Twenty-seven patients (35.5%) met DSM-5-based criteria for depression and 42 (55.3%) met criteria based on PHQ-9 > 10. Depression symptom severity correlated with lower fluid cognition composite scores [r = ?.22, p = .05] and contributed to the prediction of fluid cognition performance in a model that controlled for time since injury and crystallized cognitive abilities [F(3, 72) = 7.49, p < .001; R² = 20.6%]. Examining specific NIHTB-CB fluid subtests, the largest group differences were seen on processing speed (d = .40–.49), cognitive flexibility (d = .32–.36), and episodic memory (d = .20–.34). Depression severity was strongly associated with overall post-concussion symptom burden (r = .77, p < .001).

Conclusion: Depression is a common comorbidity and an important factor to consider when interpreting neurocognitive test performance in adults with concussion in a clinical setting.     

The use of neuropsychological tests to assess intelligence

Abstract

Objective: We sought to derive a ‘neuropsychological intelligence quotient’ (NIQ) to replace IQ testing in some routine assessments. Method: We administered neuropsychological testing and a seven-subtest short form of the Wechsler Adult Intelligence Scale to a community sample of 394 adults aged 18–96 years. We regressed Wechsler Full Scale IQs (W-FSIQ) on 23 neuropsychological scores and derived an NIQ from 9 measures that explained significant variance in W-FSIQ. We then compared subgroups of 284 healthy and 108 unhealthy participants in NIQ and W-FSIQ to assess criterion validity, correlated NIQ and W-FSIQ scores with education level and independence for activities of daily living to assess convergent validity, and compared validity coefficients for the NIQ with those of ‘hold’ and ‘no-hold’ indices. Results: By design, NIQ and W-FSIQ scores correlated highly (r = .84), and both were higher in healthy participants. The difference was larger for NIQ, which accounted for more variability in activities of daily living. The NIQ and ‘no-hold’ index were better predicted by health status and less predicted by educational status than the ‘hold’ index. Conclusions: We constructed an NIQ that correlates highly with Wechsler FSIQ. Tests required to obtain NIQ are commonly used and can be administered in about 45 min. Validity properties of NIQ and W-FSIQ are similar. The NIQ bore greater resemblance to a ‘no-hold’ than ‘hold’ index. One can obtain a reasonably accurate estimate of current Full Scale IQ without formal intelligence testing from a brief neuropsychological battery.     

Association of platelet-to-lymphocyte ratio with silent brain infarcts in patients with paroxysmal atrial fibrillation

Objectives: In this study, we aimed to evaluate whether the inflammation as measured by increased platelet to lymphocyte ratio (PLR) predispose to silent infarcts in patients with paroxysmal atrial fibrillation (PAF).

Methods: The present study investigated a total of 48 new diagnosed patients with PAF who had no signs of stroke. PLR, which was calculated as the ratio of the platelet count to the lymphocyte count, C-reactive protein and erythrocyte sedimentation rate were measured due to evaluate inflammatory state. Magnetic resonance imaging (MRI) was performed to evaluate the presence of silent brain infarcts (SBIs) in patients. We calculated CHA₂DS₂–VASc scores for stratifying the stroke risk of patients.

Results: Among our study population, the mean age was 56.40 ± 8.99; 36 patients were female. The leading vascular risk factor was hypertension (45.8%). SBI was determined in 16 patients (33.3%) on MRI. It was found that a higher PLR is significantly associated with the presence of SBIs in patients with PAF (P = .001). High PLR group showed silent lesions predominantly multiple, greater than 5 mm, bilateral and in the subcortical region; though no statistically significant differences were found in each lesion areas (P = .214; P = .509; P = .746; P = .059, respectively). Of 16 patients who showed SBI, 1 (6.3%) patient had CHA₂DS₂–Vasc scores of 0; 7 (43.8%) patients had CHA₂DS₂–Vasc scores of 1; 6 (37.5%) patients had CHA₂DS₂ -Vasc scores of 2 and 2 (12.5%) patients had CHA₂DS₂–Vasc scores of 3. We did not find any significant relationship between CHA₂DS₂–Vasc scores and presence of SBI in the study patients (P = .850).

Discussion: High PLR might be a factor to induce inflammatory process on SBIs even with low CHA₂DS₂–VASc scores.