Normative data for healthy older adults and an abbreviated version of the Stroop test

Normative Data Estimation in Neuropsychological Tests: A Systematic Review

OBJECTIVE

To quantify the evolution, impact, and importance of normative data (ND) calculation by identifying trends in the research literature and what approaches need improvement.

METHODS

A PRISMA-guideline systematic review was performed on literature from 2000 to 2022 in PubMed, Pub-Psych, and Web of Science. Inclusion criteria included scientific articles about ND in neuropsychological tests with clear data analysis, published in any country, and written in English or Spanish. Cross-sectional and longitudinal studies were included. Bibliometric analysis was used to examine the growth, productivity, journal dispersion, and impact of the topic. VOSViewer compared keyword co-occurrence networks between 1952-1999 and 2000-2022.

RESULTS

Four hundred twelve articles met inclusion and exclusion criteria. The most studied predictors were age, education, and sex. There were a greater number of studies/projects focusing on adults than children. The Verbal Fluency Test (12.7%) was the most studied test, and the most frequently used variable selection strategy was linear regression (49.5%). Regression-based approaches were widely used, whereas the traditional approach was still used. ND were presented mostly in percentiles (44.2%). Bibliometrics showed exponential growth in publications. Three journals (2.41%) were in the Core Zone. VOSViewer results showed small nodes, long distances, and four ND-related topics from 1952 to 1999, and there were larger nodes with short connections from 2000 to 2022, indicating topic spread.

CONCLUSIONS

Future studies should be conducted on children's ND, and alternative statistical methods should be used over the widely used regression approaches to address limitations and support growth of the field.

Attention and processing speed tests: Normative data for Spanish-speaking adults in the United States

BACKGROUND

Hispanics/Latinos are the largest racial/ethnic group among underrepresented populations in the U.S. and multiple sociodemographic, cultural, and linguistic factors have been found to impact their performances on cognitive testing. Despite this, few normative data are available for the heterogeneous Spanish-speaking population in the U.S.

OBJECTIVE

To generate normative data on the Trail-Making Test (TMT), Bells Test, Symbol-Digit Modalities Test (SDMT), and the Brief Test of Attention (BTA) for Spanish speakers residing in the U.S.

METHODS

The sample included 245 Spanish-speaking individuals aged 18- 80 from eight states across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered attention and processing speed measures as part of a comprehensive neuropsychological battery. We used a Bayesian regression approach to estimate normative data, including covariates found to be important for predicting performances on measures of attention and processing speed.

RESULTS

Sociodemographic factors including education, time in the U.S., acculturation, age, and/or sex had differential effects on the TMT-A, TMT-B, SDMT, and the BTA whereas the Bells Test was not influenced by any of these sociodemographic factors.

CONCLUSION

Our findings indicate that while sex, age, and educational attainment are important factors to consider, language and acculturation can also influence attention and processing speed performances among Spanish speakers in the U.S.

Lifespan normative data (18-89 years) for Raven's Advanced Progressive Matrices Set I

Raven's Advanced Progressive Matrices (APM) Set I is a validated and brief test of fluid intelligence, ideal for use in busy clinical settings. However, there is a dearth of normative data allowing an accurate interpretation of APM scores. To address this, we present normative data from across the adult lifespan (18-89 years) for the APM Set I. Data are presented in five age cohorts (total N = 352), including two older adult cohorts (65-79 years and 80-89 years), which allows age-standardized assessment. We also present data from a validated measure of premorbid intellectual ability, which was absent from previous standardizations of longer forms of the APM. In line with previous findings, a striking age-related decline was noted, beginning relatively early in adulthood and most marked amongst lower-scoring individuals. Older adults did not demonstrate difficulty with specific test items or make an increased proportion of specific errors. Sex was not a significant predictor of performance. The data set is of particular use in the neuropsychological assessment of older adults, given the known susceptibility of fluid intelligence to both the effects of normal ageing and acquired brain injury in older age. The results are discussed in light of theories of neurological ageing.

Arterial Stiffness and Cardiorespiratory Fitness Are Associated With Cognitive Function in Older Adults

Age-related cognitive impairment has been associated with arterial stiffening and decreased cardiorespiratory fitness. The aims of this cross-sectional study were to compare cognitive function domains and cardiovascular parameters in older adults (≥ 65 years old) with high and normal aortic stiffness (via carotid-femoral pulse wave velocity, cfPWV) and to explore relationships among cfPWV, carotid intima-media thickness, cardiorespiratory fitness, and cognitive function. Vascular and cognitive function were measured in older adults with either normal or high cfPWV. Cognitive function was measured via an intensive one-time neuropsychological battery, while cfPWV by applanation tonometry, carotid intima-media thickness and function (i.e., distensibility) by ultrasonography, and cardiorespiratory fitness (i.e., VO₂peak) by a submaximal exercise test. Correlations among age, VO₂peak, carotid intima-media thickness, cfPWV, and cognitive function were performed along with a series of multivariate analyses of variance. Compared with NAS, participants with HAS had greater aortic, carotid, and brachial blood pressures but similar cardiorespiratory fitness and carotid intima-media thickness and distensibility. Participants with NAS exhibited better neuropsychological performance in executive function and attention and overall cognitive function than those with HAS. When controlling for age, visual scanning and perception scores were correlated with cfPWV and VO₂peak. Our findings suggest that certain cognitive domains for older adults are associated with their cardiorespiratory fitness and aortic stiffness.

Relationship of regular physical activity with neuroelectric indices of interference processing in young adults

The relationship of physical activity with interference processing was examined using behavioral and neuroelectrical measures in young adults divided into more active and less active groups. The participants completed Stroop (i.e., color-naming) and reverse Stroop (i.e., word-meaning) tasks that differed in the level of difficulty while event-related potentials were assessed. In the low interference Stroop task, participants were asked to respond to the ink color of the word, while the meaning was either congruent or incongruent with the color. In the high interference reverse Stroop task, participants had to indicate the meaning of colored words while ignoring the color of the font. The results indicated that young adults in the more active group exhibited a shorter response time (RT) and a lower intra-individual variability of RT than did those in the less active group. These behavioral differences were associated with larger P2 and P3 and smaller N450 amplitudes in the Stroop task and with larger P2 and N2 and smaller N450 amplitudes in the reverse Stroop task. No differences were observed in the contingent negative variation (CNV) between the groups. These findings suggest that, for young adults, regular physical activity is positively associated with a better neural efficiency in resource allocation for tasks that require the ability to inhibit cognitive interference and provide evidence for the potential neural mechanisms underlying the improved Stroop performance.

Effects of Neural Mechanisms of Pretask Resting EEG Alpha Information on Situational Awareness: A Functional Connectivity Approach

OBJECTIVE

In this study, the influence of pretask resting neural mechanisms on situational awareness (SA)-task is studied.

BACKGROUND

Pretask electroencephalography (EEG) information and Stroop effect are known to influence task engagement independently. However, neural mechanisms of pretask resting absolute alpha (PRAA) and pretask resting alpha frontal asymmetry (PRAFA) in influencing SA-task which is undergoing Stroop effect is still not understood.

METHOD

The study involved pretask resting EEG measurements from 18 healthy individuals followed by functional magnetic resonance imaging (fMRI) acquisition during SA-task. To understand the effect of pretask alpha information and Stroop effect on SA, a robust correlation between mean reaction time, SA Index, PRAA, and PRAFA were assessed. Furthermore, neural underpinnings of PRAA, PRAFA in SA-task, and functional connectivity were analyzed through the EEG-informed fMRI approach.

RESULTS

Significant robust correlation of reaction time was observed with SA Index (Pearson: r = .50, pcorr = .05) and PRAFA (Pearson: r = .63; pcorr = .01), respectively. Similarly, SA Index significantly correlated with PRAFA (Pearson: r = .56, pcorr = .01; Spearman: r = .61, pcorr = .007), and PRAA (Pearson: r = .59, pcorr = .005; Spearman: r = .59, pcorr = .002). Neural underpinnings of SA-task revealed regions involved in visual-processing and higher-order cognition. PRAA was primarily underpinned at frontal-temporal areas and functionally connected to SA-task regions pertaining to the emotional regulation. PRAFA has correlated with limbic and parietal regions, which are involved in integration of visual, emotion, and memory information of SA-task.

CONCLUSION

The results suggest a strong association of reaction time with SA-task and PRAFA and strongly support the hypothesis that PRAFA, PRAA, and associated neural mechanisms significantly influence the outcome of SA-task.

APPLICATION

It is beneficial to study the effect of pretask resting information on SA-task to improve SA.

The Cost of Intrinsic and Extrinsic Cognitive Demands on Auditory Functioning in Older Adults With Normal Hearing or Using Hearing Aids

OBJECTIVES

We investigated the impact of both intrinsic and extrinsic cognitive demands on auditory and secondary task performance in older adults with normal hearing (NH) and adults using hearing aids (HAs) in an ecologically relevant listening environment.

DESIGN

Fifteen adults with NH and 15 adults using HAs (60 to 72 years of age) were recruited to perform the "Audiovisual True-to-Life Assessment of Auditory Rehabilitation"-paradigm (AVATAR), which combines an auditory-visual speech-in-noise task with three secondary tasks on either auditory localization or visual short-term memory in a preload multitask paradigm. Intrinsic demands were altered by presenting speech either at equivalent speech accuracy levels of 50% correct (SPIN50%) or equivalent speech-to-noise ratios of +5dB SNR (SPIN+5dB). We manipulated the amount of extrinsic cognitive demands by including one (dual condition) or three secondary tasks (quadruple condition). Performance decrements on the secondary tasks were considered to reflect an increase in resource allocation to speech understanding and thus an increase in listening effort. In addition, we administered a cognitive test battery as well as a questionnaire on self-reported hearing difficulties and subjective measures of effort and motivation.

RESULTS

Speech understanding and secondary task performance on the visual short-term memory task were lower in the SPIN50% condition compared to SPIN+5dB. Whereas speech understanding at SPIN50% was equally high in the dual and quadruple conditions, the quadruple condition resulted in lower secondary task performance on the visual short-term memory task, higher levels of self-reported effort, and lower motivation compared to the dual-task condition. The same was true for experimental conditions at SPIN+5dB. Additionally, adults with NH outperformed adults using HAs on speech understanding, auditory localization, and self-reported hearing abilities, but no group differences were observed on secondary task costs or cognitive measures.

CONCLUSIONS

This study showed that, irrespective of the hearing status of the listener, speech performance was not affected by the amount of extrinsic cognitive demands, but was worse and required more effort under conditions with a more negative SNR. Also, increasing the extrinsic cognitive demands resulted in lower performance on one of the secondary tasks, suggesting that more complex listening environments require more effort. Although adults with NH outperformed HA users on speech understanding and auditory localization, the two groups did not differ with respect to secondary task costs.

The Number of Items on Each Stroop Test Card Is Unrelated to Its Sensitivity

OBJECTS

Different variations of the Stroop Color-Word Test (SCWT) exist and the tests differ in the number of items on each test card. The optimal number of items per card of the SCWT is unclear.

METHODS

A comprehensive neuropsychological battery including the SCWT was administered to 237 cognitively normal controls (NC), 221 patients with mild cognitive impairment (MCI), and 160 patients with Alzheimer's disease (AD). We compared the accuracy for different items of card C (SCWT-C10accuracy, SCWT-C24accuracy, and SCWT-C50accuracy) in distinguishing patients with MCI and AD from NC.

RESULTS

The correct responses for different items of card C were ranked in the order: NC > MCI > AD group and mild AD > moderate AD, except for SCWT-C24accuracy. The validity of SCWT-C24accuracy was similar to that of SCWT-C50accuracy for discriminating MCI and AD from NC, as well as different levels of AD.

CONCLUSION

We concluded that the number of items on the accuracy of the response was unrelated to its sensitivity to deficits and we preferred the 24-item version in daily clinical use.

The Stroop Color and Word Test

The Stroop Color and Word Test (SCWT) is a neuropsychological test extensively used to assess the ability to inhibit cognitive interference that occurs when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute, well-known as the Stroop Effect. The aim of the present work is to verify the theoretical adequacy of the various scoring methods used to measure the Stroop effect. We present a systematic review of studies that have provided normative data for the SCWT. We referred to both electronic databases (i.e., PubMed, Scopus, Google Scholar) and citations. Our findings show that while several scoring methods have been reported in literature, none of the reviewed methods enables us to fully assess the Stroop effect. Furthermore, we discuss several normative scoring methods from the Italian panorama as reported in literature. We claim for an alternative scoring method which takes into consideration both speed and accuracy of the response. Finally, we underline the importance of assessing the performance in all Stroop Test conditions (word reading, color naming, named color-word).

The effects of multimodal exercise on cognitive and physical functioning and brain-derived neurotrophic factor in older women: a randomised controlled trial

OBJECTIVE

to test the effect of a 16-week multimodal exercise program on neurocognitive and physical functioning and brain-derived neurotrophic factor (BDNF).

DESIGN

a single-blinded, parallel-group randomised controlled trial.

SETTINGS

university campus and community-based halls.

SUBJECTS

forty-nine women aged 65 to 75 years, with no cognitive impairment and not undertaking more than 1 h of formal exercise training per week.

METHODS

the intervention group attended a 60-min multimodal class twice each week which included cardiovascular, strength and motor fitness training. The primary outcome was neurocognitive functioning and secondary outcomes were physical functioning and plasma levels of BDNF.

RESULTS

twenty-five participants were randomised to the intervention group and 24 to the control group. One control participant withdrew before follow-up data collection. The intervention group performed significantly better than the control group at follow-up (when controlled for baseline) in the Trail Making test A and B, the California Older Adult Stroop test (Word, Interference and Total scores), Controlled Oral Word Association test and the Timed Up-and-Go test, Six-Minute Walk test, One-Legged Stance test and plasma BDNF.

CONCLUSION

this multimodal exercise program resulted in neurocognitive and physical performance improvements and increased levels of plasma BDNF, in older women, when compared with controls. This RCT provides evidence that a multimodal exercise intervention can achieve larger effect sizes than those generally resulting from single modality interventions. Increases in BDNF levels imply neurogenesis may be a component of the mechanism underpinning the cognitive improvements associated with multimodal exercise.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registration Number: ANZCTR12612000451808.

Evaluation of a 10-minute version of the Attention Network Test

The widely used Java version of the Attention Network Test (ANT), which can be downloaded from https://www.sacklerinstitute.org/cornell/assays_and_tools/ , takes approximately 20 minutes to complete. A shorter version would be useful in clinical or applied research settings where many tests are administered. We assessed how well a new 10-minute version of the ANT agrees with the 20-minute version. Response time (RT) measures from the shorter version correlated very highly with the corresponding measures from the 20-minute version (Pearson correlations ranging from .88 to .92). Therefore RT measures from the shorter version can safely be used in place of those same measures from the 20-minute version. Correlations for the three network scores (alerting, orienting and conflict efficiency) were not as strong (range = .10 to .53). This is not surprising, given that the network scores are difference scores. Further research is needed to determine whether adequate reliability can be achieved for the network scores without unduly increasing the length of the task.