The Autism Diagnostic Observation Schedule (ADOS) is widely used to assess symptoms of autism spectrum disorder (ASD). Given well-documented differences in social behaviors across cultures, this ...study examined whether item-level biases exist in ADOS scores across sociodemographic groups (race, ethnicity, and gender). We examined a subset of ten ADOS items among participants (N = 2458). Holding level of overall ADOS behavioral symptoms constant, we found significant item level bias (measurement noninvariance) for race and ethnicity on three ADOS items. Item-level bias was not apparent across gender. Although the magnitude of bias was small, our findings highlight the need to reevaluate norms and operational definitions used in assessments to increase ASD diagnostic accuracy among culturally-diverse groups.
Abstract Introduction As the relationship between delirium and long-term cognitive decline has not been well-explored, we evaluated this association in a prospective study. Methods SAGES is an ...ongoing study involving 560 adults age 70 years or more without dementia scheduled for major surgery. Delirium was assessed daily in the postoperative period using the Confusion Assessment Method. General Cognitive Performance (GCP) and the Informant Questionnaire for Cognitive Decline in the Elderly were assessed preoperatively then repeatedly out to 36 months. Results On average, patients with postoperative delirium had significantly lower preoperative cognitive performance, greater immediate (1 month) impairment, equivalent recovery at 2 months, and significantly greater long-term cognitive decline relative to the nondelirium group. Proxy reports corroborated the clinical significance of the long-term cognitive decline in delirious patients. Discussion Cognitive decline after surgery is biphasic and accelerated among persons with delirium. The pace of long-term decline is similar to that seen with mild cognitive impairment.
Background
Practice effects (PEs) are improvements in performance after repeated exposure to test materials, and typically viewed as a source of bias in repeated cognitive assessments. We aimed to ...determine whether characterizing PEs could also provide a useful marker of early cognitive decline.
Methods
We conducted a systematic review of the literature, searching PsycInfo (Ebsco) and PubMed databases for articles studying PEs in aging and dementia populations. Articles published between 1920 and 2019 were included.
Result
We identified 259 articles, of which 27 studied PEs as markers of cognitive performance. These studies consistently showed that smaller, less‐robust PEs were associated with current diagnostic status and/or future cognitive decline. In addition, lower PEs were associated with Alzheimer's disease risk factors and neurodegeneration biomarkers.
Conclusion
PEs provide a potentially useful marker of cognitive decline, and could prove valuable as part of a cost‐effective strategy to select individuals who are at‐risk for dementia for future interventions.
Introduction
Composite scores may be useful to summarize overall language or visuospatial functioning in studies of older adults.
Methods
We used item response theory to derive composite measures for ...language (ADNI‐Lan) and visuospatial functioning (ADNI‐VS) from the cognitive battery administered in the Alzheimer's Disease Neuroimaging Initiative (ADNI). We evaluated the scores among groups of people with normal cognition, mild cognitive impairment (MCI), and Alzheimer's disease (AD) in terms of responsiveness to change, association with imaging findings, and ability to differentiate between MCI participants who progressed to AD dementia and those who did not progress.
Results
ADNI‐Lan and ADNI‐VS were able to detect change over time and predict conversion from MCI to AD. They were associated with most of the pre‐specified magnetic resonance imaging measures. ADNI‐Lan had strong associations with a cerebrospinal fluid biomarker pattern.
Discussion
ADNI‐Lan and ADNI‐VS may be useful composites for language and visuospatial functioning in ADNI.
Introduction
Our goal was to determine if features of surgical patients, easily obtained from the medical chart or brief interview, could be used to predict those likely to experience more rapid ...cognitive decline following surgery.
Methods
We analyzed data from an observational study of 560 older adults (≥70 years) without dementia undergoing major elective non‐cardiac surgery. Cognitive decline was measured using change in a global composite over 2 to 36 months following surgery. Predictive features were identified as variables readily obtained from chart review or a brief patient assessment. We developed predictive models for cognitive decline (slope) and predicting dichotomized cognitive decline at a clinically determined cut.
Results
In a hold‐out testing set, the regularized regression predictive model achieved a root mean squared error (RMSE) of 0.146 and a model r‐square (R2) of .31. Prediction of “rapid” decliners as a group achieved an area under the curve (AUC) of .75.
Conclusion
Some of our models could predict persons with increased risk for accelerated cognitive decline with greater accuracy than relying upon chance, and this result might be useful for stratification of surgical patients for inclusion in future clinical trials.
Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment.
To develop and ...validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method.
Validation analysis in 2 independent cohorts.
Three academic medical centers.
The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older.
A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated.
Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend < 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend < 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend < 0.001).
Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older.
The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes.
National Institute on Aging.
Abstract
Background
Assessment of self‐perceived cognitive decline (SCD) is relevant in the context of Alzheimer’s disease and related disorders, but heterogeneity in measurement limits its ...interpretability and usability. Selection of optimal content for a questionnaire measuring SCD requires statistical information and expert opinion to ensure reliability as well as acceptability and feasibility. This study aims to survey experts about their perspectives on essential features of SCD measurement.
Method
The survey was distributed through the ISTAART Subjective Cognitive Decline PIA, International Neuropsychological Society’s Dementia Special Interest Group, and authors’ professional networks. Targeted experts included professionals working with older adults with SCD through research and/or clinical practice. Main topics were item content, item format, and questionnaire features. Topics were evaluated with multiple choice questions and open‐ended questions. Furthermore, experts were shown items from existing SCD questionnaires with relatively high information value as identified in a previous statistical harmonization effort using Item Response Theory analyses (see Rabin et al., 2021), and asked to select items they viewed as most relevant. Frequency analyses were performed.
Result
Ninety‐one experts (66% female) across four continents completed the questionnaire (Table 1). Thirty‐nine experts (43%) indicated routinely using an instrument to assess SCD (17 different instruments were mentioned). Seventy‐nine experts (87%) perceived a need for a harmonized SCD instrument. Whereas most experts (72%) responded that a questionnaire should measure both current ability and change in ability, views on the most relevant timeframe varied substantially (top choices: past year (33%) and past six months (25%)). Figure 1a and 1b show that items with the highest statistical information value were not necessarily selected as most relevant by experts. Preferred practical features of a questionnaire were availability of an informant version and coverage of multiple cognitive domains (chosen by 13% and 14% respectively). Preferred validation approaches were distinguishing psychiatric illness from neurodegenerative disorders and the correlation with neuropsychological test performance (both chosen by 20%).
Conclusion
Despite agreeing on the need for a harmonized SCD instrument, experts express varying views on optimal content, format, and validation approaches. The complementary information derived from statistical results and expert opinion can facilitate more comprehensive measurement of SCD.
Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD).
To determine risks for institutionalization, cognitive decline, or death ...associated with hospitalization and delirium in patients with AD.
Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry.
Community-based.
771 persons aged 65 years or older with a clinical diagnosis of AD.
Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs).
Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 95% CI, 1.9 to 11.6) and institutionalization (adjusted RR, 6.9 CI, 4.0 to 11.7). With delirium, risk for death (adjusted RR, 5.4 CI, 2.3 to 12.5) and institutionalization (adjusted RR, 9.3 CI, 5.5 to 15.7) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium.
Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data.
Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may represent an important strategy for reducing adverse outcomes in this population.
Repeated measure data design has been used extensively in a wide range of fields, such as brain aging or developmental psychology, to answer important research questions exploring relationships ...between trajectory of change and external variables. In many cases, such data may be collected from multiple study cohorts and harmonized, with the intention of gaining higher statistical power and enhanced external validity. When psychological constructs are measured using survey scales, a fundamental psychometric challenge for data harmonization is to create commensurate measures for the constructs of interest across studies. Traditional analysis may fit a unidimensional item response theory model to data from one time point and one cohort to obtain item parameters and fix the same parameters in subsequent analyses. Such a simplified approach ignores item residual dependencies in the repeated measure design on one hand, and on the other hand, it does not exploit accumulated information from different cohorts. Instead, two alternative approaches should serve such data designs much better: an integrative approach using multiple-group two-tier model via concurrent calibration, and if such calibration fails to converge, a Bayesian sequential calibration approach that uses informative priors on common items to establish the scale. Both approaches use a Markov chain Monte Carlo algorithm that handles computational complexity well. Through a simulation study and an empirical study using Alzheimer's diseases neuroimage initiative cognitive battery data (i.e., language and executive functioning), we conclude that latent change scores obtained from these two alternative approaches are more precisely recovered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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