Cognitive performance and age: norms from the Maine-Syracuse Study

The primary objective of this study was to provide contemporary normative data on aging and cognition from an ongoing community-based study. This dementia and stroke-free sample (age range = 20-79; mean = 53) consisted of 623 women and 322 men participating in the Maine-Syracuse Longitudinal Study at waves 4 to 6 (1993 to 2003). We employed a battery of 22 widely utilized cognitive tests. A 5 (age) x 3 (education) x 2 (gender) analysis of variance indicated that, in general, higher educated and younger participants exhibited better performance on cognitive tests. We found education group to be the strongest, and gender to be the weakest, predictor of cognitive performance. However, education cohort was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease health variables to a model including age, education, and gender groupings provided statistically significant, but modest, increases in prediction of performance on some tests. Results are discussed in relation to findings for previous studies presenting normative data on cognitive ability as a function of age, education, and gender.     

Cognitive Performance and Age: Norms from the Maine-Syracuse Study

The primary objective of this study was to provide contemporary normative data on aging and cognition from an ongoing community-based study. This dementia and stroke-free sample (age range = 20–79; mean = 53) consisted of 623 women and 322 men participating in the Maine-Syracuse Longitudinal Study at waves 4 to 6 (1993 to 2003). We employed a battery of 22 widely utilized cognitive tests. A 5 (age) × 3 (education) × 2 (gender) analysis of variance indicated that, in general, higher educated and younger participants exhibited better performance on cognitive tests. We found education group to be the strongest, and gender to be the weakest, predictor of cognitive performance. However, education cohort was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease health variables to a model including age, education, and gender groupings provided statistically significant, but modest, increases in prediction of performance on some tests. Results are discussed in relation to findings for previous studies presenting normative data on cognitive ability as a function of age, education, and gender.     

Normative data for elderly adults: the Maine-Syracuse study

The primary objective of this study was to provide supplementary normative data on aging and cognition from an ongoing community-based study. This dementia- and stroke-free sample (age range = 70-89; mean = 77.5) consisted of 228 women and 155 men participating in the Maine-Syracuse Longitudinal Study at waves 6 to 7 (2001-2009). The authors employed a battery of 23 widely utilized clinical cognitive tests. In this cross-sectional study, the authors focus on subjects 70 to 79 (n = 248) and 80 to 89 (n = 135) years old, and provide preliminary data for a smaller number of subjects aged 90 to 98 years old (n = 14). More highly educated and younger participants exhibited better performance on cognitive tests. Education was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease (CVD)/health variables to a model including age, education, and gender main effects provided statistically significant increases in R2 (range = .021-.084) of performance on some tests. Results are discussed in relation to this study's value with respect to determining cognitive impairment in individuals free from probable dementia or stroke.     

Cognitive function in hepatitis C patients with advanced fibrosis enrolled in the HALT-C trial

BACKGROUND/AIMS: Prior studies have demonstrated neuropsychological abnormalities in chronic hepatitis C (CHC) patients even with mild fibrosis. The aim of this study was to determine the frequency, type, and severity of cognitive impairment in a large group of CHC patients with advanced fibrosis. METHODS: Ten validated neuropsychological tests were administered to 201 CHC patients. Standard scores for individual tests were calculated using normative population data that controlled for age, gender, and/or education. Lifetime psychiatric history, alcohol consumption, and mood status were also determined. RESULTS: 33% of patients met criteria for cognitive impairment (i.e. standard score <40 on at least 4 tests). Mild impairment in verbal recall and working memory were noted with other domains remaining intact. Liver disease severity and lifetime psychiatric/substance abuse history did not correlate with group mean cognitive test results or the presence of cognitive impairment. In contrast, IQ and depression scores were significant and independent predictors of cognitive impairment (ROC = 0.84). CONCLUSIONS: 33% of patients entering the HALT-C trial have evidence of a mild, non-focal subcortical processing deficit which was highly correlated with IQ, education, and occupation. Future studies of cognitive function in CHC patients should control for general cognitive ability.     

The cross-cultural utility of foreign- and locally-derived normative data for three WHO-endorsed neuropsychological tests for South African adolescents

Interpretation of neuropsychological tests may be hampered by confounding sociodemographic factors and by using inappropriate normative data. We investigated these factors in three tests endorsed by the World Health Organization: the Grooved Pegboard Test (GPT), the Children’s Color Trails Test (CCTT), and the WHO/UCLA version of the Auditory Verbal Learning Test (AVLT). In a sample of 12-15-year-old, Afrikaans- and English-speaking adolescents from the Cape Town region of South Africa, analyses of covariance (ANCOVAs) demonstrated that quality of education was the sociodemographic factor with the biggest influence on test performance, and that age also significantly influenced GPT and CCTT performance. Based on those findings, we provide appropriately stratified normative data for the age group in question. Comparisons between diagnostic interpretations made using foreign normative data versus those using the current local data demonstrate that it is imperative to use appropriately stratified normative data to guard against misinterpreting performance.     

Population Normative Data for the CERAD Word List and Victoria Stroop Test in Younger- and Middle-Aged Adults: Cross-Sectional Analyses from the Framingham Heart Study

Background/Study Context: To provide baseline normative data on tests of verbal memory and executive function for nondemented younger- and middle-aged adults.

Methods: The Consortium to Establish a Registry for Alzheimer’s Disease word list memory task (CERAD-WL) and Victoria Stroop Test (VST) were administered to 3362 Framingham Heart Study (FHS) volunteer participants aged 24–78 years. Analyses of the effects of age, gender, and education were conducted. Normative data on traditional measures and error responses are reported for each test.

Results: Traditional measures were significantly associated with both age and education in this cohort. Error responses also evidenced significant age and education effects.

Conclusion: These data provide a normative comparison for assessment of verbal memory and executive functioning capabilities in younger- and middle-aged adults and may be utilized as a tool for preclinical studies of disease in this population.     

Normative Data for Elderly Adults: The Maine-Syracuse Study

The primary objective of this study was to provide supplementary normative data on aging and cognition from an ongoing community-based study. This dementia- and stroke-free sample (age range = 70–89; mean = 77.5) consisted of 228 women and 155 men participating in the Maine-Syracuse Longitudinal Study at waves 6 to 7 (2001–2009). The authors employed a battery of 23 widely utilized clinical cognitive tests. In this cross-sectional study, the authors focus on subjects 70 to 79 (n = 248) and 80 to 89 (n = 135) years old, and provide preliminary data for a smaller number of subjects aged 90 to 98 years old (n = 14). More highly educated and younger participants exhibited better performance on cognitive tests. Education was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease (CVD)/health variables to a model including age, education, and gender main effects provided statistically significant increases in R² (range = .021–.084) of performance on some tests. Results are discussed in relation to this study's value with respect to determining cognitive impairment in individuals free from probable dementia or stroke.     

Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study)

Heart failure is a risk factor for Alzheimer's disease and cerebrovascular disease. In the absence of heart failure, it was hypothesized that left ventricular ejection fraction (LVEF), an indicator of cardiac dysfunction, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected from 1,114 Framingham Heart Study Offspring Cohort participants free from clinical stroke or dementia (aged 40 to 89 years, mean age 67 ± 9 years, 54% women). Neuropsychological and neuroimaging markers of brain aging were related to cardiac MRI-assessed LVEF. In multivariable-adjusted linear regressions, LVEF was not associated with any brain aging variable (p values >0.15). However, LVEF quintile analyses yielded several U-shaped associations. Compared to the referent (quintile 2 to 4), the lowest quintile (quintile 1) LVEF was associated with lower mean cognitive performance, including Visual Reproduction Delayed Recall (β = -0.27, p <0.001) and Hooper Visual Organization Test (β = -0.27, p <0.001). Compared to the referent, the highest quintile (quintile 5) LVEF values also were associated with lower mean cognitive performance, including Logical Memory Delayed Recall (β = -0.18, p = 0.03), Visual Reproduction Delayed Recall (β = -0.17, p = 0.03), Trail Making Test Part B - Part A (β = -0.22, p = 0.02), and Hooper Visual Organization Test (β = -0.20, p = 0.02). Findings were similar when analyses were repeated excluding prevalent cardiovascular disease. In conclusion, although these observational cross-sectional data cannot establish causality, they suggest a nonlinear association between LVEF and measures of accelerated cognitive aging.     

Cognitive Function,Physical Performance,Health, and Disease: Norms From the Georgia Centenarian Study

This study provides, for the first time, normative data on cognitive functioning and physical performance, health and health behaviors, and diseases from a population-based sample of 244 centenarians and near-centenarians (M age = 100.5 years, range 98–108, 84.8% women, 21.3% African American) from the Georgia Centenarian Study. Data are presented by the four key dimensions of gender, race, residence, and educational attainment. Results illustrate the profound range of functioning in this age group and indicate considerable differences as a function of each dimension. Bivariate models generally suggest that cognitive functioning and physical performance is higher for men than women; whites than African Americans; community than facility residents; and those with more than high school education than those with less than high school education. Multivariate models elaborate that differences in educational attainment generally account for the largest proportion of variance in cognitive functioning and residential status generally accounts for the largest proportion of variance in physical performance measures. Addition of health variables seldom increases variance accounted for in each domain beyond these four dimensions.     

Cognitive activity in older persons from a geographically defined population.

Patterns of cognitive activity, and their relation to cognitive function, were examined in a geographically defined, biracial population of persons aged 65 years and older. Persons (N = 6,162) were given cognitive performance tests and interviewed about their participation in common cognitive activities, like reading a newspaper. Overall, more frequent participation in cognitive activities was associated with younger age, more education, higher family income, female gender, and White race; participation in activities judged to be more cognitively intense was not strongly related to age, but was associated with more education, higher family income, male gender, and White race. Substantial heterogeneity in activity patterns remained after accounting for demographic factors, however. In an analysis controlling for demographic variables, level of cognitive function on performance tests was positively related to composite measures of the frequency and intensity of cognitive activity. Longitudinal studies are needed to assess the relation of cognitive activity patterns to stability and change in cognitive function in older persons.     

An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: demographic influence and population-based norms (the AGE study)

The mini-mental state examination (MMSE) is a brief global instrument used to assess cognitive abilities, and has been translated into the K-MMSE. The clinical value of the K-MMSE is restricted by the small amount of normative data available, especially for the elderly population. We investigated the population-based data of K-MMSE scores to obtain the norms specific for the sociodemographic characteristics of elderly Koreans. The K-MMSE was applied to a cognitively normal sample of 977 subjects aged 60-84 years in Ansan, South Korea. We determined whether the sociodemographic characteristics were related to the K-MMSE scores and calculated the norms. The K-MMSE score was significantly associated with age, gender, and level of education, and this result was used to develop normative data with age, gender, and educational strata. The normative data based on age, gender, and level of education presented here are suitable for clinical use.     

Neuropsychological Test Performance in Cognitively Normal Spanish-speaking Nonagenarians with Little Education

To find associations of age, sex, and education with neuropsychological test performance in cognitively normal Spanish-speaking Costa Rican nonagenarians with little education; to provide norms; and to compare their performance with similar Puerto Ricans. For 95 Costa Ricans (90–102 years old, 0–6 years of education), multiple regression assessed associations with demographics of performance on six neuropsychological tests. Analyses of covariance compared them with 23 Puerto Ricans (90–99 years old). Younger age and being female—but not education—were associated with better performance on some neuropsychological tests, in particular episodic memory. The Puerto Ricans performed better on learning and memory tasks. In cognitively intact Spanish-speaking nonagenarians with little or no education, education did not affect test performance. Additional studies of the effect of education on cognitive performance are warranted in other samples with extremely low education or old age. National differences in performance highlight the importance of group-specific norms.     

An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: Demographic influence and population-based norms (the AGE study)

The mini-mental state examination (MMSE) is a brief global instrument used to assess cognitive abilities, and has been translated into the K-MMSE. The clinical value of the K-MMSE is restricted by the small amount of normative data available, especially for the elderly population. We investigated the population-based data of K-MMSE scores to obtain the norms specific for the sociodemographic characteristics of elderly Koreans. The K-MMSE was applied to a cognitively normal sample of 977 subjects aged 60–84 years in Ansan, South Korea. We determined whether the sociodemographic characteristics were related to the K-MMSE scores and calculated the norms. The K-MMSE score was significantly associated with age, gender, and level of education, and this result was used to develop normative data with age, gender, and educational strata. The normative data based on age, gender, and level of education presented here are suitable for clinical use.     

Multidimensional risk assessment versus age as criterion for retirement of airline pilots.

OBJECTIVE: To determine whether airline pilots over the age of 60 pose a hazard to aviation safety and whether risk assessment could replace age-based retirement. DATA SOURCES: A computer-assisted literature search (MEDLINE), expert consultation, and government reports. STUDY SELECTION: Original studies on flight performance and pilot age; sudden incapacitation, neuropsychological testing, and/or medication use in pilots; and/or non-invasive testing for predicting sudden death or stroke in asymptomatic subjects. DATA EXTRACTION: Pertinent results and methods data were abstracted from the 49 included studies. DATA SYNTHESIS: No study on aircraft accidents or pilot performance has shown an increased accident risk for over-60-year-old pilots. Normal age-related cognitive changes probably have minimal impact on aviation safety up to age 70, given above average health, education, and experience in airline pilots. Cognitive tests have not been validated for predicting flight performance safety, but they can detect early stages of cognitive disease. Cardiovascular incapacitation risk increases with age, but risk factor profiles and non-invasive tests could identify pilots with non-acceptable risk. CONCLUSIONS: An improved medical certification test could identify those pathologic conditions that might occur more frequently in older subjects. If pilots also underwent adequate performance testing, a gradual increase of the retirement age to approximately age 70 would seem justified. In the future, a longitudinal database should be established to validate medical tests for their ability to predict a pilot's accident risk. Using individual pilots as their own controls might be more sensitive than using population-based norm values. Progress in this field would advance medical assessment for other groups such as air traffic controllers or automobile drivers.     

Normative Data for the Cognitively Intact Oldest-Old: The Framingham Heart Study

Background/Study Context: The number of individuals who reach extreme age is quickly increasing. Much of the current literature focuses on impaired cognition in extreme age, and debate continues regarding what constitutes “normal” cognition in extreme age. This study aimed to provide oldest-old normative data and to compare cognitive performances of cognitively intact elderly individuals from the Framingham Heart Study.

Methods: A total of 1302 individuals aged 65+ years from the Framingham Heart Study were separated into 5-year age bands and compared on cognitive tests. Multivariate linear regression analyses were conducted, adjusting for gender, the Wide Range Achievement Test—Third Edition (WRAT-III) Reading score, and cohort. Analyses also included comparisons between 418 individuals aged 80+ and 884 individuals aged 65–79, and comparisons within oldest-old age bands.

Results: Normative data for all participants are presented. Significant differences were found on most tests between age groups in the overall analysis between young-old and oldest-old, and analysis of oldest-old age bands also revealed select significant differences (all ps <.05).

Conclusion: As aging increases, significant cognitive differences and increased variability in performances are evident. These results support the use of age-appropriate normative data for oldest-old individuals.     

Effect of Exercise on Neuropsychological Performance in Asymptomatic HIV Infection

The present study examined the relationship between self-reported exercise participation both at the time of the study and prior to HIV diagnosis on neuropsychological performance of 139 asymptomatic HIV-positive men. History of exercise participation prior to diagnosis was significantly associated with performance on several neuropsychological tests and with overall impairment. After the effects of education were removed from this analysis, the groups differed only in their performance on the Grooved Pegboard Test. When stratified by current exercise participation, the groups differed only on one trial of the Paced Auditory Serial Addition Test. These results suggest that exercise, while it may have other benefits for this population, is not associated with improved cognitive functioning.     

The use of the Halstead-Reitan test battery with older adults

As with younger individuals, neuropsychological evaluation of the older patient with suspected cognitive decline should be reasonably comprehensive. Only through careful analysis of the overall pattern as well as level of performance across various measures can both the likelihood and nature of cerebral dysfunction be ascertained. A neuropsychological battery such as an expanded HRB appears to be well suited for the comprehensive evaluation of the older individual who may be mildly to moderately impaired, whereas briefer test batteries may be sufficient and more practical in some cases. The HRB is widely used in clinical and research settings, yet only a few published studies have provided reference data with respect to large groups of adults over the age of 60. Preliminary data suggest that the HRB has adequate reliability and validity in older as well as younger age groups. However, information regarding the level and pattern of performance of normal individuals over the age of 75 is lacking for the HRB as well as for virtually all other popular neuropsychological measures. Studies consistently have shown that many of the component HRB measures are quite sensitive to the effects of age (as well as education), and therefore, traditional normative cutoff scores produce an unacceptably high rate of false positive diagnostic predictions in older populations. Until more appropriate older age norms are available, great caution must be used in the interpretation of results.     

CERAD-NP-Testbatterie: Alters-, geschlechts- und bildungsspezifische Normen ausgew?hlter Subtests

The CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimer’s dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners’ patients from Germany aged 75 years and older. The study participants had a mean age of 80.2 years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.