Re-evaluation of psychometric evidence and update of normative data for the Test of Practical Judgment

ObjectiveThe Test of Practical Judgment (TOP-J) has shown utility in inpatient and outpatient settings in older adults who present with mild cognitive impairment and various dementia subtypes. The TOP-J has two versions (i.e. 9 items and 15 items), and was initially validated within a small rural non-Hispanic White sample. In the current study, we re-evaluated the psychometric evidence and refined scoring criteria and administration guidelines in older adults with more diverse demographic characteristics than the original validation sample. Method: Participants (N = 348) were recruited from several boroughs of New York City and surrounding areas (mean/median age = 79; mean years education = 15, median = 15.5; 68% female; 30% Black/African-American, 8% Hispanic). Results: Reliability and validity were comparable to original findings. Based on confirmatory factor analysis, one item was replaced on the 9-item version, now called TOP-J Form A. Normative data for cognitively intact participants (n = 261) were updated and stratified by two education groups. Conclusions: The TOP-J is increasingly used in clinical and research settings in the U.S. and abroad, and the current study provides improved normative data and administration and scoring guidelines for use with demographically diverse older individuals.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia

Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions.

Effects of leisure-time physical activity interventions on frailty-related characteristics of frail older adults in long-term care: a systematic review

Background: The proportion of frailty in older adults is increasing in many countries. Demand for institutional long-term care followed by an increasing globally. Aims: The effects of leisure-time physical activity (LTPA) interventions on frail older adults in long-term care facilities (LTCFs) of randomized controlled trials. Design: A literature searches of the published articles indexed in CINAHL, MEDLINE, PsycINFO, ProQuest, and Google Scholar between 2000 and 2017 was conducted. Methods: The inclusion criteria were divided into four sections: (1) design: randomized controlled trials; (2) sample population: LTCF adults aged 60 years or over with frailty; (3) intervention: LTPA; and (4) body composition: physical, functional or neuropsychological tests as either the primary or the secondary outcomes. Results: Three main themes were identified (the particular monitor, intervention duration and outcome measurement dimensions). Impact statement and conclusions: LTPA interventions effectively improved the physical performance and body composition of frail older adults in LTCFs. Nevertheless, an optimal combination of intensity, duration and frequency is crucial.

Can deficits in functional capacity and practical judgment indicate cognitive impairment in older adults?

Neuropsychological literature has demonstrated a significant relationship between cognitive decline and functional capacity, but the directionality of this relationship is still not well understood. Further, the construct of practical judgment has been linked to both cognitive impairment and functional capacity, but these associations are still under-researched. Moreover, few studies to date have examined the relationships among all three constructs utilizing performance-based, ecologically valid and psychometrically sound measures. The present study aimed to address this gap in published literature and investigated whether a practical judgment and functional capacity can help differentiate individuals with cognitive dysfunction from those without. Participants were 270 community-dwelling individuals aged 56-95 years referred for neuropsychological evaluation in an outpatient setting. Bivariate correlations revealed moderate to strong relationships among the three studied variables. Additionally, logistic regression analysis indicated that ability to make sound practical judgments and ability to perform instrumental activities of daily living (IADL) can be used as indicators of cognitive impairment. The clinical implications of these findings are discussed.

Assessing Executive Function in Adolescence: A Scoping Review of Existing Measures and Their Psychometric Robustness

Background: There is much research examining adolescents' executive function (EF) but there is little information about tools that measure EF, in particular preference of use, their reliability and validity. This information is important as to help both researchers and practitioners select the most relevant and reliable measure of EF to use with adolescents in their context. Aims: We conducted a scoping review to: (a) identify the measures of EF that have been used in studies conducted among adolescents in the past 15 years; (b) identify the most frequently used measures of EF; and (c) establish the psychometric robustness of existing EF measures used with adolescents. Methods: We searched three bibliographic databases (PsycINFO, Ovid Medline, and Web of Science) using key terms "Adolescents," "Executive Functions," and "measures". The search covered research articles published between 1st January 2002 and 31st July 2017. Results: We identified a total of 338 individual measures of EF from 705 eligible studies. The vast majority of these studies (95%) were conducted in high income countries. Of the identified measures, 10 were the most used frequently, with a cumulative percent frequency accounting for nearly half (44%) the frequency of usage of all reported measures of EF. These are: Digit Span (count = 160), Trail Making Test (count = 158), Behavior Rating Inventory of Executive Function (count = 148), Wisconsin Card Sorting Test (count = 140), Verbal Fluency Tasks (count = 88), Stroop Color-Word Test (count = 78), Classical Stroop Task (count = 63), Color-Word Interference Test from Delis-Kaplan battery (count = 62), Rey-Osterrieth Complex Figure Test (count = 62), and Original Continuous Performance Test (count = 58). In terms of paradigms, tasks from Span (count = 235), Stroop (count = 216), Trails (count = 171), Card sorting (count = 166), Continuous performance (count = 99), and Tower (count = 94) paradigms were frequently used. Only 48 studies out of the included 705 reported the reliability and/or validity of measures of EF used with adolescents, but limited to studies in high income countries. Conclusion: We conclude that there is a wide array of measures for assessing EF among adolescents. Ten of these measures are frequently used. However, the evidence of psychometric robustness of measures of EF used with adolescents remains limited to support the validity of their usage across different contexts.

The capacity of the BATCH as a predictive tool for discharge planning for people with neuropsychiatric disorders

BACKGROUND/AIM

Assessment of cognitive function in people with neurosychiatric disorders can be challenging, due to behavioural and psychiatric symptomatology. The Behavioural Assesment Tool for Cognition and Higher Functioning (BATCH) is a validated observational tool that complements formal cognitive testing in this patient population. This study aimed to determine the capacity of the BATCH as a predictive tool for discharge planning.

METHOD

BATCH scores for 330 consecutive admissions for assessment to a specialist neuropsychiatry unit between 2007 and 2015 were analysed. The variables of interest included discharge destination, diagnosis, length of stay, age at discharge and BATCH scores (both subdomain and total). Significant predictors of discharge destination were identified using logistic regression analysis.

RESULTS

After adjusting for age at discharge, three variables were found to be significant predictors of discharge destination - length of stay, diagnosis, and BATCH total score. The odds of being discharged to a destination other than home decreased by 3% for each additional BATCH total score unit. The length of stay remained a significant predictor of discharge destination when adjusting for BATCH total score, age at admission and diagnosis.

CONCLUSION

BATCH total scores, but not subdomain scores, were predictive of discharge destination, along with the patients' length of stay and diagnosis. Knowledge of this relationship may guide clinical discharge planning, when working with the complex needs of this group of patients. A larger study is indicated to determine the range and cut-off scores for discharge destinations other than home.

Executive functioning: perspectives on neurotrophic activity and pharmacology

Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.

The unity and diversity of executive functions: A systematic review and re-analysis of latent variable studies

Confirmatory factor analysis (CFA) has been frequently applied to executive function measurement since first used to identify a three-factor model of inhibition, updating, and shifting; however, subsequent CFAs have supported inconsistent models across the life span, ranging from unidimensional to nested-factor models (i.e., bifactor without inhibition). This systematic review summarized CFAs on performance-based tests of executive functions and reanalyzed summary data to identify best-fitting models. Eligible CFAs involved 46 samples (N = 9,756). The most frequently accepted models varied by age (i.e., preschool = one/two-factor; school-age = three-factor; adolescent/adult = three/nested-factor; older adult = two/three-factor), and most often included updating/working memory, inhibition, and shifting factors. A bootstrap reanalysis simulated 5,000 samples from 21 correlation matrices (11 child/adolescent; 10 adult) from studies including the three most common factors, fitting seven competing models. Model results were summarized as the mean percent accepted (i.e., average rate at which models converged and met fit thresholds: CFI ≥ .90/RMSEA ≤ .08) and mean percent selected (i.e., average rate at which a model showed superior fit to other models: ΔCFI ≥ .005/.010/ΔRMSEA ≤ -.010/-.015). No model consistently converged and met fit criteria in all samples. Among adult samples, the nested-factor was accepted (41-42%) and selected (8-30%) most often. Among child/adolescent samples, the unidimensional model was accepted (32-36%) and selected (21-53%) most often, with some support for two-factor models without a differentiated shifting factor. Results show some evidence for greater unidimensionality of executive function among child/adolescent samples and both unity and diversity among adult samples. However, low rates of model acceptance/selection suggest possible bias toward the publication of well-fitting but potentially nonreplicable models with underpowered samples. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

An fMRI paradigm based on Williams inhibition test to study the neural substrates of attention and inhibitory control

The purpose of this study is to present an fMRI paradigm, based on the Williams inhibition test (WIT), to study attentional and inhibitory control and their neuroanatomical substrates. We present an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioral performances of healthy participants from those of individuals with acquired brain injury. Stroop and Simon tests present similarities with WIT, but this latter is more demanding. We analyze the BOLD signal in 10 healthy participants performing the WIT. The dorsolateral prefrontal cortex, the inferior prefrontal cortex, the anterior cingulate cortex, and the posterior cingulate cortex were defined for specified region of interest analysis. We additionally compare behavioral data (hits, errors, reaction times) of the healthy participants with those of eight acquired brain injury patients. Data were analyzed with GLM-based random effects and Mann-Whitney tests. Results show the involvement of the defined regions and indicate that the WIT is sensitive to brain lesions. This WIT-based block design paradigm can be used as a research methodology for behavioral and neuroimaging studies of the attentional and inhibitory components of executive functions.

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

The Judgment Test of the Neuropsychological Assessment Battery (NAB): psychometric considerations in an assisted-living sample

A total of 82 older adults recruited from assisted-living facilities completed the Judgment subtest of the Neuropsychological Assessment Battery. The internal consistency reliability of Judgment scores in this sample, as estimated by Cronbach's α, was .83. Significant and strong Judgment score correlations with measures of general cognitive functioning and instrumental activities of daily living provided evidence of construct validity. Furthermore, participants who exhibited the capacity to consent to the evaluation performed significantly better on the Judgment subtest than did participants who did not exhibit consent capacity. Finally, Judgment scores predicted a significant proportion of variance in both instrumental and basic activities of daily living over and above the variance accounted for by scores on measures of general cognitive functioning and executive functioning. This study presents promising preliminary evidence of the incremental validity of Judgment subtest scores for predicting both basic and instrumental activities of daily living in an assisted-living sample.

The role of self-regulation in predicting sleep hygiene in university students

University students have poor sleep hygiene, leading to poorer health. Facets of self-regulation such as planning, behavioural inhibition, cognitive flexibility and working memory were explored in relation to three sleep hygiene behaviours: Avoiding stress or anxiety before bed, avoiding going to bed hungry or thirsty, and making the bedroom restful. One hundred and thirty-seven participants took part in an Internet-based survey over two time points separated by a period of two weeks. Only cognitive flexibility and behavioural inhibition correlated with sleep hygiene. Cognitive flexibility significantly predicted an aspect of sleep hygiene after controlling for past behaviour. However, when past behaviour was controlled for, behavioural inhibition no longer predicted sleep hygiene. Thus, cognitive flexibility may play a role in explaining sleep hygiene; however, behavioural inhibition does not appear as important as previously assumed. Further research could build on this study to determine whether cognitive flexibility can be experimentally improved.

Predicting story goodness performance from cognitive measures following traumatic brain injury

PURPOSE

This study examined the prediction of performance on measures of the Story Goodness Index (SGI; Lê, Coelho, Mozeiko, & Grafman, 2011) from executive function (EF) and memory measures following traumatic brain injury (TBI). It was hypothesized that EF and memory measures would significantly predict SGI outcomes.

METHOD

One hundred sixty-seven individuals with TBI participated in the study. Story retellings were analyzed using the SGI protocol. Three cognitive measures--Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) Sorting Test, Wechsler Memory Scale--Third Edition (WMS-III; Wechsler, 1997) Working Memory Primary Index (WMI), and WMS-III Immediate Memory Primary Index (IMI)--were entered into a multiple linear regression model for each discourse measure. Two sets of regression analyses were performed, the first with the Sorting Test as the first predictor and the second with it as the last.

RESULTS

The first set of regression analyses identified the Sorting Test and IMI as the only significant predictors of performance on measures of the SGI. The second set identified all measures as significant predictors when evaluating each step of the regression function.

CONCLUSION

The cognitive variables predicted performance on the SGI measures, although there were differences in the amount of explained variance. The results (a) suggest that storytelling ability draws on a number of underlying skills and (b) underscore the importance of using discrete cognitive tasks rather than broad cognitive indices to investigate the cognitive substrates of discourse.

Judgment in Mild Cognitive Impairment and Alzheimer's disease

Judgment is the capacity to make decisions after considering available information, contextual factors, possible solutions and probable outcomes. Our aim was to investigate previous research studies regarding assessment of judgment in older adults with different degrees of cognitive impairment. To this end, a search of Pubmed and Lilacs electronic databases for studies published from January 1990 until August 2011 in English, Spanish and Portuguese was carried out. The terms used were "judgment" combined with the terms "dementia" or "Mild Cognitive Impairment" (MCI) or "Alzheimer's disease" (AD). Some studies showed that MCI and AD patients had impaired judgment. There is a lack of specific methods to measure judgment capacity, and data on judgment abilities in older adults with MCI and dementia are scarce. No studies with specific measures of judgment capacity in other dementias were found.