Beta-mapping and beta-regression for changes of ordinal-rating measurements on Likert scales: A comparison of the change scores among multiple treatment groups

Association between oral health and cognitive function among Chinese older adults: the Taizhou imaging study

BACKGROUND

We aimed to investigate the association between oral health and cognitive function in a sample of older adults from a Chinese rural community.

METHODS

The cross-sectional cognitive function of 677 individuals were assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A comprehensive profile of the oral health status was evaluated by questionnaire and clinical examination.

RESULTS

Multiple covariates-adjusted regression models demonstrated decayed teeth (DT) and decayed/missing/filled teeth (DMFT) were negatively associated with MoCA score (all p < 0.05). Calculus index (CI) and clinical attachment loss (CAL) were significantly associated with the lower MoCA, short-term memory and executive function score, respectively (all p < 0.05). Additionally, participants with missing teeth unrestored tend to get lower MMSE and MoCA scores (p < 0.05). The results also showed that increased DT and CI were modestly associated with higher odds of cognitive impairment (p < 0.05).

CONCLUSIONS

There is an association between oral health and global cognition. Poor periodontal status was strongly associated with worse global cognition performance, especially in the short-term memory and executive domain for the aging population.

The Effects of Brain Magnetic Resonance Imaging Indices in the Association of Olfactory Identification and Cognition in Chinese Older Adults

Background

Olfactory identification dysfunction frequently occurs in individuals with cognitive decline; however, a pathological mechanism linking the two has not been discovered. We aimed to study the association between olfactory identification and cognitive function, and determine the effects of brain regions atrophy therein.

Methods

A total of 645 individuals (57.5% were female) from the Taizhou Imaging Study, who underwent cognitive and olfactory identification measurements, were included. A subsample of participants underwent brain magnetic resonance imaging (n = 622). Cognition was assessed with a neuropsychological battery. Olfactory identification was measured using a 12-item Sniffin’ Sticks test. Beta and logistic regressions were used to elucidate the association between olfactory identification and cognition, and the effects of brain regions atrophy in this association.

Results

Dementia was diagnosed in 41 (6.4%) individuals (mean age = 64.8 years), and mild cognitive impairment (MCI) in 157 (24.3%) individuals (mean age = 64.4 years). Olfactory identification was associated with MMSE and MoCA (both P < 0.001) and specific cognitive domains (memory, executive function, visuospatial function, and language; all P < 0.05). Higher olfactory identification was associated with lower likelihood of MCI and dementia (P < 0.05). The amygdala volume was significantly related to olfactory identification, MMSE, MoCA, and language, and could attenuate the association between olfactory identification and cognitive function.

Conclusion

The association between olfactory identification and cognition can be partly attributable to differences in amygdala volume, suggesting that the amygdala could be a shared neural substrate that links olfactory identification and cognitive function. Limitations of this study include that all these results were based on a cross-sectional study.

Total Cerebral Small Vessel Disease Burden Is Related to Worse Performance on the Mini-Mental State Examination and Incident Dementia: A Prospective 5-Year Follow-Up

Individual cerebral small vessel disease (CSVD) may cause cognitive decline. However, the association between total burden of CSVD and cognitive deterioration in the general population remains unclear. We aimed to determine whether total CSVD score is associated with cognitive performance change and incident dementia in the general population. In the longitudinal population-based Taizhou Imaging Study, 556 participants free of neurological disorders underwent brain MRI and neuropsychological testing at baseline. A total of 456 participants were followed up for cognitive performance for a mean (standard deviation) of 4.6 (0.6) years. Total CSVD score (range 0-4) was calculated by assigning 1 point for the presence of each of the following markers: lacune, white matter hyperintensity, cerebral microbleed, and perivascular space. Beta regression was used to evaluate the association between total CSVD burden and MMSE score change. The association of prevalent CSVD with incident dementia was studied using Fisher's exact test. CSVDs were present in 262 individuals (47.1%). The total CSVD score was significantly associated with MMSE score decline (p = 0.001). Compared to those with no CSVD, participants with 4 CSVD markers had a steeper decline in MMSE score (β: -0.53, 95% CI: -0.86 to -0.21; p = 0.001). A total of 15 participants developed dementia during follow-up. The presence of more than three CSVD markers at baseline was associated with a significantly higher risk of dementia (p = 0.020). Total CSVD burden appears to be associated with MMSE score decline and incident dementia in a general population in China.

Considerations in testing treatment effects on transient event driven health status changes measured by patient reported outcomes

Many treatments and drugs are intended to reduce the occurrence of negative events of interest, control the severity of the events, accelerate recovery from the events, or a combination of these effects. While assessing the clinical effect is typically the primary objective of a trial, testing the treatment effect on the health status of patients based on patient reported outcome (PRO) can be a useful component in determining the value of a treatment. Analysis of PROs in this setting, however, face the following challenges: the PRO value immediately after the event occurrence is often not captured, and the effect of the event on health status measured by the PRO is transient as subjects recover over time. Therefore, traditional statistical methods used to assess treatment effects suffer from low power for PROs. In this manuscript, we apply a kernel smoothing technique to estimate before- and after-event PRO values. We also propose new test outcomes based on observed and estimated PRO values and evaluate tests that focus on the tail distributions. We demonstrate that the tail distribution tests using the new outcomes can achieve high power under certain conditions.

Translation, Adaptation, and Validation of the Brazilian Version of the Dickman Impulsivity Inventory (Br-DII)

Impulsivity has mainly been described as a negative or dysfunctional characteristic associated with several disorders. However, impulsivity is not only related to dysfunctional outcomes and may explain individual differences in optimal human functioning as well. The Dickman Impulsivity Inventory (DII) is a self-report instrument measuring both the dysfunctional and the functional aspects of impulsivity. In this study, we performed the translation and cultural adaptation of the DII to the Brazilian context and analyzed its psychometric properties. Translation and cultural adaptation followed a rigorous process, which relied on an expert panel in the cross-cultural adaptation of psychological instruments. Data from 405 undergraduate students were obtained for the Brazilian version of the DII (Br-DII). The 23 items of the Br-DII was considered unsuitable according to model fit indices of the Confirmatory Factor Analysis (both for Oblique and Orthogonal models). Exploratory Factor Analysis showed an 18 items version of the Br-DII to be suitable (CFI = 0.92; TLI = 0.90, and RMSEA = 0.057). The DII's 18 items version also showed adequate Cronbach's alpha, intraclass correlation coefficient, and convergent and discriminant validity with the BIS-11. Therefore, the Br-DII demonstrated reliability and validity in the measurement of functional and dysfunctional impulsivity.

CDF-quantile distributions for modelling random variables on the unit interval

This paper introduces a two-parameter family of distributions for modelling random variables on the (0,1) interval by applying the cumulative distribution function of one 'parent' distribution to the quantile function of another. Family members have explicit probability density functions, cumulative distribution functions and quantiles in a location parameter and a dispersion parameter. They capture a wide variety of shapes that the beta and Kumaraswamy distributions cannot. They are amenable to likelihood inference, and enable a wide variety of quantile regression models, with predictors for both the location and dispersion parameters. We demonstrate their applicability to psychological research problems and their utility in modelling real data.

Psychometric features of an assessment instrument with likert and dichotomous response formats

OBJECTIVE

To assess the psychometric properties of a Likert-formatted assessment instrument after altering the responses to a dichotomous format.

DESIGN AND SAMPLE

This methodological study used a 15-item instrument to obtain data from 183 participants who responded in both Likert and dichotomous formats. Response sets from each format were compared.

MEASURES

Each response set underwent factor analysis, Kuder-Richardson 20, Cronbach's α coefficient, item-total correlation, and parallel form equivalence tests.

RESULTS

Factor loads of the instrument varied between .362 and .754 when responses were Likert-formatted and between .370 and .713 when responses were dichotomous. The Cronbach's α coefficient with Likert-formatted responses was .858; the Kuder-Richardson 20 coefficient of the dichotomous responses was .827. Parallel form equivalences were significant at the level of r = .753.

CONCLUSIONS

The instrument had valid results when either Likert or dichotomous responses were obtained.

Exposure-response modeling of clinical end points using latent variable indirect response models

Exposure-response modeling facilitates effective dosing regimen selection in clinical drug development, where the end points are often disease scores and not physiological variables. Appropriate models need to be consistent with pharmacology and identifiable from the time courses of available data. This article describes a general framework of applying mechanism-based models to various types of clinical end points. Placebo and drug model parameterization, interpretation, and assessment are discussed with a focus on the indirect response models.