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Validation and Norms for a Recognition Task for the Spanish Version of the Free and Cued Selective Reminding Test
Abstract
Objective: the aim of the present work was to develop and validate a recognition task to
be used with the Spanish version of the 16-items Free and Cued Selective Reminding
Test (FCSRT). Method: ninety-six (67.7% women) cognitively healthy, functionally
independent community-dwelling participants aged 55 years or older underwent a
comprehensive neuropsychological assessment. A recognition task for the FCSRT was
developed that included the original 16 items, 16 semantically related items and 8
unrelated foils. Indices of discriminability (d’) and response bias (C), as well as 95%
confidence intervals for chance level responding were calculated. Results: on average,
our sample was 65.71 years old (standard deviation – SD = 6.68, range: 55-87), had
11.39 years of formal education (SD = 3.37, range: 3-19), and a Mini-Mental State
Examination score = 28.42 (SD = 1.49, range: 25-30). Recognition scores did not differ
statistically between sexes, nor did they correlate with demographics. Participants
scored at ceiling levels (mean number of Hits = 15.52, SD = 0.906, mean number of
False Alarms = 0.27, SD = 0.589). All the participants scored above chance levels.
Conclusions: normative data from a novel recognition task for the Spanish version of
the FCSRT are provided for use in clinical and research settings. Including a
recognition task in the assessment of memory functioning might help uncover the
pattern of memory impairments in older adults, and can help improve the memory
profile of people with amnestic Mild Cognitive Impairment. Future research is
warranted to validate and expand the recognition task.
... The features of the sample have been previously described [52]. Inclusion criteria were (a) being 55 years old or older, (b) being cognitively normal (CN) without subjective cognitive complaints and (c) living independently in the community. ...
... In this paper, data are reported for tests assessing memory and visuospatial perception: the FCSRT [40,41], the ROCF [43,44] and the JLO [45][46][47] tests. Descriptive statistics for the remaining tests can be found in Bonete-López et al. [52]. ...
... If any word was not remembered, the task was followed by the cued-recall trial. Lastly, 40 words were read out loud by the examiner [52]. Of them, 16 were words from the previous free-and cued-recall tasks (targets) and 24 were distractors. ...
The aim of this work was to develop normative data for neuropsychological tests for the assessment of independent and cognitively active Spanish older adults over 55 years of age.
Methods:
regression-based normative data were calculated from a sample of 103 nondepressed independent community-dwelling adults aged 55 or older (66% women). The raw data for the Free and Cued Selective Reminding Test (FCSRT), the Rey-Osterrieth Complex Figure Test (ROCF) and the Judgement of Line Orientation Test (JLO) were regressed on age, sex and education. The model predicting the FCSRT delayed-recall (FCSRT-Del) scores also included the FCSRT immediate-recall (FCSRT-Imm) scores. The model predicting the ROCF immediate-recall (ROCF-Imm) scores included the ROCF copy-trial (ROCF-C) scores, and the model predicting the ROCF delayed-recall (ROCF-Del) scores included both the ROCF-C and the ROCF-Imm scores. In order to identify low scores, z-scores were used to determine the discrepancy between the observed and the predicted scores. The base rates of the low scores for both the SABIEX normative data and the published normative data obtained from the general population were compared.
Results:
the effects of the different sociodemographic variables (age, sex and education) varied throughout the neuropsychological measures. Despite finding similar proportions of low scores between the normative data sets, the agreement was irrelevant or only fair-to-good.
Conclusions:
the normative data obtained from the general population might not be sensitive enough to identify low scores in cognitively active older adults, incorrectly classifying them as cognitively normal compared to the less active population.
... Prior to enrollment, an informed consent was obtained from all participants. The tests included in the neuropsychological battery have been previously reported [65], and included measures of attention, working memory, information processing speed, verbal and visual memory, visuospatial abilities, executive functioning, and language. This work was performed according to the Declaration of Helsinki and all participants provided an informed consent prior to enrollment. ...
An increased cognitive reserve is associated with changes in the pattern of cognitive decline during aging. Thus, normative data adapted to the characteristics of the target population are needed to reduce the possibility of false diagnoses. The aim of this work was to develop normative data for the Phonemic Verbal Fluency test, the Semantic Verbal Fluency test and the Boston Naming Test (BNT).
Method:
Regression-based normative data were calculated from a sample of 118 non-depressed, cognitively active, independent community-dwelling adults aged 55 or older (64.4% women) from SABIEX (University for Seniors at the Universidad Miguel Hernández de Elche). Raw scores were regressed on age, sex, and education.
Results:
The effects of age and education varied across neuropsychological measures. No effect of sex was found in any of the tests assessed. Statistically significant differences were found in the proportion of low scores using SABIEX or population-based normative datasets. The level of agreement identifying individuals labeled as showing one or more low scores was only fair-to-good.
Conclusions:
Normative data obtained from the general population might not be sensitive to identify low scores in cognitively active older adults, increasing the risk of misdiagnoses. A friendly calculator is available for neuropsychological assessment.
... In addition, the reference population to which an individual's performance on cognitive testing will be compared, termed the normative data, must be from an appropriate culturally representative sample. To this end, a growing number of initiatives in cross-cultural neuropsychology are being established 28,[36][37][38] , including work to develop culturally appropriate measures for Spanish-speaking individuals (such as the Brain Health Assessment 39,40 and the Latin American Spanish version of the Face-Name Associative Memory Exam (LAS-FNAME) 41 ) and to obtain normative data from several Spanish-speaking countries or regions, including Colombia 42 , Ecuador 43 , the USA 30 , Mexico 44 , the US-Mexico border region 8 and Spain 45 . Similarly, the US National Alzheimer's Coordinating Center has worked on translating and adapting the Uniform Data Set 3, which is used in standardized annual evaluations conducted at the National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers across the USA 46 , for use in diverse Spanish-speaking Latino populations, and efforts are under way to include social determinants of health measures. ...
Alzheimer disease and related dementias present considerable challenges to health-care and medical systems worldwide. In the USA, older Black and Latino individuals are more likely than older white individuals to have Alzheimer disease and related dementias. In this Perspective, we leverage our experience and expertise with older US Latino groups to review and discuss the need to integrate cultural factors into dementia research and care. We examine the importance of considering the effects of cultural factors on clinical presentation and diagnosis, dementia risk, clinical research and recruitment, and caregiving practices, with a focus on minoritized groups in the USA. We highlight critical gaps in the literature to stimulate future research aimed at improving the prevention and early detection of Alzheimer disease and related dementias and developing novel treatments and interventions across ethnoracially diverse populations. In addition, we briefly discuss some of our own initiatives to promote research and clinical care among Latino populations living in the USA. This Perspective highlights the importance of integrating cultural factors into dementia research and care. Focusing on minoritized groups in the USA, the authors explore the effects of culture on clinical evaluation, dementia risk, research and study recruitment, and caregiving practices.
... The tests were administered in a pre-established order so that there was no interference between different tasks (e.g., interaction between language and verbal memory tasks). The tests included in the neuropsychological assessment have been previously described [79]. We calculated normative data with more than 100 participants because using linear regression models with a sample size greater than 100 and z ≤ −1.28 gives a number of true positive and true negatives around the 95% confidence interval [80]. ...
In this work, we developed normative data for the neuropsychological assessment of independent and cognitively active Spanish older adults over 55 years of age.
Method:
Regression-based normative data were calculated from a sample of 103 non-depressed independent community-dwelling adults aged 55 or older (67% women). Raw data for Digit Span (DS), Letters and Numbers (LN), the Trail Making Test (TMT), and the Symbol Digit Modalities Test (SDMT) were regressed on age, sex, and education. The model predicting TMT-B scores also included TMT-A scores. Z-scores for the discrepancy between observed and predicted scores were used to identify low scores. The base rate of low scores for SABIEX normative data was compared to the base rate of low scores using published normative data obtained from the general population.
Results:
The effects of age, sex, and education varied across neuropsychological measures. Although the proportion of low scores was similar between normative datasets, there was no agreement in the identification of cognitively impaired individuals.
Conclusions:
Normative data obtained from the general population might not be sensitive to identify low scores in cognitively active older adults, incorrectly classifying them as cognitively normal compared to the less-active population. We provide a friendly calculator for use in neuropsychological assessment in cognitively active Spanish people aged 55 or older.
Objectives
The fraction of the population that reaches the age of 100 years is growing. At this age, dementia incidence is high and cognitive functioning is highly variable across individuals. Normative data for neuropsychological tests are lacking in centenarians, which hampers the ability to evaluate their cognitive functioning for both research and clinical practice. Here, we generated norms for neuropsychological tests in a sample of cognitively healthy centenarians while taking sensory impairments into account.
Design
Cross‐sectional cohort study.
Setting
Centenarians who participate in the prospective 100‐plus Study.
Participants
A total of 235 centenarians (71.5% female), who self‐reported to be cognitively healthy, which was confirmed by an informant and a trained researcher.
Measurements
We generated normative data for 15 cognitive tests, measuring global cognition (Mini‐Mental State Examination [MMSE]), premorbid intelligence, attention, language, memory, executive function, and visuospatial function by multiple linear regressions and/or by reporting percentiles.
Results
Normative data for global cognition resulted in a mean MMSE score of 25.6 ± 3.1 (range = 17‐30; interquartile range = 24‐28). Vision problems and fatigue often complicated the ability to complete tests, and these problems explained 41% and 22% of the missing test scores, respectively. In contrast, hearing problems (4%) and task incomprehension (6%) rarely complicated test performance. While educational level was associated with performance on the majority of the tests, sex and age were only weakly associated with test performance.
Conclusions
We generated normative data for 15 common neuropsychological tests in a large sample of cognitively healthy centenarians, while taking age‐related sensory impairments into consideration. These normative data allow the detection of deficits across a wide range of cognitive domains. Our results suggest that, next to education level, vision ability and the level of fatigue should be taken into account when evaluating cognitive functioning in centenarians.
The research of reliable procedures for predicting cognitive decline or stability in persons with amnestic mild cognitive impairment (a-MCI) is a major goal for the early identification of subjects in the prodromal stages of dementia. The aim of this study was to evaluate whether different memory performances on two procedures commonly used for the neuropsychological assessment of episodic memory (i.e., free recall and recognition) might be a key in predicting a-MCI patients’ subsequent progression to Alzheimer’s disease (AD). For this purpose, 80 patients diagnosed with a-MCI at the first assessment and followed-up for at least 3 years were included. During this time, 41 subjects remained in a stable condition of cognitive impairment or improved (stable-MCI) and 39 patients converted to AD dementia (converter-MCI). Sixty-two age- and education-matched healthy individuals were also recruited as healthy controls (HC). Baseline memory performance on the free recall (5th immediate and 15-min delayed) and yes/no recognition (the sensitivity measure d′) of a 15-word list were analyzed. Results showed that stable-MCIs forgot significantly more information from immediate to delayed recall of the word list than HC, but exhibited a pronounced improvement of memory performance in the recognition test format. On the contrary, converter-MCIs showed diminished sensitivity in benefiting from cues for recognizing studied words. Word list recognition correctly classified group membership with good overall accuracy, which was higher compared to the classification of converter and stable a-MCIs provided by free recall; therefore, it could be a useful diagnostic tool for predicting progression to AD dementia from the prodromal stage.
Objectives
To investigate the implications of obtaining one or more low scores on a battery of cognitive tests on diagnosing mild cognitive impairment (MCI).
Design
Observational longitudinal study.
Setting
Alzheimer's Disease Neuroimaging Initiative.
Participants
Normal controls (NC, n = 280) and participants with MCI (n = 415) according to Petersen criteria were reclassified using the Jak/Bondi criteria and number of impaired tests (NIT) criteria.
Measurements
Diagnostic statistics and hazard ratios of progression to Alzheimer's disease (AD) were compared according to diagnostic criteria.
Results
The NIT criteria were a better predictor of progression to AD than the Petersen or Jak/Bondi criteria, with optimal sensitivity, specificity, and positive and negative predictive value.
Conclusion
Considering normal variability in cognitive test performance when diagnosing MCI may help identify individuals at greatest risk of progression to AD with greater certainty.
Objective:
Cognitive investigations in brain tumor patients have mostly explored episodic memory without differentiating between encoding, storage, and retrieval deficits. The aim of this study is to offer insight into the memory sub-processes affected in primary brain tumor patients and propose an appropriate assessment method.
Method:
We retrospectively reviewed the clinical and memory assessments of 158 patients with primary brain tumors who had presented to our departments with cognitive complaints and were investigated using the Free and Cued Selective Reminding Test.
Results:
Retrieval was the process of episodic memory most frequently affected, with deficits in this domain detected in 92% of patients with episodic memory impairments. Storage and encoding deficits were less prevalent, with impairments, respectively, detected in 41% and 23% of memory-impaired patients. The pattern of episodic memory impairment was similar across different tumor histologies and treatment modalities.
Conclusion:
Although all processes of episodic memory were found to be impaired, retrieval was by far the most widely affected function. A thorough assessment of all three components of episodic memory should be part of the regular neuropsychological evaluation in patients with primary brain tumors.
Background: Ongoing research is focusing on the identification of those individuals with mild cognitive impairment (MCI) who are most likely to convert to Alzheimer's disease (AD). We investigated whether recognition memory tasks in combination with delayed recall measure of episodic memory and CSF biomarkers can predict MCI to AD conversion at 24-month follow-up.
Methods: A total of 397 amnestic-MCI subjects from Alzheimer's disease Neuroimaging Initiative were included. Logistic regression modeling was done to assess the predictive value of all RAVLT measures, risk factors such as age, sex, education, APOE genotype, and CSF biomarkers for progression to AD. Estimating adjusted odds ratios was used to determine which variables would produce an optimal predictive model, and whether adding tests of interaction between the RAVLT Delayed Recall and recognition measures (traditional score and d-prime) would improve prediction of the conversion from a-MCI to AD.
Results: 112 (28.2%) subjects developed dementia and 285 (71.8%) subjects did not. Of the all included variables, CSF A?1-42 levels, RAVLT Delayed Recall, and the combination of RAVLT Delayed Recall and d-prime were predictive of progression to AD (?? = 38.23, df = 14, p < 0.001).
Conclusions: The combination of RAVLT Delayed Recall and d-prime measures may be predictor of conversion from MCI to AD in the ADNI cohort, especially in combination with amyloid biomarkers. A predictive model to help identify individuals at-risk for dementia should include not only traditional episodic memory measures (delayed recall or recognition), but also additional variables (d-prime) that allow the homogenization of the assessment procedures in the diagnosis of MCI.
Sample sizes of 50 have been cited as sufficient to obtain stable means and standard deviations in normative test data. The influence of skewness on this minimum number, however, has not been evaluated. Normative test data with varying levels of skewness were compiled for 12 measures from 7 tests collected as part of ongoing normative studies in Brisbane, Australia. Means and standard deviations were computed from sample sizes of 10 to 100 drawn with replacement from larger samples of 272 to 973 cases. The minimum sample size was determined by the number at which both mean and standard deviation estimates remained within the 90% confidence intervals surrounding the population estimates. Sample sizes of greater than 85 were found to generate stable means and standard deviations regardless of the level of skewness, with smaller samples required in skewed distributions. A formula was derived to compute recommended sample size at differing levels of skewness.
Objective:
To generate normative data on the Hopkins Verbal Learning Test-Revised (HVLT-R) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.
Method:
The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the HVLT-R as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.
Results:
The final multiple linear regression models explained 17-45% of the variance in HVLT-R scores. Although t-tests showed significant differences between men and women in Guatemala on the HVLT-R, it was a small effect size. As a result, gender-adjusted norms were not generated.
Conclusions:
The results from this study will have a substantial impact on the practice of neuropsychology in Latin America, as this is the first normative multicenter study to develop norms for the HVLT-R in this region.
Memory tests able to differentiate encoding and retrieval processes from the memoranda storing ones should be used to differentiate patients in a very early phase of AD. In fact, individuals with mild cognitive impairment (MCI) can be characterized by two different memory profiles: a pure amnestic one (with poor learning and retrieval and poor improvement when encoding is assisted and retrieval is facilitated) and a dysexecutive one (with inefficient encoding and/or poor retrieval strategies and improvement with assisted encoding and retrieval). The amnestic profile characterizes subjects affected by medio-temporal atrophy typical of AD. In this study, a Grober-Buschke memory procedure was used to evaluate normal controls and MCI patients with different cognitive profiles: pure amnestic (aMCIsd), amnestic plus other cognitive impairments (aMCImd) and non-amnestic (naMCI). An index of sensitivity of cueing (ISC) measured the advantage passing from free to cued recall. Results showed that both strategic and consolidation abilities were impaired in the aMCIsd and aMCImd groups and were preserved in the naMCI group. aMCImd, however, compensated the memory deficit with assisted encoding and retrieval, but aMCIsd performed very poorly. When MCI subjects were defined according to the ISC value, subjects with poor ISC were primarily in the aMCIsd group and, to a lesser extent, in the aMCImd group and the naMCI group. Finally, patients with a poor ISC showed cerebral atrophy documented in the precocious phase of AD and the retrosplenial cerebral areas seemed to be the most useful areas for identifying patients in the early phase of AD.
In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD.
Background:
To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount.
Review:
This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed.
Conclusions:
Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
The goal of this study was to investigate recognition memory performance across the lifespan and to determine how estimates of recollection and familiarity contribute to performance. In each of three experiments, participants from five groups from 14 up to 85 years of age (children, young adults, middle-aged adults, young-old adults, and old-old adults) were presented with high- and low-frequency words in a study phase and were tested immediately afterwards and/or after a one day retention interval. The results showed that word frequency and retention interval affected recognition memory performance as well as estimates of recollection and familiarity. Across the lifespan, the trajectory of recognition memory followed an inverse u-shape function that was neither affected by word frequency nor by retention interval. The trajectory of estimates of recollection also followed an inverse u-shape function, and was especially pronounced for low-frequency words. In contrast, estimates of familiarity did not differ across the lifespan. The results indicate that age differences in recognition memory are mainly due to differences in processes related to recollection while the contribution of familiarity-based processes seems to be age-invariant.
This article presents an adaptation of the Geriatric Depression Scale (GDS) (Brink et al., 1982) for elderly Spanish population currently living in residences. Before presenting, a review is given of the adaptation of this scale in Spain, concluding that, in general terms, there has been a general lack of adaptation studies, and analyses of psychometrics properties are also needed. With respect to the concrete results of this study, it was found that the GDS presents, in the version used, a high level of internal consistency, high temporal stability, and high concurrent validity with the Depression Adjetive CheckList (Lubin, 1981). Finally, using a cut-off point of 14-restrictive criterion-it was found that 35% of the elderly subjects of the sample were depressed.
Memory tests are sensitive to early identification of Alzheimer's disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n = 37), MCI (n = 37), and cognitively intact older adults (normal controls, NC; n = 35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (<120 DRS) on forced-choice recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed.
Episodic memory is affected early in the course of dementia. Two well-established tests to assess verbal episodic memory functioning are the Word List task from the Consortium to Establish a Registry for Alzheimer's disease Neuropsychological Assessment Battery (CERAD-NAB) and the California Verbal Learning Test (CVLT). In clinical and/or research settings, patients are typically administered either one or the other test, making statistical comparisons difficult. This study aimed to (i) compare the z-scores of these two tests in patients with MCI and different types of dementia and (ii) establish formulae to transform CERAD-NAB scores into CVLT scores and vice versa. Sixty-five patients completed both tests for the first time and within 10 days of each other. Pearson correlation coefficients indicated that the two tests assess similar aspects of episodic memory and that the CVLT is more sensitive to subtle episodic memory impairments. Finally, conversion formulae are provided and their implementation illustrated.
Signal detection theory (SDT) may be applied to any area of psychology in which two different types of stimuli must be discriminated.
We describe several of these areas and the advantages that can be realized through the application of SDT. Three of the most
popular tasks used to study discriminability are then discussed, together with the measures that SDT prescribes for quantifying
performance in these tasks. Mathematical formulae for the measures are presented, as are methods for calculating the measures
with lookup tables, computer software specifically developed for SDT applications, and general purpose computer software (including
spreadsheets and statistical analysis software).
ABSTRACT There is no agreement on the pattern of recognition memory deficits characteristic of patients diagnosed with mild cognitive impairment (MCI). Whereas lower performance in recollection is the hallmark of MCI, there is a strong controversy about possible deficits in familiarity estimates when using recognition memory tasks. The aim of this research is to shed light on the pattern of responding in recollection and familiarity in MCI. Five groups of participants were tested. The main participant samples were those formed by two MCI groups differing in age and an Alzheimer's disease group (AD), which were compared with two control groups. Whereas one of the control groups served to assess the performance of the MCI and AD people, the other one, composed of young healthy participants, served the purpose of evaluating the adequacy of the experimental tasks used in the evaluation of the different components of recognition memory. We used an associative recognition task as a direct index of recollection and a choice task on a pair of stimuli, one of which was perceptually similar to those studied in the associative recognition phase, as an index of familiarity. Our results indicate that recollection decreases with age and neurological status, and familiarity remains stable in the elderly control sample but it is deficient in MCI. This research shows that a unique encoding situation generated deficits in recollective and familiarity mechanisms in mild cognitive impaired individuals, providing evidence for the existence of deficits in both retrieval processes in recognition memory in a MCI stage.
This paper briefly reviews the evidence for multistore theories of memory and points out some difficulties with the approach. An alternative framework for human memory research is then outlined in terms of depth or levels of processing. Some current data and arguments are reexamined in the light of this alternative framework and implications for further research considered.
The Publication Manual of the American Psychological Association (American Psychological Association, 2001, American Psychological Association, 2010) calls for the reporting of effect sizes and their confidence intervals. Estimates of effect size are useful for determining the practical or theoretical importance of an effect, the relative contributions of factors, and the power of an analysis. We surveyed articles published in 2009 and 2010 in the Journal of Experimental Psychology: General, noting the statistical analyses reported and the associated reporting of effect size estimates. Effect sizes were reported for fewer than half of the analyses; no article reported a confidence interval for an effect size. The most often reported analysis was analysis of variance, and almost half of these reports were not accompanied by effect sizes. Partial η2 was the most commonly reported effect size estimate for analysis of variance. For t tests, 2/3 of the articles did not report an associated effect size estimate; Cohen's d was the most often reported. We provide a straightforward guide to understanding, selecting, calculating, and interpreting effect sizes for many types of data and to methods for calculating effect size confidence intervals and power analysis.
Performance on cognitive tests can be affected by age, education, and also selection bias. We examined the distribution of scores on several cognitive screening tests by age and educational levels in a population-based cohort.
An age-stratified random sample of individuals aged 65+ years was drawn from the electoral rolls of an urban US community. Those obtaining age and education-corrected scores > or = 21/30 on the Mini-Mental State Examination (MMSE) were designated as cognitively normal or only mildly impaired, and underwent a full assessment including a battery of neuropsychological tests. Participants were also rated on the Clinical Dementia Rating (CDR) scale. The distribution of neuropsychological test scores within demographic strata, among those receiving a CDR of 0 (no dementia), are reported here as cognitive test norms. After combining individual test scores into cognitive domain composite scores, multiple linear regression models were used to examine associations of cognitive test performance with age and education.
In this cognitively normal sample of older adults, younger age and higher education were associated with better performance in all cognitive domains. Age and education together explained 22% of the variation of memory, and less of executive function, language, attention, and visuospatial function.
Older age and lesser education are differentially associated with worse neuropsychological test performance in cognitively normal older adult representatives of the community at large. The distribution of scores in these participants can serve as population-based norms for these tests, and can be especially useful to clinicians and researchers assessing older adults outside specialty clinic settings.
These analyses examine the psychometric properties of the Free and Cued Selective Reminding Test with Immediate Recall (FCSRT-IR). FCSRT-IR is a measure of memory under conditions that control attention and cognitive processing in order to obtain an assessment of memory unconfounded by normal agerelated changes in cognition. FCSRT-IR performance has been associated with preclinical and early dementia in several longitudinal epidemiological studies. Factor and item response theory analyses were applied to FCSRT-IR data from patients at a geriatric primary care center who had independently established clinical diagnoses. The results provide supporting evidence for the psychometric adequacy of the FCSR-IR in terms of reliability, essential (sufficient) unidimensionality, information across the continuum of memory disability/ability, and classification accuracy. The psychometric adequacy of the FCSRT-IR adds further validity to its use as a case finding strategy for dementia.
To test the hypothesis that different neurocognitive networks underlie verbal fluency deficits in frontotemporal lobar degeneration (FTLD).
Letter ("FAS") and semantic ("animal") fluency tests were administered to patients with a behavioral/dysexecutive disorder (bvFTLD; n = 71), semantic dementia (SemD; n = 21), and progressive nonfluent aphasia (PNFA; n = 26). Tests measuring working memory, naming/lexical retrieval, and semantic knowledge were also obtained. MRI voxel-based morphometry (VBM) studies were obtained on a subset of these patients (bvFTLD, n = 51; PNFA, n = 11; SemD, n = 10).
Patients with SemD were disproportionately impaired on the semantic fluency measure. Reduced output on this test was correlated with impaired performance on naming/lexical retrieval tests. VBM analyses related reduced letter and semantic fluency to anterior and inferior left temporal lobe atrophy. Patients with bvFTLD were equally impaired on both fluency tests. Poor performance on both fluency tests was correlated with low scores on working memory and naming/lexical retrieval measures. In this group, MRI-VBM analyses related letter fluency to bilateral frontal atrophy and semantic fluency to left frontal/temporal atrophy. Patients with PNFA were also equally impaired on fluency tests. Reduced semantic fluency output was correlated with reduced performance on naming/lexical retrieval tests. MRI-VBM analyses related semantic fluency to the right frontal lobe and letter fluency to left temporal atrophy.
Distinct neurocognitive networks underlie impaired performance on letter and semantic fluency tests in frontotemporal lobar degeneration subgroups.
As part of the Spanish Multicenter Normative Studies (NEURONORMA project), we provide age- and education-adjusted norms for the following instruments: verbal span (digits), visuospatial span (Corsi's test), letter-number sequencing (WAIS-III), trail making test, and symbol digit modalities test. The sample consists of 354 participants who are cognitively normal, community-dwelling, and age ranging from 50 to 90 years. Tables are provided to convert raw scores to age-adjusted scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments. The current norms should provide clinically useful data for evaluating elderly Spanish people. These data may be of considerable use for comparisons with other normative studies. Limitations of these normative data are mainly related to the techniques of recruitment and stratification employed.
The Rey–Osterrieth complex figure (ROCF) and the free and cued selective reminding test (FCSRT) are frequently used in clinical
practice. The ROCF assesses visual perception, constructional praxis, and visuospatial memory, and the FCSRT assesses verbal
learning and memory. As part of the Spanish Normative Studies (NEURONORMA), we provide age- and education-adjusted norms for
the ROCF (copy and memory) and for the FCSRT. The sample consists of 332 and 340 participants, respectively, who are cognitively
normal, community dwelling, and ranging in age from 50 to 94 years. Tables are provided to convert raw scores to age-adjusted
scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments.
Although age and education affected the score of the ROCF and FCSRT, sex was found to be unrelated in this normal sample.
The normative data presented here were obtained from the same study sample as all other NEURONORMA norms and the same statistical
procedures were applied. These co-normed data will allow clinicians to compare scores from one test with all the tests included
in the project.
This study forms part of the Spanish Multicenter Normative Studies (NEURONORMA project). Normative data for people aged over 49 years are presented for selected tasks of the visual object and space perception battery (VOSP) and for the judgment of line orientation (JLO) test. Age-adjusted norms were derived from a sample of 341 participants who are cognitively normal and community-dwelling. Age- and education-adjusted norms are also provided. Years of education were modeled on age-scaled scores to derive regression equations that were applied for further demographic adjustments. The normative information provided here should prove useful for characterizing and interpreting individual test performances as well as comparing the scores from these tests with any other test using NEURONORMA norms.
Lexical fluency tests are frequently used in clinical practice to assess language and executive function. As part of the Spanish multicenter normative studies (NEURONORMA project), we provide age- and education-adjusted norms for three semantic fluency tasks (animals, fruit and vegetables, and kitchen tools), three formal lexical tasks (words beginning with P, M, and R), and three excluded letter fluency tasks (excluded A, E, and S). The sample consists of 346 participants who are cognitively normal, community dwelling, and ranging in age from 50 to 94 years. Tables are provided to convert raw scores to age-adjusted scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments. The current norms should provide clinically useful data for evaluating elderly Spanish people. These data may also be of considerable use for comparisons with other international normative studies. Finally, these norms should help improve the interpretation of verbal fluency tasks and allow for greater diagnostic accuracy.
As part of the Spanish Multicenter Normative Studies (NEURONORMA project), we provide age- and education-adjusted norms for
the Boston naming test and Token test. The sample consists of 340 and 348 participants, respectively, who are cognitively
normal, community-dwelling, and ranging in age from 50 to 94 years. Tables are provided to convert raw scores to age-adjusted
scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments.
Age and education affected the score of the both tests, but sex was found to be unrelated to naming and verbal comprehension
efficiency. Our norms should provide clinically useful data for evaluating elderly Spaniards. The normative data presented
here were obtained from the same study sample as all the other NEURONORMA norms and the same statistical procedures for data
analyses were applied. These co-normed data allow clinicians to compare scores from one test with all tests.
This paper describes the methods and sample characteristics of a series of Spanish normative studies (The NEURONORMA project).
The primary objective of our research was to collect normative and psychometric information on a sample of people aged over
49 years. The normative information was based on a series of selected, but commonly used, neuropsychological tests covering
attention, language, visuo-perceptual abilities, constructional tasks, memory, and executive functions. A sample of 356 community
dwelling individuals was studied. Demographics, socio-cultural, and medical data were collected. Cognitive normality was validated
via informants and a cognitive screening test. Norms were calculated for midpoint age groups. Effects of age, education, and
sex were determined. The use of these norms should improve neuropsychological diagnostic accuracy in older Spanish subjects.
These data may also be of considerable use for comparisons with other normative studies. Limitations of these normative data
are also commented on.
Normative data for neuropsychological tests are often presented in the form of percentiles. One problem when using percentile norms stems from uncertainty over the definitional formula for a percentile. (There are three co-existing definitions and these can produce substantially different results.) A second uncertainty stems from the use of a normative sample to estimate the standing of a raw score in the normative population. This uncertainty is unavoidable but its extent can be captured using methods developed in the present paper. A set of reporting standards for the presentation of percentile norms in neuropsychology is proposed. An accompanying computer program (available to download) implements these standards and generates tables of point and interval estimates of percentile ranks for new or existing normative data.
Neuropsychological evaluations conducted in the United States and abroad commonly include the use of tests translated from English to Spanish. The use of translated naming tests for evaluating predominately Spanish-speakers has recently been challenged on the grounds that translating test items may compromise a test's construct validity. The Texas Spanish Naming Test (TNT) has been developed in Spanish specifically for use with Spanish-speakers; however, it is unlikely patients from diverse Spanish-speaking geographical regions will perform uniformly on a naming test. The present study evaluated and compared the internal consistency and patterns of item-difficulty and -discrimination for the TNT and two commonly used translated naming tests in three countries (i.e., United States, Colombia, Spain). Two hundred fifty two subjects (136 demented, 116 nondemented) across three countries were administered the TNT, Modified Boston Naming Test-Spanish, and the naming subtest from the CERAD. The TNT demonstrated superior internal consistency to its counterparts, a superior item difficulty pattern than the CERAD naming test, and a superior item discrimination pattern than the MBNT-S across countries. Overall, all three Spanish naming tests differentiated nondemented and moderately demented individuals, but the results suggest the items of the TNT are most appropriate to use with Spanish-speakers. Preliminary normative data for the three tests examined in each country are provided.
Although age-related memory differences between young and older adults have been well documented, fewer studies have investigated memory changes in middle age. We examined the performance of healthy middle-aged adults (40–55 years of age; n = 32) in relation to healthy young (18–25 years of age; n = 57) and older adults (65+ years of age; n = 55) on variations of recognition discriminability (RD) indices derived from the California Verbal Learning Test-Second Edition (CVLT-II). Middle-aged adults performed significantly worse (ps < .05) than young adults on multiple RD indices that incorporate semantically related distractor items, suggesting memory changes in middle age may be associated with increased susceptibility to semantic interference. Moreover, middle-aged adults performed comparably to older adults across all RD indices, indicating the recognition profile of middle-aged adults on RD indices more closely resembles that of older adults than young adults.
Obtaining one or more low scores, or scores indicative of impairment, is
common in neuropsychological batteries that include several measures even among cognitively normal individuals. However, the expected number of low scores in batteries with differing number of tests is unknown. Using 10 neuropsychological measures from the National Alzheimer’s Coordinating Center database, 1,023 permutations were calculated from a sample of 5,046 cognitively normal individuals. The number of low scores (i.e., z-score≤-1.5) varied for the same number of measures and among different number of measures, and did not increase
linearly as the number of measures increased. According to the number
of low scores shown by fewer than 10% of the sample, cognitive
impairment should be suspected for one or more, two or more, and three
or more in batteries with up to two measures, 3-9 measures, and 10
measures respectively. These results may increase the identification of
mild cognitive impairment.
This work aims to analyze encoding impairments using new assessment scores in patients with naMCI who present to memory clinics with subjective cognitive complaints. The sample included 102 participants, of whom 28 were classified as healthy controls (HC), 24 as amnestic MCI (aMCI), 24 as naMCI and 26 patients as Alzheimer's disease (AD). Research outcomes were the Encoding, Consolidation and Retrieval deficit indices from the Item Specific Deficit Approach, and traditional indices (immediate total recall, delayed cued recall, delayed total recall) derived from the Free and Cued Selective Reminding Test (FCSRT). We found no differences in immediate recall or delayed recall between HC and naMCI on the FCSRT, both scoring higher than aMCI and AD. naMCI showed encoding deficits in between HC and aMCI, with no differences between naMCI and HC on consolidation or retrieval deficit indices. The ISDA indices were better than traditional indices to discriminate between HC and naMCI (sensitivity: 70.8%, specificity: 78.6%), whereas the opposite pattern was found between naMCI and aMCI (sensitivity: 70.8%, specificity: 91.7%). New indices derived from neuropsychological tests may help to identify objective memory impairments in naMCI. Whether these new indices are useful for predicting conversion to AD needs further research.
Objectives
To assess the utility of verbal fluency discrepancy scores in predicting progression to Alzheimer's disease (AD) in a cohort of individuals with mild cognitive impairment (MCI).
Design
Case control.
Setting
Cases identified from new referrals to a memory clinic and controls identified from The Irish Longitudinal Study on Ageing.
Participants
Of 308 individuals with MCI at baseline identified from consecutive referrals to a memory clinic and compared at with age‐, sex‐, and education‐matched controls (n=302), 161 completed 2 years of follow‐up or progressed to AD during the study period.
Measurements
Verbal fluency discrepancy (semantic–phonemic fluency) scores at baseline were calculated for each participant. Each case was followed with repeated neuropsychological measurements, and multidisciplinary consensus diagnosis was recorded.
Results
Mean discrepancy score for those who progressed to AD (2.7) was significantly lower than for those who retained a MCI diagnosis (4.8) and normal controls (7.7) (p<.001). Logistic regression revealed that, for each unit decrease in discrepancy score at baseline, the odds of progressing to AD were 9% greater. (Exp(B) = 1.09, p=.02)
Conclusion
Individuals with MCI have less of a semantic advantage than those without MCI. Those with MCI presenting with a phonemic advantage at initial assessment warrant close follow‐up and a high index of suspicion for progression to AD.
Objective:
The extent to which increasing age is associated with impairment in cognitive function, termed cognitive aging, may have been overestimated in prior studies. The inclusion of individuals with severe or uncontrolled systemic medical illness or prodromal neurodegenerative disease in normal aging samples is likely to bias estimates toward lower cognitive performance and inflate estimates of variability.
Method:
Unbiased estimates of cognitive aging in 658 adults aged 60-84, who underwent rigorous screening to ensure their general and cognitive health, were computed. The first study screened the psychometric properties of a battery of neuropsychological tests in order to identify those with optimal properties to evaluate cognitive aging. The second study used the selected tests to compare baseline performance within 5-year age bands from 60 to 84.
Results:
The first study identified a battery of 12 tests that provided reliable measures of memory, psychomotor speed, attention, and executive function and were appropriate for investigating age-related cognitive changes. The second study observed moderate to large age-related impairment for performance on tests of complex psychomotor function, category fluency, verbal learning, and verbal and visual memory. No, or only small, age effects were observed for working memory, phonemic fluency, learning of visual information, and reaction time.
Conclusions:
These data suggested that while increasing age is associated with impairment in cognitive function, this impairment is less severe and is evident only on more complex neuropsychological tests than estimated previously in samples selected using less rigorous criteria to ensure cognitive health.
The International Working Group on Alzheimer's disease (AD) suggested the free and cued selective reminding test (FCSRT) to assess memory, as it showed high sensitivity and specificity in the differentiation of AD from healthy controls and other dementias. The FCSRT involves the use of selective reminding with semantic cueing in memory assessment. This study aims to validate the FCSRT for mild cognitive impairment (MCI) and AD through the analysis of the diagnostic accuracy and the suggestion of cut-off scores. Patients were classified into two groups according to standard criteria: MCI (n = 100) and AD (n = 70). A matched control group (n = 101) of cognitively healthy subjects was included. The reliability and the validity of the FCSRT were analysed on the immediate (IR) and delayed (DR) recalls. The Cronbach's alpha was 0.915 for the IR and 0.879 for the DR. The total recall measures revealed good areas under the curve for MCI (IR: .818; DR: .828) and excellent for AD (IR: .987; DR: .991). Furthermore, the MCI group was subdivided with respect to a non-similar/similar AD pattern of impairment, with almost half of the subjects showing an AD-like decline. This analysis represents a novel contribution regarding the properties of the FCSRT in illustrating the heterogeneity of MCI at baseline. The FCSRT has proved to be a very useful tool in the characterization of the memory impairment of the AD spectrum.
Abstract The topic of multiple forms of memory is considered from a biological point of view. Fact-and-event (declarative, explicit) memory is contrasted with a collection of non conscious (non-declarative, implicit) memory abilities including skills and habits, priming, and simple conditioning. Recent evidence is reviewed indicating that declarative and non declarative forms of memory have different operating characteristics and depend on separate brain systems. A brain-systems framework for understanding memory phenomena is developed in light of lesion studies involving rats, monkeys, and humans, as well as recent studies with normal humans using the divided visual field technique, event-related potentials, and positron emission tomography (PET).
Even though theories and research have pointed out the importance of variables such as age, gender, or education on neuropsychological assessment, much less emphasis has been placed on language and culture. With the increasing population of Spanish speakers in North America and the limited amount of clinical and scholarly information currently available, neuropsychological assessment of this group has similarly become of increasing importance. Though several studies have been published over the last two decades, an assumption exists that all Spanish speakers, holding education and age constant, would perform similarly regardless of their origin. To address this assumption, a sample of 126 participants was tested from four different countries (Chile, Dominican Republic, Puerto Rico, and Spain). Participants were compared on the following commonly used neuropsychological tests: Verbal Serial Learning Curve, Rey- Osterrieth Complex Figure Test, Verbal Phonemic Fluency Test, the Stroop Color and Word Test, and the Trail Making Test. Analyses revealed significant differences across the groups in two of the five tests administered. Significant differences were observed in the delayed recall of the Serial Learning Test and in the Verbal Fluency Test. The findings highlight the importance of within-group differences between Spanish speakers.
Symptom validity testing (SVT) has become a major theme of contemporary neuropsychological research. However, many issues about the meaning and interpretation of SVT findings will require the best in research design and methods to more precisely characterize what SVT tasks measure and how SVT test findings are to be used in neuropsychological assessment. Major clinical and research issues are overviewed including the use of the “effort” term to connote validity of SVT performance, the use of cut-scores, the absence of lesion-localization studies in SVT research, neuropsychiatric status and SVT performance and the rigor of SVT research designs. Case studies that demonstrate critical issues involving SVT interpretation are presented.
Two experiments address the nature of the word-frequency mirror effect in episodic recognition performance and the underlying cognitive changes that occur in both healthy aging and in early-stage Dementia of the Alzheimer's Type (DAT). In Experiment 1, five groups of participants (young, healthy old, healthy old-old, very mildly demented individuals, and mildly demented individuals) studied lists of high- and low-frequency words and were given a yes/no episodic recognition test. The results indicated that there was a dramatic decrease in hit rate for low-frequency words across age and DAT, but no decrease for high-frequency words, thereby eliminating the low-frequency advantage typically found in recognition performance for the DAT individuals. For the distractor items, there was a clear advantage in rejecting low-frequency words compared to high-frequency words, and the size of this advantage was constant across groups of participants. This between-group pattern was replicated in a second experiment, in which only young adults were required to respond either under short or long response deadlines. The results are discussed with respect to an attentional control framework in which cognitively impaired groups of participants, and young adults at a short response deadline, rely more on baseline familiarity processes than on recollection-based processes. Discussion focuses on the nature of the recollection- and familiarity-based processes.
The National Institute on Aging and the Alzheimer's Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer's disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Biomarker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia.
Neuroimaging measures and chemical biomarkers may be important indices of clinical progression in normal aging and mild cognitive impairment (MCI) and need to be evaluated longitudinally.
To characterize cross-sectionally and longitudinally clinical measures in normal controls, subjects with MCI, and subjects with mild Alzheimer disease (AD) to enable the assessment of the utility of neuroimaging and chemical biomarker measures.
A total of 819 subjects (229 cognitively normal, 398 with MCI, and 192 with AD) were enrolled at baseline and followed for 12 months using standard cognitive and functional measures typical of clinical trials.
The subjects with MCI were more memory impaired than the cognitively normal subjects but not as impaired as the subjects with AD. Nonmemory cognitive measures were only minimally impaired in the subjects with MCI. The subjects with MCI progressed to dementia in 12 months at a rate of 16.5% per year. Approximately 50% of the subjects with MCI were on antidementia therapies. There was minimal movement on the Alzheimer's Disease Assessment Scale-Cognitive Subscale for the normal control subjects, slight movement for the subjects with MCI of 1.1, and a modest change for the subjects with AD of 4.3. Baseline CSF measures of Abeta-42 separated the 3 groups as expected and successfully predicted the 12-month change in cognitive measures.
The Alzheimer's Disease Neuroimaging Initiative has successfully recruited cohorts of cognitively normal subjects, subjects with mild cognitive impairment (MCI), and subjects with Alzheimer disease with anticipated baseline characteristics. The 12-month progression rate of MCI was as predicted, and the CSF measures heralded progression of clinical measures over 12 months.
Use of a search procedure to control processing during learning results in apparently normal cued recall by some amnesic patients with impaired free-recall learning. This suggests that their ability to encode and retrieve may be relatively intact when they are induced to carry out effective processing during learning. When processing is controlled during learning, cued recall should be useful for neuropsychological evaluation of residual learning and memory capacity.
Normal persons show better recognition memory for rare than for common words. In the first experiment, we examined this word frequency effect in 17 patients with dementia of the Alzheimer type (DAT) and 20 normal controls of equivalent age and education. The DAT patients showed a normal tendency to false alarm to common words but failed to show the normal rare word advantage in their hit rate. In a second experiment, we examined normal memory immediately and after a delay of 1 week when it is approximately equivalent to that of DAT patients. There was no attenuation of the usual rare word advantage. These findings suggest that DAT patients fail to encode the featural and intrastructural elements of to-be-remembered verbal information and that this processing deficit may contribute to their impaired recognition memory performance.
Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations. The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT). Reliability, validity, and correlational data are discussed. The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired.