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1.  Cognitive correlates of HVOT performance differ between individuals with mild cognitive impairment and normal controls 
To clinically characterize performance on the Hooper Visual Organization Test (HVOT) among participants with mild cognitive impairment (MCI) and to identify naming and executive functioning correlates associated with HVOT performance among MCI participants and normal controls (NC).
The HVOT is a common neuropsychological instrument that measures visuospatial skills and agnosia. It has, however, been criticized for its multifactorial nature, as several studies have reported executive or language correlates of HVOT performance. To our knowledge, simultaneous comparison of executive functioning and language demands of the HVOT has never been performed among an older cohort.
The HVOT, two tests of executive functioning [Trail Making Test, Part B (TMT-B), Controlled Oral Word Association (COWA)] and two tests of naming [abbreviated Boston Naming Test (BNT), Animal Naming] were administered to 222 NC, 166 MCI, and 68 Alzheimer’s disease (AD) individuals.
HVOT scores were significantly different between all three groups in the expected direction (AD < MCI < NC). Linear regression among NC participants revealed that COWA, age, and BNT were significantly associated with HVOT scores, accounting for 12%, 6%, and 4% of HVOT variance, respectively. Among MCI participants, the BNT accounted for 43% of HVOT variance. Neither TMT-B nor Animal Naming was a significant predictor for either group.
Among NC participants, rapid word generation (i.e., COWA), a measure of executive functioning, is the most salient predictor of HVOT performance. In contrast, lexical retrieval (i.e., BNT) is the most salient language or executive functioning predictor of HVOT performance among MCI participants. These findings extend previous claims that the HVOT is multifactorial by suggesting that reduced HVOT performance in MCI patients may be related to mild lexical retrieval impairments.
PMCID: PMC2746420  PMID: 16893623
Object recognition; Mild cognitive impairment; Hooper Visual Organization Test
2.  Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs) 
Executive functioning has been repeatedly linked to the integrity of instrumental activities of daily living (IADL). The present study examined the association of multiple executive functioning elements (i.e., working memory, generation, inhibition, planning, and sequencing) to IADLs among an older adult cohort at risk for future cognitive and functional decline.
Seventy-two participants with prevalent but stable cardiovascular disease completed a neuropsychological protocol assessing multiple elements of executive functioning, including COWA, PASAT, DKEFS Color-Word Interference Test, DKEFS Trail-Making Test, DKEFS Tower Test, and Ruff Figural Fluency Test. Reliable informants completed a measure of IADLs.
Stepwise logistic regression selected a model involving a single significant predictor, a measure of inhibition (i.e., DKEFS Color-Word Interference Test), which had a significant regression coefficient. Subsequent correlation analyses confirmed an association between the inhibition measure and multiple IADL items. Inter-item comparisons among the IADLs revealed significant differences, such that telephone use and laundry were significantly more intact than most other IADLs while shopping and housekeeping were most compromised.
Our data suggest that inhibition, also known as susceptibility to interference, is most strongly related to IADL impairment among patients at risk for future cognitive and functional decline.
PMCID: PMC2746400  PMID: 16814980
Cardiovascular disease; Neuropsychology; Cognition; Executive functioning; Instrumental activities of daily living (IADLs); Delis-Kaplan Executive Function System (D-KEFS); Inhibition; Geriatric
3.  Practice effects in the prediction of long-term cognitive outcome in three patient samples: A novel prognostic index 
Practice effects, defined as improvements in cognitive test performance due to repeated exposure to the test materials, have traditionally been viewed as sources of error. However, they might provide useful information for predicting cognitive outcome. The current study used three separate patient samples (older adults with mild cognitive impairments, individuals who were HIV +, individuals with Huntington’s disease) to examine the relationship between practice effects and cognitive functioning at a later point. Across all three samples, practice effects accounted for as much as 31 to 83% of the variance in the follow-up cognitive scores, after controlling for baseline cognitive functioning. If these findings can be replicated in other patients with neurodegenerative disorders, clinicians and researchers may be able to develop predictive models to identify the individuals who are most likely to demonstrate continued cognitive decline across time. The ability to utilize practice effects data would add a simple, convenient, and non-invasive marker for monitoring an individual patient’s cognitive status. Additionally, this prognostic index could be used to offer interventions to patients who are in the earliest stages of progressive neurodegenerative disorders.
PMCID: PMC1847360  PMID: 17142007
practice effects; cognitive outcome; Mild Cognitive Impairment; HIV; Huntington’s disease
4.  The relation of education and gender on the attention items of the Mini-Mental State Examination in Spanish speaking Hispanic elders 
The Mini-Mental State Examination (MMSE) has frequently been challenged for its bias against individuals with lower levels of education and the use of scoring adjustments for lower educational levels has become standard practice. An additional source of concern is that original instructions specify that the “serial 7’s” item may be replaced by an apparently less difficult “backwards spelling” task. This study compared the performance on these items and the effects for total scores on 102 unimpaired and 58 memory impaired elder Hispanic individuals (age 54-98), divided into 3 groups based on educational level (<7, 7-11, and >11 years of education). The effects of education and gender on the total MMSE scores were analyzed using the “serial 7’s” and the “backwards spelling” items. For all the studied groups, MMSE scores were higher by an average of 1.5 points when using the “backwards spelling” task. Correlation between “serial 7’s” and “backwards spelling” was a modest .37. Education had a significant effect on the MMSE scores in both the impaired and the unimpaired groups. After controlling for education, gender also explains a significant proportion of the variance of the results. The “backwards spelling” and “serial 7’s” items do not appear to be either equivalent in difficulty or to test the same abilities in the unimpaired and the impaired Hispanics elders tested in this study. Published by Elsevier Ltd on behalf of National Academy of Neuropsychology.
PMCID: PMC1949339  PMID: 16968662
Mini-Mental Exam; Spanish; Education; Age; Gender; Culture; Cognition
5.  Does the scoring of late responses affect the outcome of the paced auditory serial addition task (PASAT)? 
The Paced Auditory Serial Addition Task (PASAT) is a cognitive task purported to measure working memory, speed of information processing, and sustained and divided attention (Spreen, O. & Strauss, E. (1998). A compendium of neuropsychological tests: administration, norms, and commentary (2nd ed.). New York, NY: Oxford University Press.) The current study examined whether treating late responses on the PASAT as correct or as incorrect can significantly affect the outcome of the test in individuals with Multiple Sclerosis (MS).
Subjects consisted of 59 individuals with MS and 37 healthy controls (HC). Scoring method was found to affect the number of individuals who were considered impaired on the PASAT. When participants were penalized for late responses significantly more participants, in both groups, were found to be impaired on the 2 s trial of the task (MS: p < 0.01; HC: p < 0.05).
Results indicate that that the specific scoring of the PASAT should be reported in studies that use the test.
PMCID: PMC1892177  PMID: 17067774
Multiple sclerosis; Processing speed; Working memory; PASAT; Scoring

Results 1-5 (5)