Publications by authors named "Jared F Benge"

42 Publications

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores.

J Neuropsychol 2021 Mar 3. Epub 2021 Mar 3.

Department of Neurology, University of Texas at Austin, Texas, USA.

Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow-up evaluations. We analysed data from 9,263 older adults from the National Alzheimer's Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ (4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ (3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow-up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow-up, χ (4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow-up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow-up, χ (3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jnp.12243DOI Listing
March 2021

Preserving prospective memory in daily life: A systematic review and meta-analysis of mnemonic strategy, cognitive training, external memory aid, and combination interventions.

Neuropsychology 2021 Jan;35(1):123-140

Department of Psychology and Neuroscience, Baylor University.

Objective: To preserve or improve independent functioning in older adults and those with neurocognitive impairments, researchers and clinicians need to address prospective memory deficits. To be effective, prospective memory interventions must restore (or circumvent) the underlying attention and memory mechanisms that are impaired by aging, brain injury, and neurodegeneration. We evaluated two decades of prospective memory interventions for efficacy, time/resource costs, and ecological validity.

Method: We systematically reviewed 73 prospective memory intervention studies of middle- to older-aged healthy adults and clinical groups (N = 3,749). We also rated the ecological validity of each study's prospective memory assessment/task using a newly developed scale. When possible (72% of studies), we estimated effect sizes using random-effects models and Hedges' g.

Results: We identified four categories of prospective memory interventions, including mnemonic strategy, cognitive training, external memory aid, and combination interventions. Mnemonic strategy (g = .450) and cognitive training (g = .538) interventions demonstrated efficacy. Combination interventions showed mixed results (g = .254), underscoring that "more is not always better." External memory aids demonstrated very positive outcomes (g = .805), though often with small-sample, case-series designs. Prospective memory assessments had high ecological validity in external memory aid studies (84%), but not in mnemonic strategy (14%), cognitive training (20%), or combination intervention (50%) studies, p < .001, ηp2 = .33.

Conclusions: Everyday prospective memory can be meaningfully improved, perhaps particularly with external memory aids, but larger trials are required to optimize treatments, increase adherence, and broaden implementation in daily life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/neu0000704DOI Listing
January 2021

Factors affecting time between symptom onset and emergency department arrival in stroke patients.

eNeurologicalSci 2020 Dec 24;21:100285. Epub 2020 Oct 24.

Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.

Background And Purpose: Delays in seeking care compromise diagnosis, treatment options, and outcomes in ischemic strokes. This study identified factors associated with time between stroke symptom onset and emergency department (ED) arrival at a private nonprofit medical center serving a large rural catchment area in central Texas, with the goal of identifying symptomatic, demographic, and historical factors that might influence seeking care.

Methods: Demographic and clinical data from a large tertiary care center's Get With The Guidelines (GWTG) database were evaluated in 1874 patients presenting to the ED with a diagnosis of transient ischemic attack (TIA), intracranial hemorrhage, subarachnoid hemorrhage, or ischemic stroke. The dependent variable was time between discovery of stroke symptoms and presentation at the hospital (time-to-ED). Factors entered into regression models predicting time-to-ED within 4 h or categorical time-to-ED.

Results: The average time from symptom onset to presentation was 15.0 h (  23.2), with 43.6% of the sample presenting within 4 h of symptom onset. Results suggested that female gender (Odds Ratio [OR] = 0.70; 95% Confidence Interval [CI] 0.23-0.74), drug abuse (OR = 0.41; CI 0.23-0.74), and diabetes were significantly associated with longer time to presentation.

Conclusions: A combination of demographics, stroke severity, timing, and health history contributes to delays in presenting for treatment for ischemic stroke. Stroke education concentrating on symptom recognition may benefit from a special focus on high-risk individuals as highlighted in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ensci.2020.100285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649365PMC
December 2020

The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia.

Clin Neuropsychol 2020 Oct 26:1-18. Epub 2020 Oct 26.

Department of Health Psychology, University of Missouri, Columbia, MO, USA.

Objective: Ecological validity refers to the ability of neuropsychological measures to predict real world performance. Questions remain as to the ecological validity of commonly used measures, particularly regarding their relationships to global versus specific activities of daily living among those with neurodegenerative disease. We explored these issues through the lens of the Uniform Data Set 3.0 Neuropsychological battery (UDS3NB) in individuals with mild cognitive impairment and dementia. UDS3NB and informant rated Functional Activities Questionnaire scales were evaluated from 2,253 individuals with mild cognitive impairment and dementia. Ordinal regression equations were used to explore the relationships of demographic and cognitive variables with overall and specific instrumental activities of daily living. Delayed recall for visual and verbal material, and performance on trail making tests were consistent predictors of global and specific functions. Specific skills (i.e. naming or figure copy) showed differential relationships with specific activities, while phonemic fluency was not related to any particular activity. Measures in the UDS3NB predicted activities of daily living in individuals with MCI and dementia, providing initial support for the ecological validity of these tests. Specifically, measures that tap core deficits of Alzheimer's disease, such as delayed recall and sequencing/shifting, are consistent predictors of performance in daily tasks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854046.2020.1837246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071839PMC
October 2020

An Initial Empirical Operationalization of the Earliest Stages of the Alzheimer's Continuum.

Alzheimer Dis Assoc Disord 2021 Jan-Mar 01;35(1):62-67

Division of Neuropsychology, Plummer Movement Disorders Center, Baylor Scott and White Health, Temple.

Purpose: The Alzheimer's Continuum (AC) includes 2 preclinical stages defined by subjective cognitive complaints, transitional cognitive declines, and neurobehavioral symptoms. Operationalization of these stages is necessary for them to be applied in research.

Methods: Cognitively normal individuals with known amyloid biomarker status were selected from the National Alzheimer's Coordinating Center Uniform Data Set. Participants and their caregivers provided information on subjective cognitive complaints, neurobehavioral features, and objective cognitive functioning.

Patients: The sample included 101 amyloid positive (A+) and 447 amyloid negative (A-) individuals.

Results: Rates of subjective cognitive complaints (A+: 34.90%, A-: 29.90%) and neurobehavioral symptoms (A+: 22.40%, A-: 22.40%) did not significantly differ between A+/- individuals. However, the frequency of transitional cognitive decline was significantly higher among A+ (38.00%) than A- participants (24.90%). We explored various empirical definitions for defining the early stages of the AC among A+ participants. Rates of classification into AC stage 1 versus AC stage 2 varied depending on the number of symptoms required: 57.40% versus 42.60% (1 symptom), 28.70% versus 71.30% (2 symptoms), and 6.90% versus 93.10% (all 3 symptoms).

Conclusion: The presence of 2 of the proposed symptom classes to separate AC stage 2 from stage 1 seems to provide a good empirical balance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/WAD.0000000000000408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904575PMC
December 2019

A validation of a self-administered screening test for Parkinson's disease.

J Neurol Sci 2020 Nov 2;418:117116. Epub 2020 Sep 2.

Parkinson's Disease and Movement Disorders Center, Department of Neurology, Baylor College of Medicine, Houston, Texas Street, United States of America.

Background: The detection and diagnosis of Parkinson's disease (PD) is of paramount importance for optimal treatment and for participation in disease-modifying trials. The present study assesses the diagnostic accuracy of the Baylor Functional Assessment Scale (BFAS), a self-administered screening instrument, designed to distinguish between patients with PD, other disorders (OD), and healthy controls (HC).

Methods: Using the BFAS, we screened a total of 265 individuals including patients diagnosed at the Baylor College of Medicine Parkinson's Disease Center and Movement Disorders Clinic (PDCMDC) with PD (N = 63) and with OD (N = 47), and HC (N = 155) participants recruited from the PDCMDC and community health fairs.

Results: Significant group differences in BFAS total scores were found (F = 172.6; p < 0.001) between patients with PD and those with OD and both groups endorsed more items than the HC group. A cut-point of 3 on the BFAS total score maximized the sensitivity (85.7%, 95%CI: 74.61% to 93.25%) and the specificity (87.7%, 05% Ci: 81.52% to 92.46%) for distinguishing PD from HC with a negative predictive value (NPV) of 93.8% and a negative likelihood ratio (NLR) of 0.16. At a cut-point of 5, the BFAS maximized sensitivity (76%, 95% CI: 63.79% to 86.02%) and specificity (72%, 95% CI: 57.36% to 84.38%) for distinguishing PD from OD with a NPV of 69.4% and a NLR of 0.33.

Conclusions: In this pilot study, the BFAS provides a sensitive and specific screening tool for PD that helps differentiate individuals with PD from HC and from those with other disorders. Through future validation studies, the BFAS may be a useful instrument for identifying individuals with PD and for recruitment into PD clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2020.117116DOI Listing
November 2020

Rapid communication: Preliminary validation of a telephone adapted Montreal Cognitive Assessment for the identification of mild cognitive impairment in Parkinson's disease.

Clin Neuropsychol 2021 Jan 11;35(1):133-147. Epub 2020 Aug 11.

Department of Neurology, Baylor Scott and White Health, Temple, TX, USA.

In the current pandemic, tele-screening of neuropsychological status has become a necessity. Instruments developed for telephone screening are not as well validated as traditional neuropsychological measures. Therefore, the current study presents preliminary validation of a telephone version of the Montreal Cognitive Assessment (T-MoCA) in individuals with Parkinson's disease (PD). Twenty-one persons with PD completed the T-MoCA along with a traditional neuropsychological battery. Diagnostic accuracy for the presence of PD-related mild cognitive impairment (MCI) and correlations with traditional neuropsychological measures are reported. Individuals with MCI ( = 9) scored lower than individuals without cognitive impairment (17.56 vs. 19.50; = -2.28, = .03, = -1.00). Diagnostic accuracy for MCI ranged from 76% to 81%, with sensitivity ranging from 0.56 to 0.67 and specificity ranging from 0.92 to 1.00. Correlations of T-MoCA derived scores with traditional neuropsychological measures were quite modest, with the exception of the memory impairment scale. This rapid communication presents preliminary validation of the T-MoCA for use in individuals with PD. Caveats and implications for practical use in the current pandemic are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854046.2020.1801848DOI Listing
January 2021

Implications for technological reserve development in advancing age, cognitive impairment, and dementia.

Behav Brain Sci 2020 08 10;43:e157. Epub 2020 Aug 10.

Department of Psychology and Neuroscience, Baylor University, Waco,

This commentary draws connections between technological culture emergence and recent trends in using assistive technology to reduce the burden of Alzheimer's disease. By the technical-reasoning hypothesis, cognitively-impaired individuals will lack the cognitive ability to employ technologies. By the technological reserve hypothesis, social-motivational and cultural transmissibility factors can provide foundations for using technology as cognitive prosthetics even during neurodegenerative illnesses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0140525X20000126DOI Listing
August 2020

Development and Preliminary Validation of Standardized Regression-Based Change Scores as Measures of Transitional Cognitive Decline.

Arch Clin Neuropsychol 2020 Jul 21. Epub 2020 Jul 21.

Division of Neuropsychology, Baylor Scott and White Health, Temple, TX, USA.

Objective: An increasing focus in Alzheimer's disease and aging research is to identify transitional cognitive decline. One means of indexing change over time in serial cognitive evaluations is to calculate standardized regression-based (SRB) change indices. This paper includes the development and preliminary validation of SRB indices for the Uniform Data Set 3.0 Neuropsychological Battery, as well as base rate data to aid in their interpretation.

Method: The sample included 1,341 cognitively intact older adults with serial assessments over 0.5-2 years in the National Alzheimer's Coordinating Center Database. SRB change scores were calculated in half of the sample and then validated in the other half of the sample. Base rates of SRB decline were evaluated at z-score cut-points, corresponding to two-tailed p-values of .20 (z = -1.282), .10 (z = -1.645), and .05 (z = -1.96). We examined convergent associations of SRB indices for each cognitive measure with each other as well as concurrent associations of SRB indices with clinical dementia rating sum of box scores (CDR-SB).

Results: SRB equations were able to significantly predict the selected cognitive variables. The base rate of at least one significant SRB decline across the entire battery ranged from 26.70% to 58.10%. SRB indices for cognitive measures demonstrated theoretically expected significant positive associations with each other. Additionally, CDR-SB impairment was associated with an increasing number of significantly declined test scores.

Conclusions: This paper provides preliminary validation of SRB indices in a large sample, and we present a user-friendly tool for calculating SRB values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/arclin/acaa042DOI Listing
July 2020

Using multivariate base rates of low scores to understand early cognitive declines on the uniform data set 3.0 Neuropsychological Battery.

Neuropsychology 2020 Sep 27;34(6):629-640. Epub 2020 Apr 27.

Department of Neurology, Baylor Scott and White Health.

Objective: Low neuropsychological test scores are commonly observed even in cognitively healthy older adults. For batteries designed to assess for and track cognitive decline in older adults, documenting the multivariate base rates (MBRs) of low scores is important to differentiate expected from abnormal low score patterns. Additionally, it is important for our understanding of mild cognitive impairment and preclinical declines to and determine how such score patterns predict future clinical states.

Method: The current study utilized Uniform Data Set Neuropsychological Battery 3.0 (UDS3NB) data for 5,870 English-speaking, older adult participants from the National Alzheimer's Coordinating Center from 39 Alzheimer's disease Research Centers from March 2015 to December 2018. MBRs of low scores were identified for 2,608 cognitively healthy participants that had completed all cognitive measures. The association of abnormal MBR patterns with subsequent conversion to mild cognitive impairment and dementia were explored.

Results: Depending on the operationalization of "low" score, the MBR of demographically adjusted scores ranged from 1.40 to 79.2%. Posttest probabilities using MBR methods to predict dementia status at 2-year follow up ranged from .06 to .33, while posttest probabilities for conversion to mild cognitive impairment (MCI) ranged from .12-.32.

Conclusions: The data confirm that abnormal cognitive test scores are common among cognitively normal older adults. Using MBR criteria may improve our understanding of MCI. They may also be used to enrich clinical trial selection processes through recruitment of at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/neu0000640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484046PMC
September 2020

The Uniform Dataset 3.0 Neuropsychological Battery: Factor Structure, Invariance Testing, and Demographically Adjusted Factor Score Calculation.

J Int Neuropsychol Soc 2020 07 17;26(6):576-586. Epub 2020 Feb 17.

Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX, USA.

Objective: The goals of this study were to (1) specify the factor structure of the Uniform Dataset 3.0 neuropsychological battery (UDS3NB) in cognitively unimpaired older adults, (2) establish measurement invariance for this model, and (3) create a normative calculator for factor scores.

Methods: Data from 2520 cognitively intact older adults were submitted to confirmatory factor analyses and invariance testing across sex, age, and education. Additionally, a subsample of this dataset was used to examine invariance over time using 1-year follow-up data (n = 1061). With the establishment of metric invariance of the UDS3NB measures, factor scores could be extracted uniformly for the entire normative sample. Finally, a calculator was created for deriving demographically adjusted factor scores.

Results: A higher order model of cognition yielded the best fit to the data χ2(47) = 385.18, p < .001, comparative fit index = .962, Tucker-Lewis Index = .947, root mean square error of approximation = .054, and standardized root mean residual = .036. This model included a higher order general cognitive abilities factor, as well as lower order processing speed/executive, visual, attention, language, and memory factors. Age, sex, and education were significantly associated with factor score performance, evidencing a need for demographic correction when interpreting factor scores. A user-friendly Excel calculator was created to accomplish this goal and is available in the online supplementary materials.

Conclusions: The UDS3NB is best characterized by a higher order factor structure. Factor scores demonstrate at least metric invariance across time and demographic groups. Methods for calculating these factors scores are provided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S135561772000003XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319897PMC
July 2020

Functional neurological symptoms masquerading as Wernicke encephalopathy following bariatric surgery.

Proc (Bayl Univ Med Cent) 2019 Oct 18;32(4):607-609. Epub 2019 Sep 18.

Division of Neuropsychology, Baylor Scott & White HealthTempleTexas.

Wernicke encephalopathy (WE), caused by thiamine deficiency, is classically associated with alcoholism but is increasingly recognized among patients who have undergone bariatric surgery. As with other neurocognitive conditions, alternative explanations for symptoms, such as psychiatric, neurological, and motivational factors, must be considered before arriving at a diagnosis of WE. We present a patient after sleeve gastrectomy who was presumed to have WE; after detailed neuropsychological assessment, the condition was better conceptualized as a conversion disorder. The case illustrates the heretofore unrecognized role of bariatric surgery in the development of functional symptoms and demonstrates the importance of neuropsychological assessment in detecting functional symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08998280.2019.1651149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794007PMC
October 2019

Quantitative and qualitative features of executive dysfunction in frontotemporal and Alzheimer's dementia.

Appl Neuropsychol Adult 2021 Jul-Aug;28(4):449-463. Epub 2019 Aug 19.

Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA.

Behavioral variant fronto-temporal degeneration (bvFTD) is typically distinguished from Alzheimer's disease (AD) by early, prominent dysexecutive findings, in addition to other clinical features. However, differences in executive functioning between these groups are not consistently found. The current study sought to investigate quantitative and qualitative differences in executive functioning between those with bvFTD and AD in a large sample, while controlling for dementia severity and demographic variables. Secondary data analyses were completed on a subset of cases from the National Alzheimer's Coordinating Center collected from 36 Alzheimer's Disease Research Centers and consisting of 1,577 individuals with AD and 406 individuals with bvFTD. Groups were compared on 1) ability to complete three commonly administered executive tasks (letter fluency, Trail Making Test Part B [TMTB], and digits backward); 2) quantitative test performance; and 3) errors on these tasks. Findings suggested that individuals with bvFTD were less likely to complete letter fluency, (2) = 178.62,  < .001, and number span tasks, (1) = 11.49,  < .001), whereas individuals with AD were less likely to complete TMTB, (2) = 460.38,  < .001. Individuals with bvFTD performed more poorly on letter fluency, (1) = 28.06,  = .013, but there were not group differences in TMTB lines per second or number span backwards. Errors generally did not differentiate the diagnostic groups. In summary, there is substantial overlap in executive dysfunction between those with bvFTD and AD, though individuals with bvFTD tend to demonstrate worse letter fluency performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23279095.2019.1652175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028481PMC
August 2019

Neuropsychological impact of white matter hyperintensities in older adults without dementia.

Appl Neuropsychol Adult 2021 May-Jun;28(3):354-362. Epub 2019 Jul 9.

College of Medicine, Texas A&M Health Science Center, Temple, Texas, USA.

The purpose of this study was to determine (a) if simple clinical judgements of white matter hyperintensities (WMH) on imaging are associated with measurable cognitive impacts in otherwise cognitively normal older adults, (b) if neuropsychological measures can predict those with WMH, and (c) the frequency of low cognitive scores in those with WMH on a battery of measures. Forty-four individuals judged free of other cognitive disorders despite moderate to extensive WMH were compared with 50 individuals matched on age (mean of 83), education (college educated), and gender (predominantly female). Data was obtained from the National Alzheimer's Coordinating Center database. The group with at least moderate WMH had lower scores on the Trail Making Test A, verbal fluency, and digit span. A component score derived from these measures was a significant predictor of the presence of WMH, though only correctly classified 68% of participants. Even in individuals free from other suspected conditions, clinically judged moderate to extensive WMH was associated with cognitive weaknesses for processing speed, working memory, and executive functioning. This shows that a relatively simple judgment of WMH burden is meaningfully associated with worse cognition. Implications and future directions for are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23279095.2019.1633536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949427PMC
July 2019

Normative Data for Derived Measures and Discrepancy Scores for the Uniform Data Set 3.0 Neuropsychological Battery.

Arch Clin Neuropsychol 2019 Jan;35(1):75-89

Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA.

Objective: The Uniform Data Set 3.0 (UDS 3.0) neuropsychological battery is a recently published battery intended for clinical research with older adult populations. While normative data for the core measures has been published, several additional discrepancy and derived scores can also be calculated. We present normative data for Trail Making Test (TMT) A & B discrepancy and ratio scores, semantic and phonemic fluency discrepancy scores, Craft Story percent retention score, Benson Figure percent retention score, difference between verbal and visual percent retention, and an error index.

Method: Cross-Sectional data from 1803 English speaking, cognitively normal control participants were obtained from the NACC central data repository.

Results: Descriptive information for derived indices is presented. Demographic variables, most commonly age, demonstrated small but significant associations with the measures. Regression values were used to create a normative calculator, made available in a downloadable supplement. Statistically abnormal values (i.e., raw scores corresponding to the 5th, 10th, 90th, and 95th percentiles) were calculated to assist in practical application of normative findings to individual cases. Preliminary validity of the indices are demonstrated by a case study and group comparisons between a sample of individuals with Alzheimer's (N = 81) and Dementia with Lewy Bodies (DLB; N = 100).

Conclusions: Clinically useful normative data of such derived indices from the UDS 3.0 neuropsychological battery are presented to help researchers and clinicians interpret these scores, accounting for demographic factors. Preliminary validity data is presented as well along with limitations and future directions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/arclin/acz025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014972PMC
January 2019

Regional neuropathology distribution and verbal fluency impairments in Parkinson's disease.

Parkinsonism Relat Disord 2019 08 10;65:73-78. Epub 2019 May 10.

Department of Neurology, Baylor Scott and White Health, Temple, TX, USA; Texas A&M College of Medicine, Temple, TX, USA. Electronic address:

Background: Verbal fluency deficits are common in patients with Parkinson's disease. The association of these impairments with regional neuropathological changes is unexplored.

Objectives: Determine if patients with verbal fluency impairments have greater neuropathological burden in frontal, temporal, and limbic regions and if Lewy bodies or neurofibrillary tangles were associated with verbal fluency impairments.

Methods: Data was derived from the Arizona Study of Aging and Neurodegenerative Disorders. 47 individuals who completed phonemic and semantic verbal fluency tasks and met clinicopathological criteria for Parkinson's disease (with and without comorbid Alzheimer's disease) were included. Impairment on fluency tasks was defined by normative data, and the density of neuropathology in temporal, limbic, and frontal regions was compared between groups.

Results: Individuals with semantic fluency impairments had greater total pathology (Lewy bodies + neurofibrillary tangles) in limbic structures (W = 320.0, p = .033, r = .33), while those who had phonemic fluency impairments had increased total neuropathology in frontal (W = 364.5, p = .011, r = .37), temporal (W = 356.5, p = .022, r = .34), and limbic regions (W = 357.0, p = .024, r = .34). Greater Lewy body density was found in those with verbal fluency impairments, though trends for greater neurofibrillary tangle density were noted as well.

Conclusions: Impaired phonemic fluency was associated with higher Lewy body and tangle burden in frontal, temporal, and limbic regions, while impaired semantic fluency was associated with greater limbic pathology. Though neurofibrillary tangles trended higher in several regions in those with impaired verbal fluency, higher Lewy body density in general was associated with verbal fluency deficits. Implications for research and clinical practice are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.parkreldis.2019.05.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774852PMC
August 2019

Cognitive Problems in Parkinson Disease: Perspectives and Priorities of Patients and Care Partners.

Cogn Behav Neurol 2019 03;32(1):16-24

Department of Neurology, Division of Neuropsychology, Baylor Scott & White Health, Temple, Texas.

Objective: To report how people with Parkinson disease (pwPD) and their care partners (CPs) describe the cognitive impacts of the disease, explore the convergent validity of subjective cognitive complaints (SCCs) with measures of cognition and daily functioning, and report the cognitive treatment priorities of pwPD and their CPs.

Background: Cognitive symptoms in pwPD are common and disabling. Although objective cognitive impairments have been closely studied, SCCs are less well understood.

Methods: Fifty dyads consisting of a person with PD and his or her CP independently completed a questionnaire that describes cognitive difficulties and was derived from a prior focus group study. Each participant rated the person with PD's degree of difficulty with symptoms and identified the top five items that would be important treatment targets. Each person with PD also completed the Montreal Cognitive Assessment (MoCA), and his or her CP completed questionnaires assessing the patient's daily functioning and the CP's distress.

Results: Significant correlations existed between CP-reported cognitive symptoms and objective cognitive impairment as assessed by the MoCA. Both patient- and CP-reported SCCs were correlated with the pwPD's cognition as assessed by the MoCA, with an increasing number of SCCs reported with declining cognition. In general, the pwPD self-reported more SCCs than did the CPs, but for patients with dementia, the CPs reported more SCCs. Language and decision-making were the top treatment priorities.

Conclusions: In view of the array of cognitive impacts of PD, clinicians and researchers must consider both the reporter (patient or CP) and the overall stage of a patient's cognitive decline when evaluating SCCs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/WNN.0000000000000184DOI Listing
March 2019

The smartphone in the memory clinic: A study of patient and care partner's utilisation habits.

Neuropsychol Rehabil 2020 Jan 16;30(1):101-115. Epub 2018 Apr 16.

Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.

Smartphones have potential as cognitive aids for adults with cognitive impairments. However, little is known about how patients and their care partners utilise smartphones in their day-to-day lives. We collected self-reported smartphone utilisation data from patients referred for neuropsychological evaluations ( = 53), their care partners ( = 44), and an Amazon Mechanical Turk control sample ( = 204). Patient participants were less likely to own a smartphone than controls, with increasing age associated with less utilisation of smartphone features in all groups. Of the patients who owned smartphones, spontaneous use of cognitive aid features (e.g., reminders and calendars) occurred on only a monthly-to-weekly basis; by comparison, patients reported utilising social/general features (e.g., email and internet) on a weekly-to-daily basis. Individuals referred for geriatric cognitive disorder evaluations were less likely to own and use smartphones than individuals referred for other reasons. Care partners reported using their smartphones more frequently than control group adults, with 55% of care partners endorsing utilising their device in caring for the patient. Building upon existing smartphone use habits to increase the use of cognitive aid features may be a feasible intervention for some patients, and including care partners in such interventions is encouraged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09602011.2018.1459307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191359PMC
January 2020

Brief Report: Knowledge of, Interest in, and Willingness to Try Behavioral Interventions in Individuals With Parkinson's Disease.

Adv Mind Body Med 2018 Winter;32(1):8-12

Purpose/Objective • Behavioral interventions hold enormous promise for managing a variety of motor and nonmotor symptoms in Parkinson's disease (PD). Despite this, prior studies have suggested that the utilization of these interventions is relatively low. The current study seeks to understand factors that could relate to the utilization of PD behavioral strategies. Specifically, the study evaluates the self-described knowledge of, interest in, and willingness to participate in behavioral interventions in a community-dwelling sample of individuals with PD. Research Method/Design • Forty-five individuals with PD completed a survey that assessed knowledge, interest, and willingness to participate in 5 behavioral interventions: hypnosis, relaxation training, mindfulness/meditation, computerized "brain games," and counseling. In addition, participants self-reported their quality of life across several domains; these domain scores were correlated with overall ratings of interest and willingness to participate in behavioral interventions. Results • Self-reported knowledge of behavioral interventions was low, but interest and willingness to participate was moderate to high across modalities. Statistically significant correlations were noted between perceived knowledge of the techniques and interest (r = 0.29, P = .05) as well as willingness to participate (r = 0.32, P = .03) in these techniques. Interest and willingness were also correlated with self-reported bodily discomfort (r = 0.36, P = .02). Conclusions/Implications • The participants of the current sample were interested and willing to participate in behavioral interventions but had limited knowledge of the potential for these techniques to manage their symptoms. The reported high level of willingness to participate in behavioral interventions suggests that it is feasible to provide behavioral interventions in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2018

Alzheimer's Disease Assessment: A Review and Illustrations Focusing on Item Response Theory Techniques.

Assessment 2018 04 28;25(3):360-373. Epub 2017 Dec 28.

4 Florida State University, Tallahassee, FL, USA.

Alzheimer's disease (AD) affects neurological, cognitive, and behavioral processes. Thus, to accurately assess this disease, researchers and clinicians need to combine and incorporate data across these domains. This presents not only distinct methodological and statistical challenges but also unique opportunities for the development and advancement of psychometric techniques. In this article, we describe relatively recent research using item response theory (IRT) that has been used to make progress in assessing the disease across its various symptomatic and pathological manifestations. We focus on applications of IRT to improve scoring, test development (including cross-validation and adaptation), and linking and calibration. We conclude by describing potential future multidimensional applications of IRT techniques that may improve the precision with which AD is measured.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1073191117745125DOI Listing
April 2018

Toward patient-centered outcomes for cognitive evaluations: the perspective of those affected by Parkinson's disease.

Clin Neuropsychol 2018 Aug - Oct;32(7):1303-1318. Epub 2017 Dec 20.

e Georgetown Area Parkinson's Support Group , Georgetown , TX , USA.

Objective: Patient-centered outcomes research is predicated on the idea that the opinions, attitudes, and preferences of patients should help inform study design and interpretation. To date, little is known about what defines patient-centered outcomes from cognitive evaluations. The current evaluation sought to explore this issue in persons with Parkinson's disease (PwPD) and their care partners (CP).

Method: Focus groups of 22 PwPD/CP dyads were conducted to identify potential consumer oriented endpoints from cognitive evaluations. These endpoints were utilized to create a Patient-Centered Cognitive Assessment Outcomes Scale, which was administered to a different group of 50 PwPD/CP dyads who rated the importance of each outcome and identified their top three priority outcomes.

Results: Three themes emerged from the focus groups: improved knowledge, advice, and planning. Both PwPD and CP rated items in all three domains as being very important outcomes. Priorities for outcomes in both groups favored treatment planning information slightly above knowledge based outcomes.

Conclusions: The PwPD and CP identified improved knowledge, advice for daily activities, and knowledge they could use to plan for future eventualities as very important. This information can be used as a framework for future studies aimed at demonstrating patient-centered outcomes from neuropsychological evaluations. Implications for future research are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854046.2017.1414884DOI Listing
August 2019

Factor structure of the Montreal Cognitive Assessment items in a sample with early Parkinson's disease.

Parkinsonism Relat Disord 2017 Aug 25;41:104-108. Epub 2017 May 25.

Plummer Movement Disorders Center, Scott & White Medical Center, 2401 S. 31st Street, Temple, TX 76508, USA; Department of Internal Medicine, Texas A&M Health Sciences Center, 2401 S. 31st Street, Temple, TX 76508, USA.

Introduction: The Montreal Cognitive Assessment (MoCA) is a frequently utilized cognitive screening tool that has attractive clinical attributes when utilized in individuals with Parkinson's disease. However, the construct validity of this instrument has not been well-characterized in Parkinson's samples. The purpose of this study is to explore the underlying factor structure of the MoCA in individuals with early stage Parkinson's disease.

Method: Item responses from the MoCA in 357 individuals with Parkinson's disease from the Parkinson's Progression Markers Initiative were analyzed first for frequency of errors and polychoric inter item correlations. This correlation matrix was then analyzed with exploratory factor analysis.

Results: Omitting items with ceiling effects, three factors emerged which explained the majority of the variance. These factors were reflective of executive dysfunction, memory, and verbal attention. Scores on the MoCA and all of its subscales were significantly different between individuals with Parkinson's disease-no cognitive impairment and those who met criteria for mild cognitive impairment.

Conclusions: In keeping with prior studies in Parkinson's disease, executive dysfunction seems to underpin performance of many items of the MoCA. Implications of this finding both in terms of optimizing the MoCA for use in this population and further steps to validate the constructs behind the MoCA are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.parkreldis.2017.05.023DOI Listing
August 2017

Informant Perceptions of the Cause of Activities of Daily Living Difficulties in Parkinson's Disease.

Clin Neuropsychol 2016 3;30(1):82-94. Epub 2016 Feb 3.

b Department of Psychology , Texas A&M University , College Station , TX , USA.

Objective: Individuals with Parkinson's disease (PD) can have difficulties with activities of daily living (ADL) that stem from cognitive, motor, or affective manifestations of the disease. Accurately attributing ADL difficulty specifically to cognitive decline is critical when conducting a neuropsychological evaluation of a person with PD. Informant description of ADL performance is frequently used for this purpose, but there has been little work assessing informants' ability to attribute ADL dysfunction to a specific symptom source in PD.

Method: Fifty community dwelling individuals with PD completed cognitive, motor, and affective measures. A knowledgeable informant completed an ADL scale that asked about degree and perceived source of difficulty (cognitive, motor, affective) for each task.

Results: Informants indicated that motor dysfunction was the most common source of ADL difficulty, but the informants viewed difficulty with certain tasks, such as financial management, as particularly related to cognitive dysfunction. Informant reports of the source of ADL dysfunction (cognitive, motor, affective) were consistent with clinical measures of those specific dysfunctions. ADL dysfunction attributed to cognition specifically (χ(2) = 9.80, p = .01) was higher in those with measurable cognitive impairment.

Conclusions: Informant reports of the sources of ADL dysfunction correlate with clinical measures of these symptoms, suggesting that informants may provide useful clinical information about the cause of ADL dysfunction in persons with PD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854046.2015.1136690DOI Listing
October 2016

Duration of disease does not equally influence all aspects of quality of life in Parkinson's disease.

J Clin Neurosci 2016 Jun 6;28:102-6. Epub 2016 Jan 6.

Movement Disorders Program, Department of Neurology, University of South Carolina, Columbia, SC, USA.

Health related quality of life (HRQoL) is negatively impacted in patients suffering from Parkinson's disease (PD). For the specific components that comprise HRQoL, the relationship between clinical variables, such as disease duration, is not fully characterized. In this cross-sectional study (n=302), self-reported HRQoL on the Parkinson's Disease Questionnaire (PDQ-39) was evaluated as a global construct as well as individual subscale scores. HRQoL was compared in three groups: those within 5years of diagnosis, those within 6-10years of diagnosis, and those greater than 11years since diagnosis. Non-parametric analyses revealed lower HRQoL with increasing disease duration when assessed as a global construct. However, when subscales were evaluated, difficulties with bodily discomfort and cognitive complaints were comparable in individuals in the 1-5years and 6-10year duration groups. Exploratory regression analyses suggested disease duration does explain unique variance in some subscales, even after controlling for Hoehn and Yahr stage and neuropsychiatric features. Our findings show that HRQoL domains in PD patients are affected differentially across the duration of the disease. Clinicians and researchers may need to tailor interventions intended to improve HRQoL at different domains as the disease progresses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2015.09.019DOI Listing
June 2016

How Do Scores on the ADAS-Cog, MMSE, and CDR-SOB Correspond?

Clin Neuropsychol 2015 30;29(7):1002-9. Epub 2015 Nov 30.

c Department of Neurology, Alzheimer's Disease and Memory Disorders Center , Baylor College of Medicine , Houston , TX , USA.

Objective: Clinicians and researchers who measure cognitive dysfunction often use the Alzheimer's Disease Assessment Scale--Cognitive Subscale (ADAS-Cog), the Mini-Mental State Examination (MMSE), or the Clinical Dementia Rating scale (CDR-SOB). But, the use of different measures can make it difficult to compare data across patients or studies. What is needed is a simple chart that shows how scores on these three important measures correspond to each other.

Methods: Using data from 1709 participants from the Alzheimer's Disease Neuroimaging Initiative and item response theory-based statistics, we analyzed how scores on each measure, the ADAS-Cog, the MMSE, and the CDR-SOB, correspond.

Results: Results indicated multiple inflections in CDR-SOB and ADAS-Cog scores within a given MMSE score, suggesting that the CDR-SOB and ADAS-Cog are more precise in measuring the severity of cognitive dysfunction than the MMSE.

Conclusions: This study shows how scores on these three popular measures of cognitive dysfunction correspond to each other, which is very useful information for both researchers and clinicians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854046.2015.1119312DOI Listing
September 2016

Adding delayed recall to the ADAS-cog improves measurement precision in mild Alzheimer's disease: Implications for predicting instrumental activities of daily living.

Psychol Assess 2015 Dec 4;27(4):1234-40. Epub 2015 May 4.

Alzheimer's Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine.

As research increasingly focuses on preclinical stages of Alzheimer's disease (AD), instruments must be retooled to identify early cognitive markers of AD. A supplemental delayed recall subtest for the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog; Mohs, Rosen, & Davis, 1983; Rosen, Mohs, & Davis, 1984) is commonly implemented, but it is not known precisely where along the spectrum of cognitive dysfunction this subtest yields incremental information beyond what is gained from the standard ADAS-cog, or whether it can improve prediction of functional outcomes. An item response theory approach can analyze this in a psychometrically rigorous way. Seven hundred eighty-eight patients with AD or amnestic complaints or impairment completed a battery including the ADAS-cog and 2 activities of daily living measures. The delayed recall subtest slightly improved the ADAS-cog's measurement precision in the mild range of cognitive dysfunction and increased prediction of instrumental activities of daily living for individuals with subjective memory impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/pas0000133DOI Listing
December 2015

Neurobehavioral effects of levetiracetam in patients with traumatic brain injury.

Front Neurol 2013 Dec 2;4:195. Epub 2013 Dec 2.

Department of Neurology, Scott & White Healthcare, Texas A&M Health Science Center College of Medicine , Temple, TX , USA.

Moderate to severe traumatic brain injury (TBI) is one of the leading causes of acquired epilepsy. Prophylaxis for seizures is the standard of care for individuals with moderate to severe injuries at risk for developing seizures, though relatively limited comparative data is available to guide clinicians in their choice of agents. There have however been experimental studies which demonstrate potential neuroprotective qualities of levetiracetam after TBI, and in turn there is hope that eventually such agents may improve neurobehavioral outcomes post-TBI. This mini-review summarizes the available studies and suggests areas for future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2013.00195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845013PMC
December 2013

Greater precision when measuring dementia severity: establishing item parameters for the Clinical Dementia Rating Scale.

Dement Geriatr Cogn Disord 2012 ;34(2):128-34

Department of Psychology, Texas A & M University, 4235 TAMU, College Station, TX 77843, USA.

Background/aims: An item response theory (IRT)-based scoring approach to the Clinical Dementia Rating Scale (CDR) can account for the pattern of scores across the CDR items (domains) and their differential abilities to indicate dementia severity. In doing so, an IRT-based approach can provide greater precision than other CDR scoring algorithms. However, neither a good set of item parameters nor an easily digestible set of instructions needed to implement this approach is readily available.

Methods: Participants were 1,326 patients at the Baylor College of Medicine Alzheimer's Disease and Memory Disorders Clinic.

Results: The item parameters necessary for an IRT-based scoring approach were identified (a parameters ranged from 3.01 to 6.22; b parameters ranged from -2.46 to 2.07).

Conclusion: This study provides, and demonstrates how to easily apply, IRT-based item parameters for the CDR
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000341731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557804PMC
February 2013

Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events.

Epilepsy Behav 2012 Aug 9;24(4):439-44. Epub 2012 Jun 9.

Jack C. Montgomery VA Medical Center, 1011 Honor Heights Blvd., Muskogee, OK 74401, USA.

The Structured Interview of Malingered Symptomatology (SIMS) is a self-report instrument that asks patients whether they experience atypical or implausible symptoms. The instrument has not been evaluated in an epilepsy population, and the potential for it to accurately distinguish between patients with psychogenic non-epileptic events (PNEE) and epileptic event groups has not been established. The SIMS was administered to patients in long-term video-EEG monitoring of these patients, 91 with PNEE and 29 with epilepsy were included in this study. Structured Interview of Malingered Symptomatology total scores as well as neurological and affective subscales were found to be predictors of group membership. Sensitivity and specificity across several different base rates of PNEE as well as maximum level likelihood ratios are presented. The findings not only demonstrate the utility of marked score elevations in differentiating PNEE from epilepsy but also point to considerable caution in interpreting mild elevations. Implications for the utility of this instrument in epilepsy evaluations are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2012.05.007DOI Listing
August 2012

Gaining precision on the Alzheimer's Disease Assessment Scale-cognitive: a comparison of item response theory-based scores and total scores.

Alzheimers Dement 2012 Jul 30;8(4):288-94. Epub 2012 Mar 30.

Department of Psychology, Texas A&M University, College Station, USA.

Background: The Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) is a commonly used measure for assessing cognitive dysfunction in patients with Alzheimer's disease (AD). The measure has 11 subscales, each of which captures an important aspect of cognitive dysfunction in AD. Traditional scoring of the ADAS-cog involves adding up the scores from the subscales without regarding their varying difficulty or their strength of relationship to AD-associated cognitive dysfunction. The present article analyzes problems associated with this approach and offers solutions for gaining measurement precision by modeling how the subscales function.

Methods: We analyzed data collected at the Baylor College of Medicine Alzheimer's Disease and Memory Disorders Clinic from 1240 patients diagnosed with varying degrees of dementia. Item response theory was used to determine the relationship between total scores on the ADAS-cog and the underlying level of cognitive dysfunction reflected by the scores.

Results: Results revealed that each total score corresponded to a spectrum of cognitive dysfunction, indicating that total scores were relatively imprecise indicators of underlying cognitive dysfunction. Furthermore, it was common for two individuals with the same total score to have significantly different degrees of cognitive dysfunction.

Conclusions: These findings suggest that item response theory scoring of the ADAS-cog may measure cognitive dysfunction more precisely than a total score method.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jalz.2011.05.2409DOI Listing
July 2012