1
|
Suchy-Dicey AM, Vo TT, Oziel K, King R, Barbosa-Leiker C, Rhoads K, Verney S, Buchwald DS, French BF. Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study. Assessment 2024; 31:745-757. [PMID: 37338127 PMCID: PMC10840386 DOI: 10.1177/10731911231180127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The Controlled Oral Word Association (COWA) test is used to assess phonemic fluency and executive function. Formal validation of test scores is important for accurate cognitive evaluation. However, there is a dearth of psychometric validation among American Indian adults. Given high burden of dementia risk and key contextual factors associated with cognitive assessments, this represents a critical oversight. In a large, longitudinal population-based cohort study of adult American Indians, we examined several validity inferences for COWA, including scoring, generalization, and extrapolation inferences, by investigation of factor structure, internal consistency, test-retest reliability, and differential test functioning. We found adequate unidimensional model fit, with high factor loadings. Internal consistency reliability and test-retest reliability were 0.88 and 0.77, respectively, for the full group. COWA scores were lowest among the oldest, lowest education, bilingual speakers; group effects for sex and bilingual status were small; age effect was medium; and education effect was largest. However, Wide Range Achievement Test (WRAT) score effect was stronger than education effect, suggesting better contextualization may be needed. These results support interpretation of total COWA score, including across sex, age, or language use strata.
Collapse
Affiliation(s)
| | - Thao T. Vo
- Washington State University, Seattle, USA
| | - Kyra Oziel
- Washington State University, Seattle, USA
| | | | | | | | | | | | | |
Collapse
|
2
|
Suchy-Dicey AM, Vo TT, Oziel K, Buchwald DS, Nelson LA, Verney SP, French BF. Psychometric reliability, validity, and generalizability of 3MSE scores among American Indian adults: the Strong Heart Study. J Int Neuropsychol Soc 2024:1-10. [PMID: 38263740 DOI: 10.1017/s1355617723011438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians. METHODS We recruited 818 American Indians aged 65-95 for 3MSE examinations in 2010-2013; 403 returned for a repeat examination in 2017-2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models. RESULTS This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small. CONCLUSION These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.
Collapse
Affiliation(s)
- Astrid M Suchy-Dicey
- Huntington Medical Research Institutes, Pasadena, CA, USA
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Thao T Vo
- Washington State University, College of Education, Pullman, WA, USA
| | - Kyra Oziel
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Dedra S Buchwald
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Lonnie A Nelson
- Washington State University, College of Nursing, Spokane, WA, USA
| | | | - Brian F French
- Washington State University, College of Education, Pullman, WA, USA
| |
Collapse
|
3
|
Suchy-Dicey AM, Oziel K, Sawyer C, Olufadi Y, Ali T, Fretts AM, Umans JG, Shibata DK, Longstreth WT, Rhoads K, Buchwald DS, Grabowski TJ. Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study. Neurology 2022; 99:e2637-e2647. [PMID: 36289000 PMCID: PMC9757873 DOI: 10.1212/wnl.0000000000201261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about incidence of vascular and Alzheimer dementias in American Indians. METHODS We conducted a large, heterogeneous, population-based, longitudinal cohort study of brain aging in community-dwelling American Indians aged 64-95 years from 11 tribes across 3 states, with neurologic examinations, 1.5T MRI, and extensive cognitive testing. Visit 1 in 2010-2013 (n = 817) and visit 2 in 2017-2019 (n = 403) included all willing, surviving participants. Standardized cognitive tests at both visits included Modified Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale digit symbol coding (WAIS), Controlled Oral Word Association (COWA), and California Verbal Learning Test short form (CVLT). Test materials added at follow-up included Wide Range Achievement (reading) Test (WRAT) and National Alzheimer Coordinating Center Uniform Data Set cognitive battery (v3 form C2), including Montreal Cognitive Assessment (MoCA). MRI neuroradiologists coded infarcts, hemorrhages, white matter hyperintensities, sulcal atrophy, and ventricle enlargement. RESULTS The mean time between examinations was 6.7 years (SD 1.1, range 3.8-9.1 years). Years of formal education had modest correlation with WRAT reading score (r = 0.45). Prevalence and incidence (respectively) of infarcts were 32% and 12.8/1,000 person-years (PYs) hemorrhages 6% and 4.4/1000 PY worsening sulci 74% and 19.0/1000 PY worsening ventricle 79% and 30.1/1000 PY worsening leukoaraiosis 44% and 26.1/1000 PY. Linear losses per year in cognitive scores were 0.6% MMSE, 1.2% WAIS, 0.6% COWA, and 2.2% CVLT. The mean MoCA scores were 18.9 (SD 4.3). DISCUSSION These are the first data on longitudinal cognitive and imaging changes in American Indians and first reports of Alzheimer disease-related features. The mean scores in MoCA were similar or lower than standard cutoffs used to diagnose dementia in other racial/ethnic groups, suggesting that standardized cognitive tests may not perform well in this population. Test validation, adaptation, and score adjustment are warranted. Years of education were a poor proxy for premorbid function, suggesting novel methods for cognitive score contextualization is also needed in this population. Evaluation of selective survival suggests attrition from death, and frailty should be accounted for in causal analyses. Overall, these data represent a unique opportunity to examine neurology topics of critical importance to an understudied population.
Collapse
Affiliation(s)
- Astrid M Suchy-Dicey
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle.
| | - Kyra Oziel
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Charles Sawyer
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Yunusa Olufadi
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Tauqeer Ali
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Amanda M Fretts
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Jason G Umans
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dean K Shibata
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - W T Longstreth
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Kristoffer Rhoads
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dedra S Buchwald
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Thomas J Grabowski
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| |
Collapse
|
5
|
Hanson JD, Noonan C, Harris A, Oziel K, Sarche M, MacLehose RF, O’Leary M, Buchwald D. Alcohol Consumption during COVID among Women with an Existing Alcohol-Use Disorder. Int J Environ Res Public Health 2021; 18:9460. [PMID: 34574387 PMCID: PMC8469880 DOI: 10.3390/ijerph18189460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 01/24/2023]
Abstract
Prior to the pandemic, our research team implemented a randomized controlled trial of an intervention to reduce risk for alcohol-exposed pregnancy (AEP) in American Indian women. When active recruitment for the in-person trial was paused due to COVID, the research team moved to conducting follow-up surveys with participants who had completed the intervention to better understand changes to their alcohol use during the pandemic. We collected surveys from 62 American Indian women who had completed the Native CHOICES intervention. Baseline data collected pre-COVID included demographics and scores on the Alcohol Use Disorders Identification Test (AUDIT). Follow-up surveys conducted during the active pandemic period included a self-reported questionnaire about changes in drinking patterns. At pre-COVID baseline, all participants were engaged in heavy or binge drinking. At follow-up during COVID, 24.2% reported drinking more, and over half had at least one binge drinking episode. Approximately half reported reduced drinking. We found that risky drinking remained an issue during the pandemic for many American Indian women who had engaged in this behavior pre-COVID, while others reported reducing their alcohol consumption. As the pandemic abates, concerted efforts must be made to reach those with identified alcohol use disorders to offer resources and intervention as needed.
Collapse
Affiliation(s)
- Jessica D. Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN 55812, USA;
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; (C.N.); (K.O.); (D.B.)
| | - Amy Harris
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN 55812, USA;
| | - Kyra Oziel
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; (C.N.); (K.O.); (D.B.)
| | - Michelle Sarche
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Richard F. MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA;
| | - Marcia O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD 57625, USA;
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; (C.N.); (K.O.); (D.B.)
| |
Collapse
|
6
|
Hanson JD, Oziel K, Sarche M, MacLehose RF, Rosenman R, Buchwald D. A culturally tailored intervention to reduce risk of alcohol-exposed pregnancies in American Indian communities: Rationale, design, and methods. Contemp Clin Trials 2021; 104:106351. [PMID: 33706001 PMCID: PMC8180500 DOI: 10.1016/j.cct.2021.106351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Prenatal exposure to alcohol can cause lifelong physical and cognitive challenges in the form of fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs). The prevention of prenatal alcohol exposure is thus a public health priority - and one that should account for the particular needs of subpopulations, including in American Indian/Alaska Native (AI/AN) communities. Prior to conception, alcohol-exposed pregnancy prevention is accomplished by encouraging the reduction or elimination of risky alcohol use and/or promoting effective contraceptive use among risky drinkers who could become pregnant. The current study builds on promising findings about the impact of the Centers for Disease Control and Prevention CHOICES intervention with AI/AN communities by implementing a randomized control trial of Native CHOICES, a cultural adaptation of CHOICES, with AI/AN women in a rural reservation community. METHODS AI/AN women aged 18-44 who are at-risk for an alcohol-exposed pregnancy are being recruited. Participants are randomized in 1:1 proportion to the intervention and a services-as-usual, waitlist control condition. The Native CHOICES intervention consists of 2 motivational interviewing (MI) sessions, an elective contraception counseling session, and electronic messaging to boost the effects of MI. Data are collected at baseline and at 6 weeks, 3 months, and 6 months post-baseline. Those assigned to the control group are eligible to enroll in Native CHOICES following the completion of the 6 months post-baseline data collection. In addition to testing intervention effectiveness, the study is designed to yield a comprehensive economic evaluation, which will provide important information regarding the financial feasibility and sustainability of Native CHOICES for healthcare systems serving AI/ANs.
Collapse
Affiliation(s)
- Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN, USA.
| | - Kyra Oziel
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Michelle Sarche
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert Rosenman
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA; School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| |
Collapse
|