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Biomedical subjects

Jennifer J Manly

Publications and source records attributed to Jennifer J Manly.

16 recordsLinked to original sources
PubMed2006

Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment.

CONTEXT: The likelihood of conversion to Alzheimer disease (AD) in mild cognitive impairment (MCI) and the "optimal" early markers of conversion need to be established. OBJECTIVES: To evaluate conversion rates to AD in subtypes of MCI and to identify neuropsychological measures most predictive of the time to conversion. DESIGN: Patients were followed up semiannually and controls annually. Subtypes of MCI were determined by using demographically adjusted regression norms on neuropsychological tests. Survival analysis was used to identify the most predictive neuropsychological measures. SETTING: Memory disorders clinic. PARTICIPANTS: One hundred forty-eight patients reporting memory problems and 63 group-matched controls. MAIN OUTCOME MEASURE: A consensus diagnosis of probable AD. RESULTS: At baseline, 108 patients met criteria for amnestic MCI: 87 had memory plus other cognitive domain deficits and 21 had pure memory deficits. The mean duration of follow-up for the 148 patients was 46.6 +/- 24.6 months. In 3 years, 32 (50.0%) of 64 amnestic-"plus" and 2 (10.0%) of 20 "pure" amnestic patients converted to AD (P = .001). In 148 patients, of 5 a priori predictors, the percent savings from immediate to delayed recall on the Selective Reminding Test and the Wechsler Adult Intelligence Scale-Revised Digit Symbol Test were the strongest predictors of time to conversion. From the entire neuropsychological test battery, a stepwise selection procedure retained 2 measures in the final model: total immediate recall on the Selective Reminding Test (odds ratio per 1-point decrease, 1.10; 95% confidence interval, 1.05-1.14; P < .0001) and Digit Symbol Test coding (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .01). The combined predictive accuracy of these 2 measures for conversion by 3 years was 86%. CONCLUSIONS: Mild cognitively impaired patients with memory plus other cognitive domain deficits, rather than those with pure amnestic MCI, constituted the high-risk group. Deficits in verbal memory and psychomotor speed/executive function abilities strongly predicted conversion to AD.

Aged↗
PubMed2006

Deconstructing race and ethnicity: implications for measurement of health outcomes.

A crucial issue for health researchers is how to measure health and health-related behaviors across racial/ethnic groups. This commentary outlines an approach that involves the deconstruction of race/ethnicity, which clarifies the independent influences of acculturation, quality of education, socioeconomic class, and racial socialization on outcomes of interest. Research on the influence of these variables on health outcomes in general, and cognitive test performance specifically, is presented. This research indicates that when variables such as quality of education, wealth, and perceived racism are taken into account, the effect of race/ethnicity on health outcomes is greatly reduced. In other words, race/ethnicity serves as a proxy for these more meaningful variables, and explicit measurement of these constructs will improve research of health within majority and minority ethnic groups.

Acculturation↗
PubMed2006

Ethical issues in cross-cultural neuropsychology.

Clinical neuropsychologists who assess patients from diverse cultural and linguistic backgrounds face unique ethical challenges. In this article, we address 4 critical questions relevant to ethics of cross-cultural neuropsychology: (a) Should culture or race be considered in neuropsychological testing? (b) Should race- and ethnicity-specific normative data be used in the clinical neuropsychological evaluation? (c) Who is competent to design and translate tests for ethnic minority groups and non-English speakers and who is competent to administer and interpret them? and (d) Are neuropsychology training programs adequately preparing clinicians to be competent in the assessment of cross-cultural groups? The overall aims of the article are to highlight the complexity of these clinical and ethical issues, to provide comprehensive and balanced information to help guide clinician choices, and to stimulate future research in this area.

Cross-Cultural Comparison↗
PubMed2005

Sources of errors on visuoperceptual tasks: role of education, literacy, and search strategy.

The current study explored possible sources of demographic effects through analyses of errors from modified formats of the Benton Visual Retention Test (BVRT) completed by African American elders. Results indicate that: (1) reading level was a stronger predictor of BVRT performance than years of education; (2) on the single-item matching format of the task, individuals with lower reading levels disproportionately produced errors on items that differed in geometric, rather than spatial features; and (3) on a multiple-choice matching format, individuals with lower reading levels committed more errors on items where the target was located in the lower half of a 2 x 2 matrix.

Black or African American↗
PubMed2005

Implementing diagnostic criteria and estimating frequency of mild cognitive impairment in an urban community.

BACKGROUND: Reported rates of mild cognitive impairment (MCI) range widely depending on methodologic differences, including specific sample characteristics, cognitive measures used, normative samples used for neuropsychological tests, and diagnostic criteria. OBJECTIVES: To operationalize diagnostic criteria for MCI and examine the frequency of MCI in ethnically and linguistically diverse elders (individuals older than 65 years). DESIGN: Prospective, community-based longitudinal cohort study. SETTING: Northern Manhattan, New York, NY. PARTICIPANTS: A cohort of 1315 nondemented elderly participants. MAIN OUTCOME MEASURE: A diagnosis of MCI was assigned retrospectively on the basis of comprehensive neuropsychological, functional, and neurologic assessments. Amnestic MCI, as well as forms of mild impairment with other cognitive characteristics, were classified. RESULTS: The frequency of amnestic MCI was 5.0% (95% confidence interval, 3.8-6.2). Other subtypes of MCI ranged in frequency from 2.1% to 6.2%. Mild cognitive impairment was more common among those older than 75 years compared with those aged 65 to 75 years. Individuals with fewer than 9 years of schooling were more likely to meet MCI criteria. Apolipoprotein (APOE) E4 allele was more frequent among those with amnestic MCI. CONCLUSIONS: When proper normative values are used, only age and education, and not race or ethnicity, are associated with higher frequency of MCI. The proportion of nondemented elders with isolated memory deficits is smaller than the proportion with deficits in multiple cognitive domains. The strong association of the APOE E4 allele with only amnestic MCI suggests that there are likely to be multiple causes of cognitive impairment and differential rates of conversion to Alzheimer disease within the cognitive subtypes of MCI.

Activities of Daily Living↗
PubMed2005

Neuropsychological test performance among Caribbean-born and U.S.-born African American elderly: the role of age, education and reading level.

Within-group variation is an important yet under-studied component of cross-cultural neuropsychology. The current study explored this potential source of variation in a neurologically healthy African American elderly sample by comparing the neuropsychological test performance of nondemented groups of Caribbean-born and U.S.-born African American elders who live in New York City. Caribbean-born elders resided in the U.S. for a mean of 41.5 years (SD=17.0). Results indicate that in general, Caribbean-born elders in this cohort did not demonstrate a unique cognitive testing profile from U.S.-born African American elders. However, the Caribbean-born group demonstrated a higher quality of education than their U.S.-born counterparts. The influence of demographic factors (i.e., age and education) on neuropsychological test performance was markedly attenuated in Caribbean-born elders though reading level was the strongest predictor of test performance for all elders, regardless of birthplace.

Black or African American↗
PubMed2005

Advantages and disadvantages of separate norms for African Americans.

Limitations of neuropsychological measures and normative data are exposed as use of these measures among culturally and linguistically different people expands in clinical and research settings. Several different tactics to solve the problem of poor specificity of cognitive measures among ethnic minorities have emerged in the literature; however, the development of separate racial/ethnic group norms has been the predominant approach. This commentary addresses the advantages and disadvantages of establishing separate norms for African Americans. Another approach, involving the deconstruction of race and education, may help to clarify the independent influences of race, culture, quality of education, and socioeconomic status on cognition and neuropsychological test performance.

Black or African American↗
PubMed2005

Cognitive decline and literacy among ethnically diverse elders.

Researchers on genetic and environmental influences on risk for Alzheimer's disease must be prepared for the growing ethnic and racial diversity of our participants. Within the investigation, years of education has typically served as a proxy for cognitive reserve, which may be one factor in influencing risk of cognitive decline among aging people. However, among ethnic minorities, years of education is a poor reflection of the value of educational experience and native ability. This study was conducted among 1002 ethnically diverse English-speaking residents of Northern Manhattan who were cognitively and functionally normal at a baseline evaluation. We found that literacy level was a better predictor of decline in memory, executive function, and language skills than was years of education. The results of this study suggest that in an ethnically diverse cohort, literacy level should be considered as a mediator of the interactions of biological and environmental factors on cognitive decline.

Aged↗
PubMed2004

Comparison of dementia with Lewy bodies to Alzheimer's disease and Parkinson's disease with dementia.

We compared the clinical and neuropsychological pattern of dementia with Lewy bodies (DLB) to Alzheimer's disease (AD) and Parkinson's disease with dementia (PD-d). Sixteen patients clinically diagnosed with DLB were compared with two groups of patients with PD-d (n = 15) and AD (n = 16) matched for level of dementia. Isolated cognitive impairment was the most common form of presentation in AD (93.8%) and DLB (31.3%) groups, while parkinsonism was in 100% of PD-d subjects. Psychoses associated with cognitive impairment at the beginning of the disease were more frequent in DLB patients (31.3%) than in AD (6.3%) and PD-d (0%) groups. There were no significant differences in Unified Parkinson Disease Rating Scale motor-subscale scores between DLB and PD-d patients. DLB and PD-d patients performed significantly worse on attentional functions and better on memory tests than AD. DLB patients also showed lower scores than AD subjects on visual memory, visuoperceptive, and visuoconstructive tests. No significant differences were found between PD-d group and DLB subjects on any neuropsychological test. We were unable to find any differences in cognitive tasks between PD-d and DLB subjects. Clinical features and neuropsychological deficiencies of DLB (attentional, visuoperceptive, and visuoconstructive deficits) and PD (attentional deficits) compared to AD (amnesic syndrome) can contribute to accurate identification of these entities and to the understanding of the neuropathological and neurochemical substrate underlying these diseases.

Aged↗
PubMed2004

Elevated sex-hormone binding globulin in elderly women with Alzheimer's disease.

BACKGROUND: Hormone levels change significantly with increasing age. These changes may be related to, or be associated with, the emergence of age-related diseases, such as Alzheimer's disease (AD). METHODS: Five hundred and seventy-six women over the age of 65 were studied from the Washington Heights-Inwood Columbia Aging Project (WHICAP). These women were selected from a group of healthy Medicare beneficiaries that were aged 65 and older living in the geographically defined area of northern Manhattan in New York City. Serum levels of estrone (E1), estradiol (E2), total testosterone (TT), dehydroepiandosterone (DHEA), luteinizing hormone (LH), follicle stimulating hormone (FSH), and sex-hormone binding globulin (SHBG) were measured. RESULTS: Significant differences were found between patients with AD and controls only in the level of SHBG, which was 20% higher in patients compared to controls (68.5nmol/l versus 54.7nmol/l, P<0.001). We also estimated levels of total E2 because after menopause, E2 is largely derived from E1. AD patients had significantly lower levels of estimated E2 (AD 0.46 versus controls 0.49, P<0.01). Differences remained significant after adjusting for age, ethnic group, education, and body mass index (BMI). CONCLUSIONS: A marked increase in SHBG levels was found in AD patients. SHBG normally responds to circulating testosterone and estrogen, therefore, elevated SHBG suggests an abnormal increase in its production and regulation. Further work is needed to clarify the cause and consequences of this observation.

Aged↗
PubMed2004

Cancellation test performance in African American, Hispanic, and White elderly.

Shape and letter cancellation test performance was investigated among large samples of African American, Hispanic, and White non-demented elders. Ethnic minority elders took significantly longer to complete both tasks compared to Whites. An index of task efficiency, which simultaneously measures time and accuracy, suggested that slower time by minority elders was not related to a measurable effort to achieve greater accuracy. The frequency of commission errors was greater in our sample than in previous reports, especially among ethnic minority elders. Although significant differences were observed between the ethnic groups when matched for years of education, equating for literacy level eliminated all performance differences between African Americans and Whites on both cancellation tasks.

Black or African American↗
PubMed2004

Acculturation, reading level, and neuropsychological test performance among African American elders.

The independent effects of cultural and educational experience on neuropsychological test performance were examined among 503 nondemented African Americans ages 65 and older. Measures of cultural experience (acculturation) and quality of education (reading level) were administered. Reading level was the most influential predictor of cognitive test performance, even after accounting for age, sex, years of education, and acculturation level. Age had small but significant unique effects on most measures, especially word list learning. Years of education had independent effects on measures of verbal abstraction, fluency, and figure matching. More acculturated African Americans obtained higher scores on most measures; however, after accounting for age, years of education, sex, and reading level, the effect of acculturation was diminished. The results suggest that quality of education and cultural experience influence how older African Americans approach neuropsychological tasks; therefore, adjustment for these variables may improve specificity of neuropsychological measures.

Acculturation↗
PubMed2003

Literacy and memory decline among ethnically diverse elders.

Literacy may be a more powerful indicator of brain reserve than years of education. Literacy level may be a proxy for native intellectual capacity or life experience that can compensate for brain damage or provide brain reserve. Alternately, the experience of acquiring literacy skills may in itself change the organization of the brain and increase protection against cognitive decline. However, because people with low levels of literacy obtain poor scores on most cognitive measures, only longitudinal studies can elucidate the role of reading ability in reserve. We determined whether literacy skills could predict cognitive change in a sample of 136 English-speaking African American, Caucasian, and Hispanic elders selected from a longitudinal aging study in New York City. According to a physician's independent examination, all participants were nondemented throughout the four longitudinal assessments. Literacy level was assessed using the WRAT-3 reading subtest. After accounting for age at baseline and years of education, GEE analyses showed that elders with low levels of literacy had a steeper decline in both immediate and delayed recall of a word list over time as compared to high literacy elders. Our findings suggest that literacy skills are protective against memory decline among nondemented elders.

Black or African American↗
PubMed2002

Reading level attenuates differences in neuropsychological test performance between African American and White elders.

The current study sought to determine if discrepancies in quality of education could explain differences in cognitive test scores between African American and White elders matched on years of education. A comprehensive neuropsychological battery was administered to a sample of African American and non-Hispanic White participants in an epidemiological study of normal aging and dementia in the Northern Manhattan community. All participants were diagnosed as nondemented by a neurologist, and had no history of Parkinson's disease, stroke, mental illness, or head injury. The Reading Recognition subtest from the Wide Range Achievement Test-Version 3 was used as an estimate of quality of education. A MANOVA revealed that African American elders obtained significantly lower scores than Whites on measures of word list learning and memory, figure memory, abstract reasoning, fluency, and visuospatial skill even though the groups were matched on years of education. However, after adjusting the scores for WRAT-3 reading score, the overall effect of race was greatly reduced and racial differences on all tests (except category fluency and a drawing measure) became nonsignificant. These findings suggest that years of education is an inadequate measure of the educational experience among multicultural elders, and that adjusting for quality of education may improve the specificity of certain neuropsychological measures.

Black or African American↗
PubMedDate not supplied

Neuropsychological testing: helpful or harmful?

Neuropsychological testing is important for the diagnosis and follow-up of dementia; it can also help provide consultation on patient care. However, lengthy testing is costly and can be stressful to the subjects. Tests developed for members of the majority culture often are inappropriate for ethnic minorities, especially those who speak a different language, have little or no formal education, and grew up in vastly different circumstances. Variables that directly affect test performance, such as education and acculturation instead of race or ethnicity, should be considered as explanatory variables for test performance. Reading level may be a better index for educational attainment than the number of years in school. Neuropsychological testing can be improved in several directions: (1) Use tests that are appropriate for the subject's background. (2) Use detailed scoring of a smaller number of test items to reduce test time, and establish discontinuation rules to limit the subject's experience of failure. (3) Develop parallel test forms for repeated assessment of the same individuals. (4) Strive for large and representative standardization samples. (5) Use computerized test norms based on findings of statistical analysis to better adjust for confounding variables.

Anxiety↗