Self-reports on the IQCODE in older adults: a psychometric evaluation

The effect of motor resource suppression on speech perception in noise in younger and older listeners: An online study

Speech motor resources may be recruited to assist challenging speech perception in younger normally hearing listeners, but the extent to which this occurs for older adult listeners is unclear. We investigated if speech motor resources are also recruited in older adults during speech perception. Specifically, we investigated if suppression of speech motor resources via sub-vocal rehearsal affects speech perception compared to non-speech motor suppression (jaw movement) and passive listening. Participants identified words in speech-shaped noise at signal-to-noise ratios (SNRs) from -16 to +16 dB in three listening conditions during which participants: (1) opened and closed their jaw (non-speech movement); (2) sub-vocally mimed 'the' (articulatory suppression); (3) produced no concurrent movement (passive listening). Data from 46 younger adults (M age = 20.17 years, SD = 1.61, 36 female) and 41 older adults (M age = 69 years, SD = 5.82, 21 female) were analysed. Linear mixed effects modelling investigated the impact of age, listening condition, and self-reported hearing ability on speech perception (d' prime). Results indicated that speech perception ability was significantly worse in older adults relative to younger adults across all listening conditions. A significant interaction between age group and listening condition indicated that younger adults showed poorer performance during articulatory suppression compared to passive listening, but older adults performed equivalently across conditions. This finding suggests that speech motor resources are less available to support speech perception in older adults, providing important insights for auditory-motor integration for speech understanding and communication in ageing.

Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans?

Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia.Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans.Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment.Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11-1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98-1.45).Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.

Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study

INTRODUCTION

This is the fourth phase of a longitudinal cohort study (2022-2023) to investigate the health and well-being of UK serving (Regulars and Reservists) and ex-serving personnel (veterans) who served during the era of the Iraq and Afghanistan conflicts. The cohort was established in 2003 and has collected data over three previous phases including Phase 1 (2004-2006), Phase 2 (2007-2009) and Phase 3 (2014-2016).

METHODS AND ANALYSIS

Participants are eligible to take part if they completed the King's Centre for Military Health Research Health and Wellbeing Cohort Study at Phase 3 (2014-2016) and consented to be recontacted (N=7608). Participants will be recruited through email, post and text message to complete an online or paper questionnaire. Data are being collected between January 2022 and September 2023. Health and well-being measures include measures used in previous phases that assess common mental disorders, post-traumatic stress disorder (PTSD) and alcohol misuse. Other areas of interest assess employment, help-seeking and family relationships. New topics include the impact of the British withdrawal from Afghanistan in 2021, complex PTSD (C-PTSD), illicit drug use, gambling and loneliness. Analyses will describe the effect size between groups deployed to Iraq and/or Afghanistan or not deployed, and those who are currently in service versus ex-service personnel, respectively, reporting prevalences with 95% CIs, and ORs with 95% CI. Multivariable logistic and multiple linear regression analyses will be conducted to assess various health and well-being outcomes and associations with risk and protective factors.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Ministry of Defence Research Ethics Committee (Ref: 2061/MODREC/21). Participants are provided with information and agree to a series of consent statements before taking part. Findings will be disseminated to UK Armed Forces stakeholders and international research institutions through stakeholder meetings, project reports and scientific publications.

The Impact of Age and Psychosocial Factors on Cognitive and Auditory Outcomes During the COVID-19 Pandemic

PURPOSE

In March 2020, the U.K. government announced that people should isolate to reduce the spread of the virus that causes COVID-19. Outside a pandemic, psychosocial factors, such as socialization and mental health, may impact the relationship between hearing loss and increased dementia risk. We aim to report the impact of psychosocial factors, including social isolation, depression, and engagement in activities, on hearing and cognitive function in younger and older adults during the COVID-19 pandemic.

METHOD

An online survey and experiment assessed self-reported psychosocial factors, self-reported hearing ability and speech-in-noise perception, and cognition. Data were collected between June 2020 and February 2021. Older (n = 112, Mage = 70.08) and younger (n = 121, Mage = 20.52) monolingual speakers of English, without any language or neurological disorders participated. Multiple linear regression models were employed to investigate hypothesized associations between psychosocial factors, and hearing and cognition, in older and younger adults.

RESULTS

Multiple regression analyses indicated that older adults displayed poorer speech-in-noise perception and poorer performance on one of four cognitive tasks, compared with younger adults; increased depression was associated with poorer subjective hearing. Other psychosocial factors did not significantly predict hearing or cognitive function.

CONCLUSIONS

Data suggest that self-reported hearing and depression are related. This conclusion is important for understanding the associations between hearing loss and cognitive decline in the long term, as both hearing loss and depression are risk factors for dementia.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23810838.

Applying generalizability theory to examine assessments of subjective cognitive complaints: whose reports should we rely on - participant versus informant?

OBJECTIVES

This study aimed to apply the generalizability theory (G-theory) to investigate dynamic and enduring patterns of subjective cognitive complaints (SCC), and reliability of two widely used SCC assessment tools.

DESIGN

G-theory was applied to assessment scales using longitudinal measurement design with five assessments spanning 10 years of follow-up.

SETTING

Community-dwelling older adults aged 70-90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study.

PARTICIPANTS

The sample included 232 participants aged 70 years and older, and 232 associated informants. Participants were predominantly White Europeans (97.8%). The sample of informants included 76 males (32.8%), 153 females (65.9%), and their age ranged from 27 to 86 years, with a mean age of 61.3 years (SD = 14.38).

MEASUREMENTS

The Memory Complaint Questionnaire (MAC-Q) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS

The IQCODE demonstrated strong reliability in measuring enduring patterns of SCC with G = 0.86. Marginally acceptable reliability of the 6-item MAC-Q (G = 0.77-0.80) was optimized by removing one item resulting in G = 0.80-0.81. Most items of both assessments were measuring enduring SCC with exception of one dynamic MAC-Q item. The IQCODE significantly predicted global cognition scores and risk of dementia incident across all occasions, while MAC-Q scores were only significant predictors on some occasions.

CONCLUSIONS

While both informants' (IQCODE) and self-reported (MAC-Q) SCC scores were generalizable across sample population and occasions, self-reported (MAC-Q) scores may be less accurate in predicting cognitive ability and diagnosis of each individual.

Examining for Cavum Septum Pellucidum and Ventricular Enlargement in Retired Elite-Level Rugby League Players

Objective

A cavum septum pellucidum (CSP) has been reported as a visible brain anomaly in normal individuals as well in some former combat and collision sport athletes. The appearance of CSP with fenestrations and ventricular enlargement are considered associated features of the neuropathological diagnosis of chronic traumatic encephalopathy. The current study examined CSP anatomic features and lateral ventricle size in retired elite rugby league players and controls.

Methods

Forty-one retired rugby league players and 41 healthy community controls, similar in age and education, underwent structural MRI scans. CSP grade, CSP length, corpus callosum septal length, and Evans' ratio (for lateral ventricle size) were rated by two of the current study authors. All participants also self-reported concussion exposure histories, depressive symptoms, daytime sleepiness, and impulsivity. They completed a neuropsychological test battery assessing premorbid intellectual functioning, attention, processing speed, language, visuospatial skills, memory, and aspects of executive functioning.

Results

The two raters had high agreement for CSP grade (Cohen's κ = 0.80), CSP length [intraclass correlation (ICC) = 0.99], corpus callosum septal length (ICC = 0.73), the CSP/septal ratio (ICC = 0.99), and the Evans' ratio (ICC = 0.75). Twenty-five retired players (61.0%) had an abnormal CSP compared to 17 controls [41.5%; χ(1, 82)2 = 3.12, p = 0.08, odds ratio = 2.21]. The CSP/septal ratio was larger for retired players than for the controls. The Evans' ratio did not differ between the two groups. In the retired rugby league players (n = 41), those with normal (n = 16) and abnormal (n = 25) CSP grades did not differ across age, age of first exposure to collision sport, years of sport exposure, concussion history, or 23 clinical and cognitive variables.

Conclusion

This study revealed a difference in the size of the CSP between retired professional rugby league players and controls. There was no significant difference in the size of the ventricles between the two groups. There were no significant differences between those with vs. without an abnormal CSP on age of first exposure to rugby league, years of exposure to repetitive neurotrauma, number of lifetime concussions, depression, impulsivity, perceived cognitive decline, or on any neuropsychological test.

Predictors and Correlates of Perceived Cognitive Decline in Retired Professional Rugby League Players

Objective: Rugby league is an international full-contact sport, with frequent concussive injuries. Participation in other full-contact sports such as American football has been considered to be a risk factor for neuropsychiatric sequelae later-in-life, but little research has addressed the mental and cognitive health of retired professional rugby league players. We examined predictors and correlates of perceived (self-reported) cognitive decline in retired National Rugby League (NRL) players. Methods: Participants were 133 retired male elite level rugby league players in Australia. Participants completed clinical interviews, neuropsychological testing, and self-report measures. The Informant Questionnaire on Cognitive Decline in the Elderly, self-report (IQCODE-Self), measured perceived cognitive decline. Results: The median age of the sample was 55.0 (M = 53.1, SD = 13.9, range = 30-89) and the median years of education completed was 12.0 (M = 11.9, SD = 2.6, range = 7-18). The retired players reported a median of 15.0 total lifetime concussions (M = 28.0, SD = 36.6, range = 0-200). The mean IQCODE-Self score was 3.2 (SD = 0.5; Range = 1.3-5.0); 10/133 (7.5%) and 38/133 (28.6%) scored above conservative and liberal cutoffs for cognitive decline on the IQCODE-Self, respectively. Perceived cognitive decline was positively correlated with current depressive symptoms, negatively correlated with years of professional sport exposure and resilience, and unrelated to objective cognition and number of self-reported concussions. A multiple regression model with perceived cognitive decline regressed on age, concussion history, professional rugby league exposure, depression, resilience, objective cognitive functioning, daytime sleepiness, and pain severity showed depression as the only significant predictor. Conclusion: This is the first large study examining subjectively experienced cognitive decline in retired professional rugby league players. Similar to studies from the general population and specialty clinics, no relationship was found between objective cognitive test performance and perceived cognitive decline. Depressive symptoms emerged as the strongest predictor of perceived cognitive decline, suggesting that subjective reports of worsening cognition in retired elite rugby league players might reflect psychological distress rather than current cognitive impairment.

Positivity effect and decision making in ageing

Across various contexts, older adults demonstrate a positivity effect - an age-related increase in a relative bias toward positive emotional stimuli as compared to negative stimuli. Previous research has demonstrated how this effect can influence decision making processes, specifically information search and choice satisfaction. However, the potential impact of the positivity effect and resulting age differences in information acquisition on decision quality has not been conclusively determined. We conducted an online decision making study comprising choices among charitable organisations with 152 younger and 152 older adults to investigate this relationship. We did not observe the positivity effect defined as higher positivity bias in older compared to younger adults. On the contrary, younger adults showed a slightly higher positivity bias. We also did not observe a link between a bias in information search toward positive or negative stimuli and decision quality. The results replicate the link between positivity bias and decision satisfaction. Older and younger adults did not differ in their decision quality. Finally, the findings did not support a potential influence of loss prevention orientation. Further research is required to address the factors that could influence the positivity effect in decision making.

Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively Normal Older Adults

OBJECTIVE

Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergent neuropsychiatric symptoms (NPS) that represent an at-risk state for incident cognitive decline and dementia in people with mild cognitive impairment (MCI). We undertook a study to determine whether MBI was associated with progressive changes in neuropsychological performance in people without significant cognitive impairment.

METHODS

A total of 9,931 older adults enrolled in the PROTECT study who did not have MCI or dementia undertook a comprehensive neuropsychological battery measuring attention, reasoning, executive function, and working memory at baseline and 1 year. MBI was ascertained using self-administration of the Mild Behavioral Impairment Checklist at 1 year, and participants were grouped according to MBI status: No Symptoms, Intermediate NPS and MBI. All assessments were completed online, and data analyzed using mixed-effects model repeated measures analysis of covariance.

RESULTS

A total of 949 (10%) people had MBI. These individuals had significantly worse cognitive performance at baseline and significantly greater decline over 1 year in the four composite cognitive scores measuring attentional intensity (F [2,8578] = 3.97; p = 0.019), sustained attention (F [2,8578] = 18.63; p <0.0001), attentional fluctuation (F [2,8578] = 10.13; p <0.0001) and working memory (F [2,9895] = 13.1; p <0.0001).

CONCLUSION

Our novel findings show that MBI is associated with faster decline in attention and working memory in this cognitively normal sample. MBI may be an earlier marker of neurodegenerative disease than MCI, captured at the stage of subjective cognitive decline or before, raising the possibility that MBI represents a novel target for dementia clinical trials or prevention strategies.

A qualitative review of instrumental activities of daily living in dementia: what's cooking?

SUMMARY 

The measurement of instrumental activities of daily living (IADL) is common in clinical practice and research into dementia. IADL are cognitively complex daily activities, such as cooking and doing finances. Their measurement is required for the diagnostic process of dementia, and also useful for the monitoring of disease progression. Since problems in IADL contribute to the disease burden of both patient and caregiver, it is a relevant outcome measure for disease-modifying and non-pharmacological interventions. Despite the widespread use of IADL instruments, an overview of its theoretical background, measurement methods, and potential sources of bias is lacking. In the current manuscript, we therefore aim to provide a selective overview of these topics.

Accuracy of the Brazilian version of the informant questionnaire on cognitive decline in the elderly at screening for dementia in community-dwelling elderly participants: findings from FIBRA-RJ study

OBJECTIVES

To determine the accuracy of the Brazilian version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) for screening for dementia and to analyze the association of sociodemographic variables of the elderly participants and informant, as well as the mental health of the informant, in the scores of the questionnaire.

METHODS

A cross-sectional study was carried out with 417 elderly participants and their informants from the sample of the Frailty in the Brazilian Elderly Study, Rio de Janeiro, Brazil. The older individuals were assessed by clinical, functional, and neurocognitive evaluation, and the diagnosis of dementia was established according to Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria. The informants were evaluated by Mini-Mental State Examination (MMSE), Center of Epidemiologic Studies--Depression Scale, and Burden Interview Scale. The Cambridge Cognitive Examination Test--Revised (CAMCOG-R) was used for convergent validity analysis. The association between IQCODE-BR and the study variables was determined by multivariate logistic regression analysis.

RESULTS

The best cutoff point was 3.26; the sensitivity, specificity, and area under the receiver-operating characteristic curve were 89%, 72%, and 0.88 (95% confidence interval: 0.837-0.917), respectively. The CAMCOG-R and the MMSE showed a moderate and negative association with IQCODE-BR.

CONCLUSION

The IQCODE-BR is an instrument with good accuracy for the detection of dementia syndrome in Brazilian older person.

Is expressed emotion related to estimates of ability made by older people with cognitive impairments and their partners?

OBJECTIVES

Discrepancies in ratings of ability are used to assess awareness in people with cognitive impairments, and previously have been found to be associated with comorbid depression and carer distress. This study explored how the degree of discrepancy between self-ratings of ability made by older people with a cognitive impairment and informant ratings made by their partners relates to aspects of their relationship quality. It was hypothesised that discrepancies between self- and partner ratings would be associated with partner's expressed emotion (EE), and replicate previous findings for associations with depression and carer distress.

METHOD

Forty-six people aged over 65 with mild cognitive impairment or early-stage dementia were recruited through NHS mental health services for older people. In a semi-structured interview, they and their partners gave separate ratings of cognitive abilities and instrumental activities of daily living (IADL). Partners also completed a 5-minute speech sample task to assess the type of EE. Depression in cognitively impaired participants and partner distress were also measured.

RESULTS

High EE, depression and carer distress were associated with larger discrepancies in ratings of ability on the cognitive measure. EE was not associated with self-ratings or partner ratings of cognitive or IADL ability.

CONCLUSION

The findings suggest that where disagreement about the abilities of an older person with cognitive impairments is greater, the affective environment around that person is more likely to be characterised by criticism and/or emotional over-involvement. The implications of this for assessment, diagnosis, and helping couples adjust to cognitive deterioration are discussed.

Self-reported cognitive decline on the informant questionnaire on cognitive decline in the elderly is associated with dementia, instrumental activities of daily living and depression but not longitudinal cognitive change

BACKGROUND/AIM

A subjective history of cognitive decline is integral to dementia screening, yet there are few data on the accuracy of retrospective self-reports. We prospectively examined the longitudinal predictors of self-reported decline, including rate of cognitive change, clinical diagnosis, depressive symptoms and personality.

METHODS

We used a large (n = 2,551) community-dwelling sample of older adults (60-64 years at baseline) and tracked their cognitive functioning over 3 waves across a period of 8 years. Individual rates of change in multiple domains of cognition, incident dementia and mild cognitive disorders, apolipoprotein E (APOE) ε4 genotype, level of education, depressive symptoms and personality were examined as predictors of wave 3 retrospective self-reported decline as measured by the Informant Questionnaire on Cognitive Decline in the Elderly.

RESULTS

The rate of cognitive decline did not predict subjective decline. Significant predictors of self-reported decline included dementia diagnosis, problems with instrumental activities of daily living, depression and neuroticism at the time of self-report, as well as the presence of an APOE ε4 allele.

CONCLUSIONS

In this relatively young cohort, retrospective self-report of cognitive decline does not reflect objective deterioration in cognition over the time period in question, but it may identify individuals in the initial stages of dementia and those with elevated psychological and genotypic risk factors for the development of dementia.

The Cognitive Change in Women study (CCW): informant ratings of cognitive change but not self-ratings are associated with neuropsychological performance over 3 years

The value of self-reported memory complaints for identifying or predicting future cognitive decline or dementia is controversial, but observations from a third party, or "informant," may prove more useful. The relationship between Informant and Self-ratings of cognitive status and neuropsychological test scores was examined in a cohort of 384 nondemented, community-dwelling women, aged 60 years and older, participating in a single-site Women's Health Initiative ancillary study. Each participant and her respective informant separately completed the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Participants also underwent neuropsychological testing and responded to questionnaires on depression and functioning in complex activities of daily living. All neuropsychological test scores were significantly correlated (P values <0.05 to <0.01) with IQCODE ratings whereas Self-ratings overestimated cognitive functioning in some domains. Furthermore, the Self and Informant ratings were both positively correlated with depression and negatively correlated with participants' activity level. Therefore, informant judgments of functional abilities are robust predictors of cognitive status in high functioning nondemented women. These results suggest that informants may be sensitive to changes that are not clinically significant but that may represent an incipient trend for decline.

Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomized controlled trial [ISRCTN05358495]

OBJECTIVE

Can indicative prevention of home-visiting nurses be effective when targeted at a frail senior population using multidimensional geriatric assessments and personalized care plans?

METHODS

We performed an individually randomized controlled trial in 33 blinded primary care practices over 18 months. The 651 participants were aged 75 years or older, lived at home, and were frail but neither terminally ill nor demented. A score in the lowest quartile on at least two of six self-reported functional health domains (COOP-WONCA charts), defined frail health. We compared usual care with proactive home visits by trained community nurses. The nurses (a) assessed the care needs with a multidimensional computerized geriatric instrument, which enabled direct identification of health risks; (b) determined care priorities together with the person; (c) designed and executed individually tailored interventions; and (d) monitored participants by telephone and on average three home visits. Primary outcome measures were functional health and instrumental activities of daily living disability. Secondary outcomes were acute hospital admittance (time until), institutionalization, and mortality.

RESULTS

We found no significant differences between intervention and usual care group on any of the outcome measures. Predefined subgroup analyses revealed a higher risk of hospital admission for persons with poor health in the intervention group.

CONCLUSIONS

We could not demonstrate preventive effects of home visits by nurses in vulnerable older persons. Hospital admissions increased in the frailest group. The search for effective interventions for vulnerable persons requires further investigation. Future efforts may focus on improved integrated approaches.