Differential item functioning due to cognitive status does not impact depressive symptom measures in four heterogeneous samples of older adults

Subjective Cognitive Complaints: Predictors and Health Outcomes in People Living with HIV

There is a paucity of research on the prevalence of subjective cognitive complaints in people living with human immunodeficiency virus, along with the predictors and outcomes related to these complaints. We assessed demographics, substance use and psychiatric predictors, and HIV-related outcomes associated with subjective cognitive complaint items from the Cognitive Difficulties Scale. The sample consisted of 889 people living with HIV in the survey-based Florida Cohort. Results of multivariable regression models indicated that age (45-54), hazardous alcohol consumption, more frequent marijuana use and psychiatric symptoms (depression, anxiety, PTSD) were significant predictors of subjective cognitive complaints. Subjective cognitive complaints were associated with lower adherence to antiretroviral therapy in bivariate analyses, but this relationship was no longer significant after controlling for depression, race, alcohol and drug use. Further research into the relationship between depressive and subjective cognitive complaints may provide additional avenues for intervention.

Differential item functioning of the Beck Anxiety Inventory in a rural, multi-ethnic cohort

BACKGROUND

Evaluating measurement bias is vital to ensure equivalent assessment across diverse groups. One approach for evaluating test bias, differential item functioning (DIF), assesses item-level bias across specified groups by comparing item-level responses between groups that have the same overall score. Previous DIF studies of the Beck Anxiety Inventory (BAI) have only assessed bias across age, sex, and disease duration in monolingual samples. We expand this literature through DIF analysis of the BAI across age, sex, education, ethnicity, cognitive status, and test language.

METHODS

BAI data from a sample (n = 527, mean age=61.4 ± 12.7, mean education=10.9 ± 4.3, 69.3% female, 41.9% Hispanic/Latin American) from rural communities in West Texas, USA were analyzed. Item response theory (IRT) / logistic ordinal regression DIF was conducted across dichotomized demographic grouping factors. The Mann-Whitney U test and Hedge's g standardized mean differences were calculated before and after adjusting for the impact of DIF.

RESULTS

Significant DIF was demonstrated in 10/21 items. An adverse impact of DIF was not identified when demographics were assessed individually. Adverse DIF was identified for only one participant (1/527, 0.2%) when all demographics were aggregated.

LIMITATIONS

These results might not be generalizable to a sample with broader racial representation, more severe cognitive impairment, and higher levels of anxiety.

CONCLUSIONS

Minimal item-level bias was identified across demographic factors considered. These results support prior evidence that the BAI is valid for assessing anxiety across age and sex while contributing new evidence of its clinical relevance across education, ethnicity, cognitive status, and English/Spanish test language.

Association of remote traumatic brain injury and military employment with late-life trajectories of depressive symptom severity

BACKGROUND

Traumatic brain injury (TBI) and military service are common lifetime exposures among current older adults that may affect late-life mental health. The objective of the present study was to evaluate the association between TBI with loss of consciousness (LOC) and military employment and late-life depressive symptom severity trajectory.

METHODS

1445 males and 2096 females adults at least 65 years old without dementia or recent TBI were enrolled and followed biennially for up to 10 years in the Adult Changes in Thought study from Kaiser Permanente Washington in Seattle, Washington.

RESULTS

Using group-based trajectory modeling, we documented four distinct depressive symptom severity trajectories that followed a similar course in males and females (Minimal, Decreasing, Increasing, and Persistent). In multinomial regression analyses, TBI with LOC in males was associated with greater likelihood of Persistent versus Minimal depressive symptom severity compared to individuals without TBI (OR = 1.51, 95% CI: 1.01, 2.27; p=0.046). Males reporting past military employment had greater likelihood of Decreasing versus Minimal depressive symptom severity compared to individuals without past military employment (OR = 1.54, 95% CI: 1.03, 2.31; p=0.035). There was no association between TBI or military employment and depression trajectories in females, and no evidence of effect modification by age or between exposures.

LIMITATIONS

Lifetime history of TBI was ascertained retrospectively and may be subject to recall bias. Also, past military employment does not presuppose combat exposure.

CONCLUSIONS

Remote TBI and past military employment are relevant to late-life trajectories of depressive symptom severity in dementia-free older males.

Metabolic Syndrome and Cognitive Trajectories in the Framingham Offspring Study

Metabolic syndrome (MetS) has been linked to increased risk of developing cognitive impairment and dementia including Alzheimer's disease. It remains unclear whether and at what stage in the adult lifespan MetS and its components begin to alter the trajectory of cognitive performance. In the present study, 2,892 Framingham Offspring participants completed health assessments every four years since 1971 and underwent repeat neuropsychological testing from 1999 to 2014. We estimated the associations of levels and changes in cognitive trajectories with hazard of MetS using a joint growth/survival model. All models were adjusted for baseline age, sex, education, and smoking status. Findings showed that both mid-life and late-life MetS were associated with lower level of cognitive functioning but not cognitive trajectories. Associations were strongest among those who were nondemented and apolipoprotein (APOE) ɛ4 noncarriers. In addition, individuals with the most rapid cognitive decline were more likely to have MetS. The pattern of results showed that associations between MetS and cognition varied, depending upon whether the sample was stratified by genetic and cognitive status and whether we considered cognitive performance as a continuous variable or examined categorical groupings. Given that mid-life MetS was associated with poorer cognition at age 55, cognitive changes may occur early during the MetS process. Our findings suggest that those with MetS are at greater risk of dementia given their lower level of cognitive functioning and also suggest that MetS may be a risk factor for decline in the absence of known risk factors including the APOEɛ4 allele.

Patient-Reported Outcomes and Evidence-Based Practice in Speech-Language Pathology

Purpose The patient's perspective of their health is a core component of evidence-based practice (EBP) and person-centered care. Patient-reported outcomes (PROs), captured with PRO measures (PROMs), are the main way of formally soliciting and measuring the patient's perspective. Currently, however, PROs play a relatively small role in mainstream speech-language pathology practice. The purpose of this article is to raise important questions about how PROs could be applied to EBP in speech-language pathology for individuals with communication disorders and to propose preliminary approaches to address some of these questions. Method Based on a narrative review of the literature, this article introduces relevant terminology and broadly describes PRO applications in other health care fields. The article also raises questions related to PRO-informed clinical practice in speech-language pathology. To address some of these questions, the article explores previous research to provide suggestions for clinical administration, interpretation, and future research. Conclusion More routine measurement of subjective health constructs via PROMs-for example, constructs such as effort, participation, self-efficacy, and psychosocial functioning-may improve EBP. More routine use of PROMs could significantly expand the information that is available to clinicians about individual clients and add to the evidence base for the profession of speech-language pathology. However, careful consideration and more research are needed on how to capture and interpret PROs from individuals with cognitive and language disorders.

Associations Between Midlife (but Not Late-Life) Elevated Coronary Heart Disease Risk and Lower Cognitive Performance: Results From the Framingham Offspring Study

It is unclear how coronary heart disease (CHD) risk across the adult life span affects late-life cognition. We estimated associations of midlife and late-life elevated CHD risk with cognitive trajectories (general cognitive performance, processing speed/executive function, memory) in later life (after age 55 years or age 70 years) among 2,892 Framingham Offspring Study participants who had completed CHD risk assessments approximately every 4 years since 1971 and had undergone neuropsychological testing between 1999 and 2014. We stratified analyses by apolipoprotein E gene (APOE) Ɛ4 allele carrier status. Using linear mixed-effects models, elevated CHD risk in midlife (age 55 years) was associated with lower levels of general cognitive performance (β = -0.560 standard deviation (SD) units, 95% confidence interval (CI): -0.874, -0.246), executive function (β = -0.624 SD units, 95% CI: -0.916, -0.332), and memory (β = -0.560 SD units, 95% CI: -0.907, -0.213) at age 70 years but not with rates of cognitive change. Late-life (age 70 years) elevated CHD risk, however, was associated with somewhat better levels of general cognitive performance and memory. There were associations between duration of elevated CHD risk during midlife and levels (but not trajectories) of later-life cognitive outcomes. Associations were not modified by APOE-ɛ4 status. These findings suggest that midlife elevated CHD risk is associated with lower cognition, independently of APOE-ɛ4 status, suggesting that risk of vascular disease may not contribute a "second hit" to AD risk.

Differential item functioning analysis of items on the Geriatric Depression Scale-15 based on the presence or absence of cognitive impairment

OBJECTIVE

The Geriatric Depression Scale-15 (GDS-15) is a screener for depressive symptoms in older adults. The present study aims to investigate the differential item functioning (DIF) of the GDS-15 items to determine whether or not they are biased by the presence of cognitive impairment.

METHOD

Data from 215 older patients were used to examine the GDS-15. Individuals were categorized as cognitively impaired if they scored below the 10th percentile on the Mattis Dementia Rating Scale II. To evaluate DIF, configural invariance, metric invariance, scalar invariance, residual invariance, and factor variance were evaluated. Additional analyses were conducted to know the role identified DIF items play in the screening process.

RESULTS

Most levels of invariance indicated that items operated equivalently across groups (p > 0.05). However, analysis of scalar invariance indicated worse model fit (p = 0.001), such that the threshold for Item 13 differed between the groups. Freeing this threshold resulted in scalar invariance (p = 0.12).

CONCLUSIONS

Because partial measurement invariance was achieved suggesting that the tool as a whole functions similarly for older adults with and without cognitive impairment, professionals can be confident that the GDS-15 screens for depression as well in individuals with cognitive impairment as those without.

Anxiety symptoms bias memory assessment in older adults

BACKGROUND

Older adults with anxiety and/or depression experience additional memory dysfunction beyond that of the normal aging process. However, few studies have examined test bias in memory assessments due to anxiety and/or depressive symptoms. The current study investigated the influence of self-reported symptoms of anxiety and depression on the measurement equivalence of memory tests in older adults.

METHOD

This is a secondary analysis of the Advanced Cognitive Training for Independent and Vital Elderly dataset, a randomized controlled trial of community-dwelling older adults. Baseline data were included in this study (n = 2802). Multiple indicators multiple causes modeling was employed to assess for measurement equivalence, differential item functioning (DIF), in memory tests.

RESULTS

The DIF was present for anxiety symptoms but not for depressive symptoms, such that higher anxiety placed older adults at a disadvantage on measures of memory performance. Analysis of DIF impact showed that compared with participants scoring in the bottom quartile of anxious symptoms, participants in the upper quartile exhibited memory performance scores that were 0.26 standard deviation lower.

CONCLUSION

Anxious but not depressive symptoms introduce test bias into the measurement of memory in older adults. This indicates that memory models for research and clinical purposes should account for the direct relationship between anxiety symptoms and memory tests in addition to the true relationship between anxiety symptoms and memory construct. These findings support routine assessments of anxiety symptoms among older adults in settings in which cognitive testing is being conducted. Copyright © 2016 John Wiley & Sons, Ltd.

Dementia Risk and Protective Factors Differ in the Context of Memory Trajectory Groups

BACKGROUND

Previous research has identified multiple risk and protective factors for late onset Alzheimer's disease (LOAD). However, it is not known whether these risk and protective factors differ for individuals who are cognitively stable versus those already experiencing declines.

OBJECTIVE

This study examined how dementia risk factors differ across subgroups of older adults defined by memory trajectory. This line of research may lead to more individualized risk profiles.

METHODS

Risk factors for incident LOAD were compared across previously-validated groups of older adults exhibiting different memory trajectories ("Stable-High," "Stable-Low," "Decliner," "Rapid Decliner") using stratified Cox regressions. Participants included 2,593 racially/ethnically diverse older adults (mean age of 76 at study entry) in the Washington Heights-Inwood Columbia Aging Project.

RESULTS

Predictors of incident dementia differed across trajectory groups: older age only incurred independent risk in stable groups, education did not incur independent protection in the rapidly declining group, depression only incurred independent risk in the stable-low group, stroke incurred independent risk in the two extreme groups, and APOE-ɛ4 only incurred independent risk in the rapidly declining group.

CONCLUSION

The finding that different risk factors for LOAD were associated with specific memory trajectories may reflect the existence of resilience or vulnerability factors that modify the individual influences of risk/protective factors. This study highlights the utility of considering interactions between dementia risk factors and a patient's unique cognitive history.

Late-life depression symptom dimensions and cognitive functioning in the Longitudinal Aging Study Amsterdam (LASA)

BACKGROUND

Depression often co-occurs in late-life in the context of declining cognitive functions, but it is not clear whether specific depression symptom dimensions are differentially associated with cognitive abilities.

METHODS

The study sample comprised 3107 community-dwelling older adults from the Longitudinal Aging Study Amsterdam (LASA). We applied a Multiple Indicators Multiple Causes (MIMIC) model to examine the association between cognitive abilities and latent dimensions of the Center for Epidemiologic Studies Depression Scale (CES-D), while accounting for differential item functioning (DIF) due to age, gender and cognitive function levels.

RESULTS

A factor structure consisting of somatic symptoms, positive affect, depressed affect, and interpersonal difficulties fitted the data well. Higher levels of inductive reasoning were significantly associated with lower levels of depressed affect and somatic symptoms, whereas faster processing speed was significantly associated with lower levels of somatic symptoms. DIF due to age and gender was found, but the magnitude of the effects was small and did not alter substantive conclusions.

LIMITATIONS

Due to the cross-sectional context of this investigation, the direction of influence between depression symptom levels and cognitive function levels cannot be established. Furthermore, findings are relevant to non-clinical populations, and they do not clarify whether certain DIF effects may be found only at high or low levels of depression.

CONCLUSIONS

Our findings suggest differential associations between late-life depression dimensions and cognitive abilities in old age, and point towards potential etiological mechanisms that may underline these associations. These findings carry implications for the prognosis of cognitive outcomes in depressed older adults.

Do measures of depressive symptoms function differently in people with spinal cord injury versus primary care patients: the CES-D, PHQ-9, and PROMIS®-D

PURPOSE

To evaluate whether items of three measures of depressive symptoms function differently in persons with spinal cord injury (SCI) than in persons from a primary care sample.

METHODS

This study was a retrospective analysis of responses to the Patient Health Questionnaire depression scale, the Center for Epidemiological Studies Depression scale, and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS^®) version 1.0 eight-item depression short form 8b (PROMIS-D). The presence of differential item function (DIF) was evaluated using ordinal logistic regression.

RESULTS

No items of any of the three target measures were flagged for DIF based on standard criteria. In a follow-up sensitivity analyses, the criterion was changed to make the analysis more sensitive to potential DIF. Scores were corrected for DIF flagged under this criterion. Minimal differences were found between the original scores and those corrected for DIF under the sensitivity criterion.

CONCLUSIONS

The three depression screening measures evaluated in this study did not perform differently in samples of individuals with SCI compared to general and community samples. Transdiagnostic symptoms did not appear to spuriously inflate depression severity estimates when administered to people with SCI.