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Kiselica AM, Karr JE, Mikula CM, Ranum RM, Benge JF, Medina LD, Woods SP. Recent Advances in Neuropsychological Test Interpretation for Clinical Practice. Neuropsychol Rev 2024; 34:637-667. [PMID: 37594687 DOI: 10.1007/s11065-023-09596-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/28/2023] [Indexed: 08/19/2023]
Abstract
Much attention in the field of clinical neuropsychology has focused on adapting to the modern healthcare environment by advancing telehealth and promoting technological innovation in assessment. Perhaps as important (but less discussed) are advances in the development and interpretation of normative neuropsychological test data. These techniques can yield improvement in diagnostic decision-making and treatment planning with little additional cost. Brooks and colleagues (Can Psychol 50: 196-209, 2009) eloquently summarized best practices in normative data creation and interpretation, providing a practical overview of norm development, measurement error, the base rates of low scores, and methods for assessing change. Since the publication of this seminal work, there have been several important advances in research on development and interpretation of normative neuropsychological test data, which may be less familiar to the practicing clinician. Specifically, we provide a review of the literature on regression-based normed scores, item response theory, multivariate base rates, summary/factor scores, cognitive intraindividual variability, and measuring change over time. For each topic, we include (1) an overview of the method, (2) a rapid review of the recent literature, (3) a relevant case example, and (4) a discussion of limitations and controversies. Our goal was to provide a primer for use of normative neuropsychological test data in neuropsychological practice.
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Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA.
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Cynthia M Mikula
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| | - Rylea M Ranum
- Department of Health Psychology, University of Missouri, 115 Business Loop 70 W, Columbia, MO, 65203, USA
| | - Jared F Benge
- Department of Neurology, University of Texas-Austin, TX, Austin, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
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Khan D, Edgell H, Rotondi M, Tamim H. The association between shift work exposure and cognitive impairment among middle-aged and older adults: Results from the Canadian Longitudinal Study on Aging (CLSA). PLoS One 2023; 18:e0289718. [PMID: 37610977 PMCID: PMC10446236 DOI: 10.1371/journal.pone.0289718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Shift work, especially rotating and night shift work, has been linked to a wide range of detrimental health outcomes. Occupational factors like shift work and their potential impact on cognitive functions have received little attention, and the evidence is inconclusive. The objective of our study is to explore associations between shift work exposure and cognitive impairment indicators based on comparisons with the normative standards from the Canadian population. METHODS Cross-sectional analyses were performed using baseline Canadian Longitudinal Study on Aging database, including 47,811 middle-aged and older adults (45-85 years). Three derived shift work variables were utilized: ever exposed to shift work, shift work exposure in longest job, and shift work exposure in current job. Four cognitive function tests were utilized, Rey Auditory Verbal Learning Tests (immediate and delayed) representing memory domain, and Animal Fluency, and Mental Alteration, representing the executive function domain. All cognitive test scores included in study were normalized and adjusted for the participant's age, sex, education and language of test administration (English and French), which were then compared to normative data to create "cognitive impairment' variables. Unadjusted and adjusted multivariable logistic regression models were used to determine associations between shift work variables and cognitive impairment individually (memory and executive function domains), and also for overall cognitive impairment. RESULT Overall, one in every five individuals (21%) reported having been exposed to some kind of shift work during their jobs. Exposure to night shift work (both current and longest job) was associated with overall cognitive impairment. In terms of domain-based measures, night shift work (longest job) was associated with memory function impairment, and those exposed to rotating shift work (both current and longest job) showed impairment on executive function measures, when compared to daytime workers. CONCLUSION This study suggests disruption to the circadian rhythm, due to shift work has negative impact on cognitive function in middle-aged and older adults and this warrants further investigation.
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Affiliation(s)
- Durdana Khan
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Heather Edgell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Grewal KS, Gowda-Sookochoff R, Kirk A, Morgan DG, O'Connell ME. Base rates of low neuropsychological test scores in older adults with subjective cognitive impairment: Findings from a tertiary memory clinic. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 37155741 DOI: 10.1080/23279095.2023.2208699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Base rates of low scores are typically determined from normative samples, which differ from clinical samples. We examined base rates of spuriously low scores for 93 older adults with subjective cognitive impairment presenting to a memory clinic. Crawford's Monte Carlo simulation algorithm was used to estimate multivariate base rates by calculating the percentage of cognitively intact memory clinic patients who produced normed scores at or below the 5th percentile. Neuropsychological tests included: Weschler Adult Intelligence Scale block design, digit span backwards, coding, Weschler Memory Scale logical memory immediate/delayed; California Verbal Learning Test immediate/delayed memory; Brief Visuospatial Memory Test immediate/delayed; and Delis-Kaplan Executive Functioning category switching, letter number sequencing, and inhibition/switching. An estimated 33.58% of the cognitively intact memory clinic population would have one or more low scores, 14.7% two or more, 6.55% three or more, 2.94% four or more, and 1.31% 5 or more due to chance. Base rates were then applied to a subset of clinical data: all with dementia and most with MCI had low scores that exceeded the base rates. Determining base rates of spuriously low scores on a neuropsychological battery in clinical samples could reduce false positives by using empirical adjustments for expected low scores.
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Affiliation(s)
- Karl S Grewal
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | | | - Andrew Kirk
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
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O'Connell ME, Kadlec H, Griffith LE, Maimon G, Wolfson C, Taler V, Simard M, Tuokko H, Voll S, Kirkland S, Raina P. Methodological considerations when establishing reliable and valid normative data: Canadian Longitudinal Study on Aging (CLSA) neuropsychological battery. Clin Neuropsychol 2022; 36:2168-2187. [PMID: 34470568 DOI: 10.1080/13854046.2021.1954243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Creation of normative data with regression corrections for demographic covariates reduces risk of small cell sizes compared with traditional normative approaches. We explored whether methods of correcting for demographic covariates (e.g., full regression models versus hybrid models with stratification and regression) and choice of covariates (i.e., correcting for age with or without sex and/or education correction) impacted reliability and validity of normative data. Method: Measurement invariance for sex and education was explored in a brief telephone-administered cognitive battery from the Canadian Longitudinal Study on Aging (CLSA; after excluding persons with neurological conditions N = 12,350 responded in English and N = 1,760 in French). Results: Measurement invariance was supported in hybrid normative models where different age-based regression models were created for groups based on sex and education level. Measurement invariance was not supported in full regression models where age, sex, and education were simultaneous predictors. Evidence for reliability was demonstrated by precision defined as the 95% inter-percentile range of the 5th percentile. Precision was higher for full regression models than for hybrid models but with negligible differences in precision for the larger English sample. Conclusions: We present normative data for a remotely administered brief neuropsychological battery that best mitigates measurement bias and are precise. In the smaller French speaking sample, only one model reduced measurement bias, but its estimates were less precise, underscoring the need for large sample sizes when creating normative data. The resulting normative data are appended in a syntax file.
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Affiliation(s)
- Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Helena Kadlec
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Geva Maimon
- CLSA Data Curation Centre, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Christina Wolfson
- Neuroepidemiology Research Unit, Montreal General Hospital, Montreal, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Martine Simard
- School of Psychology, Laval University and Centre de recherche CERVO de l'Institut universitaire en santé mentale de Québec, Québec City, Canada
| | - Holly Tuokko
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Stacey Voll
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Susan Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Parminder Raina
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster Institute for Research on Aging & Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
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Pérez-Zepeda MU, Godin J, Armstrong JJ, Andrew MK, Mitnitski A, Kirkland S, Rockwood K, Theou O. Frailty among middle-aged and older Canadians: population norms for the frailty index using the Canadian Longitudinal Study on Aging. Age Ageing 2021; 50:447-456. [PMID: 32805022 DOI: 10.1093/ageing/afaa144] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND frailty is a public health priority now that the global population is ageing at a rapid rate. A scientifically sound tool to measure frailty and generate population-based reference values is a starting point. OBJECTIVE in this report, our objectives were to operationalize frailty as deficit accumulation using a standard frailty index (FI), describe levels of frailty in Canadians ≥45 years old and provide national normative data. DESIGN this is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data. SETTING/PARTICIPANTS about 51,338 individuals (weighted to represent 13,232,651 Canadians), aged 45-85 years, from the tracking and comprehensive cohorts of CLSA. METHODS after screening all available variables in the pooled dataset, 52 items were selected to construct an FI. Descriptive statistics for the FI and normative data derived from quantile regressions were developed. RESULTS the average age of the participants was 60.3 years (95% confidence interval [CI]: 60.2-60.5), and 51.5% were female (95% CI: 50.8-52.2). The mean FI score was 0.07 (95% CI: 0.07-0.08) with a standard deviation of 0.06. Frailty was higher among females and with increasing age, and scores >0.2 were present in 4.2% of the sample. National normative data were identified for each year of age for males and females. CONCLUSIONS the standardized frailty tool and the population-based normative frailty values can help inform discussions about frailty, setting a new bar in the field. Such information can be used by clinicians, researchers, stakeholders and the general public to understand frailty, especially its relationship with age and sex.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Instituto Nacional de Geriatría, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan Edo. de México
| | - Judith Godin
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University Thunder Bay Campus, Ontario, Canada
| | - Melissa K Andrew
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Bergman I, Johansson K, Lundberg C. Five-year change scores in old age for six neuropsychological tests and normative data for the Useful Field of View (UFOV) test: The influence of physical health. J Clin Exp Neuropsychol 2018; 41:229-245. [PMID: 30332909 DOI: 10.1080/13803395.2018.1527292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Neuropsychological assessment of cognitive change over time is often conducted in clinical settings, but whether neuropsychological change scores are influenced by physical health has, as far as we know, not been examined previously. METHOD In a sample of 153 older Swedish adults (age range, 72-86 years), we evaluated the influence of common age-related diseases, terminal decline pathology, age, education, and gender, to provide (a) preliminary test-specific regression weights and 90% confidence intervals to assess significant change in performance after five years on tests of visual scanning, mental shifting, visual spatial ability, memory, reaction time, and selective attention, and (b) normative data for the Useful Field of View test (UFOV) from a single testing occasion. RESULTS Multiple regression analyses showed that test-retest changes were affected by physical health for mental shifting, visual spatial ability, memory, and reaction time, by age for mental shifting and visual reaction time, by education for visual spatial ability, and by Age × Education for auditory reaction time. Gender did not affect any of the change scores. The overall average of variance explained was 2.5%: up to 8.1% for physical health, 4.4% for age, and 3.6% for education. The UFOV scores were mostly influenced by age, but also by physical health and education. CONCLUSIONS The findings indicate that considering the influence of health on normative change scores in old age in addition to demographic factors leads to more accurate predictions of whether true change has occurred.
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Affiliation(s)
- Ingvar Bergman
- a Function Area Aging Health and Functioning , Karolinska University Hospital , Stockholm , Sweden.,b Traffic Medicine Centre , Karolinska University Hospital , Stockholm , Sweden
| | - Kurt Johansson
- b Traffic Medicine Centre , Karolinska University Hospital , Stockholm , Sweden.,c Theme Aging , Karolinska University Hospital , Stockholm , Sweden
| | - Catarina Lundberg
- a Function Area Aging Health and Functioning , Karolinska University Hospital , Stockholm , Sweden.,b Traffic Medicine Centre , Karolinska University Hospital , Stockholm , Sweden
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Hilsabeck RC. Psychometrics and statistics: two pillars of neuropsychological practice. Clin Neuropsychol 2017; 31:995-999. [PMID: 28874108 DOI: 10.1080/13854046.2017.1350752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Robin C Hilsabeck
- a Independent Private Practice , Austin , TX , USA.,b University of Texas - Austin , Austin , TX , USA.,c INC Research , Austin , TX , USA
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