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1.  Executive ability and physical performance in urban Black older adults 
Abstract
Executive dysfunction is correlated with disability in tasks of daily living. Less is known about the relationship between cognition, particularly executive dysfunction, and physical performance. This study investigated how executive ability, measured by the Trail Making Test, Part B (TMT-B), Controlled Oral Word Association test (COWA) and Animal Naming (AN), related to completion of physical tasks on the Short Physical Performance Battery (SPPB). The sample included 68 urban-dwelling Black adults ages 59–95. AN and TMT-B accounted for 6.2% and 7.1% of the variance, respectively, in SPPB total score after controlling for general cognitive functioning (Mini Mental Status Exam) and demographics. COWA and the MMSE did not obtain significance. Only the TMT-B remained significant after accounting for illness burden. Findings suggest that executive ability is related to physical performance in older urban Black adults more than general cognitive functioning. This relationship is attenuated by illness burden.
doi:10.1016/j.acn.2008.06.003
PMCID: PMC2577195  PMID: 18650058
Disability; Executive function; Short Physical Performance Battery; Cognition; Older adults
2.  Robust norms for selected neuropsychological tests in older adults 
Abstract
The current study provided longitudinal robust norms for individuals age 70 years and older for several neuropsychological tests. We compared baseline neuropsychological test performance in three groups free of dementia at baseline: a robust normative sample free of dementia for at least two post-follow-up assessments, an incident dementia sample which developed new onset dementia during the follow-up and a lost to follow-up (LTF) sample. ANCOVAs showed that the robust sample performed better on all neuropsychological tests compared to the incident dementia and LTF samples. These findings support the argument that individuals in transition to developing dementia may reduce the mean, increase the variability and therefore underestimate cognitive performance in normal aging. We suggest that longitudinal robust norms may help mitigate the limitations inherent in cross-sectional normative samples.
doi:10.1016/j.acn.2008.05.004
PMCID: PMC2610426  PMID: 18572380
Aging; Norms; Dementia; Attrition
3.  Utility of the RBANS in detecting cognitive impairment associated with Alzheimer's disease: Sensitivity, specificity, and positive and negative predictive powers 
Abstract
Although initially developed as a brief dementia battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not yet demonstrated its sensitivity, specificity, and positive and negative predictive powers in detecting cognitive impairment in patients with Alzheimer's disease (AD). Therefore, the current study examined the clinical utility of the RBANS by comparing two age-, education-, and gender-matched groups: patients with AD (n=69) and comparators (n=69). Significant differences (p<0.001) were observed on the RBANS Total score, all 5 Indexes, and all 12 subtests, with patients performing worse than the comparison participants. An optimal balance between sensitivity and specificity on RBANS scores was obtained when cutoffs of one and one and a half standard deviations below the mean of the comparison sample were implemented. Areas under the Receiver Operating Characteristic curves for all RBANS Indexes were impressive though Immediate and Delayed Memory Indexes were excellent (0.96 and 0.98, respectively). Results suggest that RBANS scores yield excellent estimates of diagnostic accuracy and that the RBANS is a useful screening tool in detection of cognitive deficits associated with AD.
doi:10.1016/j.acn.2008.06.004
PMCID: PMC2570647  PMID: 18639437
Alzheimer's disease; Dementia; Diagnostic accuracy; Repeatable Battery for the Assessment of Neuropsychological Status
4.  Neuropsychological measures probably facilitate heritability research of ADHD 
Abstract
Previous studies, in which cognitive and motor neuropsychological tasks were administered to 816 children from Attention-Deficit/Hyperactivity Disorder (ADHD)- and control-families, showed that various of these measures appeared useful for genetic research in ADHD by forming candidate endophenotypes: underlying, heritable, vulnerability traits that mark an enhanced liability for developing ADHD. The current study extends these findings by showing that six of these ten measures correlate more strongly between siblings than an ADHD composite, suggesting these measures may have a larger heritability than ADHD itself. Significant sibling cross-correlations also suggested that six of ten neuropsychological measures related to similar familial (and heritable) factors as ADHD, suggesting these measures to be useful for ADHD genetic research. An aggregated neuropsychological composite appeared to be the most powerful, since it correlated more strongly between siblings than most individual task measures. These findings suggest heritability research in ADHD will probably be facilitated by including neuropsychological measures.
doi:10.1016/j.acn.2008.06.002
PMCID: PMC3895968  PMID: 18635338
Endophenotype; Phenotype; ADHD; Heritability; Neuropsychology; Siblings
5.  An updated version of the Weigl discriminates adults with dementia from those with mild impairment and healthy controls☆ 
Dementia screening batteries often fall short on measures of executive functioning. The Weigl Color Form Sorting Test (WCFST) is a candidate for inclusion in such batteries, but can be insensitive to mild disturbance. The WCFST consists of 12 colored geometric shapes and requires the patient to sort the pieces by color or form, and then shift to the other sorting principle unassisted. We created a modified version of the WCFST (the Weigl-R) with increased conceptual complexity by adding two stimulus dimensions (texture and central shapes). The range of scores was also increased by adding the extent of examiner assistance required to achieve a correct sort, ability to verbalize conceptual strategy, and number of perseverations. We administered the Weigl-R to a group of 30 patients with mixed dementias, 34 adults with cognitive impairment without dementia, and 21 healthy controls. The new measure discriminated well between healthy controls and older adults with either cognitive impairment without dementia, or dementia. The Weigl-R may be a useful adjunct to brief dementia batteries but requires further validation.
doi:10.1016/j.acn.2007.11.002
PMCID: PMC2760247  PMID: 18093797
Dementia; Executive functioning; Neuropsychology; Conceptual reasoning
6.  Clock Drawing Performance in Cognitively Normal Elderly 
The Clock Drawing Test (CDT) is a common neuropsychological measure sensitive to cognitive changes and functional skills (e.g., driving test performance) among older adults. However, normative data have not been adequately developed. We report the distribution of CDT scores using three common scoring systems (Mendez, Ala, and Underwood, 1992; Freund, Gravenstein, Ferris, Burke, & Shaheen, 2005; and Cahn, Salmon, Monsch, Butters, Wiederholt, & Corey-Bloom, 1996), among 207 cognitively normal elderly. The systems were well correlated, took little time to use, and had high inter-rater reliability. We found statistically significant differences in CDT scores based on age and WRAT-3 Reading score, a marker of education quality. We present means, standard deviations, and t- and z-scores based on these subgroups. We found that “normal” CDT performance includes a wider distribution of scores than previously reported. Our results may serve as useful comparisons for clinicians wishing to know whether their patients perform in the general range of cognitively normal elderly.
doi:10.1016/j.acn.2007.12.003
PMCID: PMC2752157  PMID: 18243644
Clock Drawing Test; clock drawing; normal aging; normative data; scoring systems; neuropsychological tests; elderly; Alzheimer’s disease; mild cognitive impairment; dementia; cognitive decline; cognitive screening
7.  Verbal Fluency Performance in Amnestic MCI and Older Adults with Cognitive Complaints 
Verbal fluency tests are employed regularly during neuropsychological assessments of older adults, and deficits are a common finding in patients with Alzheimer’s disease (AD). Little extant research, however, has investigated verbal fluency ability and subtypes in preclinical stages of neurodegenerative disease. We examined verbal fluency performance in 107 older adults with amnestic mild cognitive impairment (MCI, n = 37), cognitive complaints (CC, n = 37) despite intact neuropsychological functioning, and demographically-matched healthy controls (HC, n = 33). Participants completed fluency tasks with letter, semantic category, and semantic switching constraints. Both phonemic and semantic fluency were statistically (but not clinically) reduced in amnestic MCI relative to cognitively intact older adults, indicating subtle changes in both the quality of the semantic store and retrieval slowing. Investigation of the underlying constructs of verbal fluency yielded two factors: Switching (including switching and shifting tasks) and Production (including letter, category, and action naming tasks), and both factors discriminated MCI from HC albeit to different degrees. Correlational findings further suggested that all fluency tasks involved executive control to some degree, while those with an added executive component (i.e., switching and shifting) were less dependent on semantic knowledge. Overall, our findings highlight the importance of including multiple verbal fluency tests in assessment batteries targeting preclinical dementia populations and suggest that individual fluency tasks may tap specific cognitive processes.
doi:10.1016/j.acn.2008.01.005
PMCID: PMC2743541  PMID: 18339515
Mild cognitive Impairment; Verbal Fluency; Assessment; Cognition
8.  Robust norms for selected neuropsychological tests in older adults 
The current study provided longitudinal robust norms for individuals age 70 years and older for several neuropsychological tests. We compared baseline neuropsychological test performance in three groups free of dementia at baseline: a robust normative sample free of dementia for at least two post-follow-up assessments, an incident dementia sample which developed new onset dementia during the follow-up and a Lost to Follow-up (LTF) sample. ANCOVAs showed that the robust sample performed better on all neuropsychological tests compared to the incident dementia and LTF samples. These findings support the argument that individuals in transition to developing dementia may reduce the mean, increase the variability and therefore underestimate cognitive performance in normal aging. We suggest that longitudinal robust norms may help mitigate the limitations inherent in cross-sectional normative samples.
doi:10.1016/j.acn.2008.05.004
PMCID: PMC2610426  PMID: 18572380
Aging; Norms; Dementia; Attrition
10.  Utility of the RBANS in detecting cognitive impairment associated with Alzheimer’s disease: Sensitivity, specificity, and positive and negative predictive powers 
Although initially developed as a brief dementia battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not yet demonstrated its sensitivity, specificity, and positive and negative predictive powers in detecting cognitive impairment in patients with Alzheimer’s disease (AD). Therefore, the current study examined the clinical utility of the RBANS by comparing two age-, education-, and gender-matched groups: patients with AD (n=69) and comparators (n=69). Significant differences (p<0.001) were observed on the RBANS Total score, all five Indexes, and all twelve subtests, with patients performing worse than the comparison participants. An optimal balance between sensitivity and specificity on RBANS scores was obtained when cutoffs of one and one and a half standard deviations below the mean of the comparison sample were implemented. Areas under the Receiver Operating Characteristic curves for all RBANS Indexes were impressive though Immediate and Delayed Memory Indexes were excellent (0.96 and 0.98, respectively). Results suggest that RBANS scores yield excellent estimates of diagnostic accuracy and that the RBANS is a useful screening tool in detection of cognitive deficits associated with AD.
doi:10.1016/j.acn.2008.06.004
PMCID: PMC2570647  PMID: 18639437
Alzheimer’s disease; dementia; diagnostic accuracy; Repeatable Battery for the Assessment of Neuropsychological Status
12.  Prediction of ADHD in Boys and Girls Using the D-KEFS 
To examine patterns of executive dysfunction associated with ADHD, 123 children (54 ADHD, 69 controls) ages 8–16 years were administered selected subtests from the Delis-Kaplan Executive Function System (D-KEFS). Children with ADHD performed significantly worse than controls on measures of both basic (less executive demand) skills and those with more executive demand from the Color-Word Interference and Tower subtests; however, no group differences were noted on any of the D-KEFS contrast scores. Most subtype comparisons yielded no differences; however, children with the Combined subtype outperformed children with the Inattentive subtype on measures of both basic and executive skills from the Trail Making Test. Children with ADHD demonstrate executive dysfunction that is identified by both D-KEFS summary, but not contrast scores. In this carefully screened sample of children with ADHD, few significant differences were found between groups suggesting limited sensitivity or specificity of the D-KEFS for classifying children with ADHD.
doi:10.1016/j.acn.2007.12.004
PMCID: PMC2427435  PMID: 18243646
ADHD; Subtype; Executive Function; Classification; Children; Pediatrics
13.  Prospective Memory in HIV Infection: Is “Remembering to Remember” a Unique Predictor of Self-reported Medication Management? 
Optimal adherence to antiretroviral medications is critical to the effective long-term management of HIV infection. Although prospective memory (ProM; i.e., “remembering to remember”) has long been theorized to play an important role in medication adherence, no prior studies have evaluated whether HIV-associated ProM impairment possesses unique predictive value in this regard. Results from this study demonstrate a robust association between ProM impairment and self-reported medication management in 87 HIV-infected persons currently prescribed antiretroviral medications. Specifically, more frequent ProM complaints and performance deficits on both laboratory and semi-naturalistic ProM tasks were all independently related to poorer self-reported medication management. A series of hierarchical regression analyses revealed that HIV-associated ProM impairment accounted for a significant amount of variance in self-reported medication management beyond that which was explained by other factors known to predict nonadherence, including mood disorders, psychosocial variables, environmental structure, and deficits on a traditional battery of neuropsychological tests. Overall, these findings support the hypothesis that ProM captures a unique and largely untapped aspect of cognition that is germane to optimal medication adherence. The potential benefits of individualized remediation strategies that are informed by conceptual models of ProM and specifically target medication adherence warrant further exploration.
doi:10.1016/j.acn.2007.12.006
PMCID: PMC2408931  PMID: 18243645
Human immunodeficiency virus; Neuropsychological assessment; Episodic memory; Treatment compliance

Results 1-13 (13)