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PubMed2004

The Test of Memory Malingering (TOMM): normative data from cognitively intact, cognitively impaired, and elderly patients with dementia.

This research adds to the psychometric validation of the Test of Memory Malingering (TOMM) by providing data for samples of elderly patients who are cognitively intact, cognitively impaired (non-dementia), and with dementia. Subjects were 78 individuals referred for evaluation of memory complaints. Significant group differences emerged between the dementia group and the two other groups (normals and cognitively impaired), although the latter two did not differ from each other. One hundred percent of normals and 92.7% of the cognitively impaired group made fewer than five errors (the suggested cut-off) on Trial 2 or the Retention trial of the TOMM, yielding an overall correct classification rate of 94.7%. However, the rate of misclassification for persons with dementia was high whether using a cut-point score of five, eight, or ten errors. This investigation extends the validity and clinical utility of this instrument. Results suggest that the TOMM is an useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out.

Activities of Daily Living↗

PubMed2003

Education and the association between vascular risk factors and cognitive function: a cross-sectional study in older Koreans with cognitive impairment.

BACKGROUND/OBJECTIVE: The association between hypertension, diabetes, and worse cognitive function has been reported to be stronger in groups with low levels of education. Using data from a cross-sectional community survey of Korean elders, we sought to investigate this within a sample with relative cognitive impairment. METHODS: The sample consisted of 341 participants with Mini-Mental State Examination (MMSE) (Korean version) scores of 24/30 or below. Previous diagnoses were ascertained and participants were examined for resting blood pressure and nonfasting blood glucose and cholesterol. RESULTS: After adjustment for age, occupation, physical dependence, and cholesterol levels, worse cognitive function (MMSE score <21) within the sample was associated with raised systolic blood pressure, raised glucose levels, and a previous diagnosis of diabetes. These associations were significant only in participants with no formal education. In this group the adjusted odds ratios for worse cognitive function were 1.18 (95% confidence interval [CI] 1.04-1.34) for each 10 mmHg increase in systolic blood pressure and 3.47 (1.14-10.6) for a previous diagnosis of diabetes. Odds ratios for the group with previous education were 0.99 (0.81-1.21) and 1.82 (0.48-6.92), respectively. CONCLUSION: The association between risk factors for cerebrovascular disease and cognitive impairment appears to be particularly strong in people with lower educational attainment.

Aged↗

PubMed2006

Impact of cognitive impairment on mild dementia patients and mild cognitive impairment patients and their informants.

BACKGROUND: The aim of this study was to identify key aspects of the impact of cognitive impairment on patients with mild cognitive impairment (MCI) and mild probable Alzheimer disease (AD) and their informants, and identify overlap and differences between the groups. METHODS: Structured focus group discussions were conducted with MCI patients, AD patients, MCI informants, and AD informants. Participants were recruited from memory clinics in the U.K. and the U.S.A. A total of 20 AD and 20 MCI patients and 16 AD and 11 MCI informants participated. Sessions were content reviewed to identify key impacts of cognitive impairment; results were compared across diagnostic groups and for patients and informants. RESULTS: Seven key themes emerged: uncertainty of diagnosis, skill loss, change in social and family roles, embarrassment and shame, emotionality, insight, and burden. Patients were able to discuss the impact of cognitive impairment on their lives and reported frustration with recognized memory problems, diminished self-confidence, fear of embarrassment, concerns about changing family roles due to cognitive impairment, and anxiety. Informants reported more symptoms and more impairment than did patients and indicated increased dependence on others among patients. CONCLUSION: MCI and mild AD exert substantial burden on patients' lives and the lives of those close to them.

Aged↗

PubMed2006

The validity of brief screening cognitive instruments in the diagnosis of cognitive impairment and dementia after first-ever stroke.

INTRODUCTION: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients. METHODS: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the "or rule"), in series (the "and rule") or as a weighted sum (the "weighted sum rule"). RESULTS: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (< or =23) was insensitive (0.50, 95% CI 0.16-0.84) and the IQCODE (> or =3.30) nonspecific (0.63, 95% CI 0.51-0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the "or rule" combination, but with only modest positive predictive value. CONCLUSIONS: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.

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PubMed2006

Cognitive stimulation therapy for Alzheimer's disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer's disease in patients treated with donepezil.

BACKGROUND: There is general consensus regarding the benefit of acetylcholinesterase inhibitors (e.g. donepezil) in Alzheimer's disease (AD). However, the combined effect of acetylcholinesterase and cognitive stimulation therapy (CST) is still controversial. OBJECTIVE: This study examines their combined effect on the progression of cognitive decline in AD by comparing the cognitive performance of 17 AD patients treated with CST and donepezil (combined treatment group) and 13 AD patients treated with donepezil alone (control group). METHODS: Patients in the combined treatment group received 5 mg of donepezil per day and about 20 one-hour CST sessions for one year, whereas the control group received only 5 mg of donepezil per day. The first eight sessions were carried out once a week, and subsequent sessions were generally once every two weeks. The patients were evaluated for changes in cognitive ability by administering the Mini-mental State Examination (MMSE) before the start of CST (baseline) and about one year later (follow-up). RESULTS: A repeated-measure analysis of variance revealed a significant group x time interaction. The MMSE score decreased significantly in the control group, but did not change significantly in the combined treatment group. Three patients in the control group declined by four points on the MMSE, compared to none in the combined treatment group. Effect size (ES) in the control group was relatively large and negative, while the ES in the combined treatment group was close to zero. CONCLUSIONS: The results suggest the possibility that donepezil plus CST slowed the rate of cognitive decline more than the administration of donepezil alone.

Aged↗

PubMed2003

Cognitive experience and its effect on age-dependent cognitive decline in beagle dogs.

Test-sophisticated beagle dogs show marked age sensitivity in a size discrimination learning task, with old and senior dogs performing significantly more poorly than young dogs. By contrast, age differences in learning were not seen in dogs naive with respect to neuropsychological test experience. These results indicate that old animals benefit less from prior cognitive experience than young animals, which is an example of an age-dependent loss in plasticity. This finding also suggests that behaviorally experienced animals are a more useful model of human cognitive aging than behaviorally naïve animals. We also looked at the effect of a program of behavioral enrichment in aged dogs. One year of enrichment did not lead to significant differences, but after 2 years the behaviorally enriched group performed significantly better than the control group. The effect after 2 years indicates that a prolonged program of cognitive enrichment can serve as an effective intervention in aged dogs. These findings demonstrate that cognitive abilities in aged animals can be modified by providing behavioral experience, indicating that cognitive abilities remain moderately plastic, even in very old animals.

Age Factors↗

PubMed2000

Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a well-recognised complication of cardiac surgery, but evidence of POCD after general surgery has been lacking. We recently showed that POCD was present in 9.9% of elderly patients 3 months after major non-cardiac surgery. The aim of the present study was to investigate whether POCD persists for 1-2 years after operation. METHODS: A total of 336 elderly patients (median age 69 years, range 60-86) was studied after major surgery under general anesthesia. Psychometric testing was performed before surgery and at a median of 7, 98 and 532 days postoperatively using a neuropsychological test battery with 7 subtests. A control group of 47 non-hospitalised volunteers of similar age were tested with the test battery at the same intervals. RESULTS: 1-2 years after surgery, 35 out of 336 patients (10.4%, CI: 7.2-13.7%) had cognitive dysfunction. Three patients had POCD at all three postoperative test sessions (0.9%). From our definition of POCD, there is only a 1:64000 likelihood that a single subject would have POCD at all three test points by chance. Logistic regression analysis identified age, early POCD, and infection within the first three postoperative months as significant risk factors for long-term cognitive dysfunction. Five of 47 normal controls fulfilled the criteria for cognitive dysfunction 1-2 years after initial testing (10.6%, CI: 1.8-19.4%), i.e. a similar incidence of age-related cognitive impairment as among patients. CONCLUSION: POCD is a reversible condition in the majority of cases but may persist in approximately 1% of patients.

Aged↗

PubMed2005

Physical, mental, and social catastrophic cognitions as prognostic factors in cognitive-behavioral and pharmacological treatments for panic disorder.

The authors explored the prognostic value of 3 different types of catastrophic cognitions in the treatment of panic disorder with and without mild-to-moderate agoraphobia using a sample of 143 participants who received either cognitive-behavioral therapy (CBT) or imipramine in a randomized controlled trial. Stronger fears of social catastrophes both prior to and following treatment with CBT or imipramine were associated with a poorer outcome. In contrast, cognitions involving physical or mental catastrophes were unrelated to outcome, regardless of whether these thoughts were measured prior to or following treatment. These findings are consistent with the notion that although the intensity of physical catastrophe cognitions may best discriminate between panic disorder and other anxiety disorders, it is the intensity of social catastrophe cognitions that is most closely tied to success in treating this disorder.

Adult↗

PubMed2006

Cognitive estimation impairment in Alzheimer disease and mild cognitive impairment.

Intact executive functioning is believed to be required for performance on tasks requiring cognitive estimations. This study used a revised version of a cognitive estimations test (CET) to investigate whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) were impaired on the CET compared with normal elderly controls (NECs). Neuropsychological tests were administered to determine the relationship between CET performance and other cognitive domains. AD patients displayed impaired CET performance when compared with NECs but MCI patients did not. Negative correlations between tests of working memory (WM) and semantic memory and the CET were found in NECs and AD patients, indicating that these cognitive domains were important for CET performance. Regression analysis suggests that AD patients were unable to maintain semantic information in WM to perform the task. The authors conclude that AD patients display deficits in working memory, semantic memory, and executive function, which are required for adequate CET performance.

Aged↗

PubMed2004

Validation of idiosyncratic cognitive schema in cognitive case formulations: an intraindividual idiographic approach.

This article describes a method for the intraindividual clinical validation of a cognitive case formulation (CCF) involving hypotheses about the patient's idiosyncratic cognitive schema (ICS). The two-stage approach begins by testing the convergent and discriminant validity of the hypothesized ICS against the individual's daily ratings of cognition items using confirmatory dynamic factor analysis. The second stage evaluates the extent to which the ICS factor scores predict daily variability in symptoms and distress and further addresses convergent and discriminant validity by evaluating intraindividual cognitive content specificity and the incremental validity of the idiographic cognition factors compared with nomothetic measures of thoughts/beliefs. This approach to validating idiographic assessment is illustrated with the CCF of a woman with comorbid mood and anxiety disorders.

Adult↗

PubMed2003

Preliminary evaluation of a scale to assess cognitive function in adults with Down's syndrome: the Prudhoe Cognitive Function Test.

BACKGROUND: In the clinical diagnosis of dementia in Down's syndrome (DS), it may be difficult to distinguish between cognitive deterioration and the various degrees of pre-existing intellectual disability (ID). Serial measurements of both cognitive function and behaviour are required. The aim of the present study was to evaluate the performance of non-demented adults with DS on a subject-directed instrument, the Prudhoe Cognitive Function Test (PCFT), preliminary to its serial use in a prospective study. METHODS: From 1985 to 1986, 85 non-demented hospitalized adults with DS were interviewed using the PCFT. The Adaptive Behavior Scale (ABS) was administered to the carers. The subjects' levels of ID (graded from mild through moderate, severe and profound to untestable) were based on their scores on the Stanford-Binet Intelligence Scale, as reported in the medical records, and the relationship between level of disability and performance on the PCFT and ABS, and their respective domains, was examined. RESULTS: Both scales produced a wide range of scores and the correlation between them was highly significant. Both scales correlated highly significantly with the degree of ID, but more subjects with high levels (i.e. profound to untestable) of disability obtained very low or zero scores on the PCFT and its domains than on the ABS. CONCLUSIONS: The PCFT provides a reliable quantitative measure of cognitive function in subjects with DS, and could be a useful adjunct to the diagnosis of dementia in prospective studies. However, the almost uniformly low scores obtained by those with high levels of ID suggests that its power to detect cognitive decline will be limited to those who are less disabled, while the ABS may be more useful than the PCFT in detecting deterioration in people with profound ID.

Adult↗

PubMed1999

Cognitive changes following recovery from depression in a group cognitive-behaviour therapy program.

OBJECTIVE: We report on the changes in cognitions as a result of cognitive-behaviour therapy (CBT), in 35 recovered and 32 non-recovered mood disordered patients who had undergone a 12-week group CBT program for depression. METHOD: An end-of-therapy cut-off score of 10 on the BDI was used to define recovered and non-recovered patients. ANOVA analyses were conducted to explore possible main effects of recovery status and time on various clinical measures, including cognitions and activity levels. RESULTS: Mean mood and activity self-rating measures were significantly higher for the recovered as compared to the non-recovered patients over the course of the program. Similarly, scores on the Automatic Thoughts Questionnaire (ATQ) for recovered patients were within the non-clinical range, in contrast to their non-recovered counterparts. In addition, recovered patients improved significantly in their Hopelessness scores, and there was a change in the expected direction in their Dysfunctional Attitudes Scale scores, although this was not significant. CONCLUSION: These results are consistent with the proposition of cognitive theory (i.e. the remediation of negative cognition plays a significant role in recovery from depression during CBT).

Adult↗

PubMed1998

Applied cognitive task analysis (ACTA): a practitioner's toolkit for understanding cognitive task demands.

Cognitive task analysis (CTA) is a set of methods for identifying cognitive skills, or mental demands, needed to perform a task proficiently. The product of the task analysis can be used to inform the design of interfaces and training systems. However, CTA is resource intensive and has previously been of limited use to design practitioners. A streamlined method of CTA, Applied Cognitive Task Analysis (ACTA), is presented in this paper. ACTA consists of three interview methods that help the practitioner to extract information about the cognitive demands and skills required for a task. ACTA also allows the practitioner to represent this information in a format that will translate more directly into applied products, such as improved training scenarios or interface recommendations. This paper will describe the three methods, an evaluation study conducted to assess the usability and usefulness of the methods, and some directions for future research for making cognitive task analysis accessible to practitioners. ACTA techniques were found to be easy to use, flexible, and to provide clear output. The information and training materials developed based on ACTA interviews were found to be accurate and important for training purposes.

Cognition↗

PubMed2006

Does the more vivid imagery of high hypnotizables depend on greater cognitive effort? A test of dissociation and social-cognitive theories of hypnosis.

In an investigation of the role of cognitive effort in hypnotic responding, high and low hypnotizable participants produced emotionally neutral imagery in response to effortful versus effortless hypnotic suggestions. Heart-rate increase served as an objective index of cognitive effort, and subjective ratings of imagery vividness, absorption, effort, and control were collected. Compared to lows, high hypnotizable participants experienced their imagery as more vivid and absorbing, yet their heart rates indicated no higher level of cognitive effort than lows. Compared to effortless wording, effortful wording of suggestions increased cognitive effort in lows, as indexed by heart-rate increase, but had no effect on the effort expended by highs. Ratings of subjective control were strongly correlated with subjective effort for lows but unrelated for highs. These results support the dissociated-control theory of hypnosis rather than the dissociated-experience or social-cognitive theories.

Adult↗

PubMed2002

Cognitive function and health-related quality of life in elderly patients with hypertension--baseline data from the study on cognition and prognosis in the elderly (SCOPE).

The Study on COgnition and Prognosis in the Elderly (SCOPE) study is a multi-centre, prospective, randomized, double-blind, and parallel-group study aiming at comparing the effects of candesartan cilexetil and placebo on cardiovascular events and cognitive function in elderly patients with hypertension. The aim of this sub-analysis was to present data on cognitive function and health-related quality of life (HRQL) at baseline (randomization), and to investigate whether cognitive function was related to HRQL. More specifically, the main aim was to investigate the possible relationship between the Mini-Mental State Examination on one hand, and the Psychological General Well-Being (PGWB) index, the Subjective Symptom Assessment (SSA-P) Profile and the EuroQoL Health Utility Index (EQ-5D) on the other. All the instruments are extensively validated. A general finding was that cognitive function was positively associated with higher well-being (PGWB total score and self-control) and higher utility value (EQ-SD current health) but was unrelated to the occurrence of subjective adverse symptoms (SSA-P). Age and the use of psychotropic drugs, but not gender and education level, influenced this relationship significantly.

Aged↗

PubMed2000

Neurophysiological measures of working memory and individual differences in cognitive ability and cognitive style.

The capacity to deliberately control attention in order to hold and manipulate information in working memory is critical to higher cognitive functions. This suggests that between-subject differences in general cognitive ability might be related to observable differences in the activity of brain systems that support working memory and attention control. To test this notion, electroencephalograms were recorded from 80 healthy young adults during spatial working memory tasks. Measures of task-related neurophysiological and behavioral variables were derived from these data and compared to scores on a test battery commonly used to assess general cognitive ability (the WAIS-R). Subjects who scored high on the psychometric test also tended to respond faster in the experimental tasks without any loss of accuracy. The amplitude of the late positive component of the event-related potential was larger in high-ability subjects, and the frontal midline theta component of the EEG signal was also selectively enhanced in this group under conditions of sustained performance and high working memory load. These results suggest that subjects who scored high on the WAIS-R were better able to focus and sustain attention to task performance. Changes in the EEG alpha rhythm in response to manipulations of task practice and load were also examined and compared between frontal and parietal regions. The results indicated that high-ability subjects developed strategies that made relatively greater use of parietal regions, whereas low-ability subjects relied more exclusively on frontal regions. Other analyses indicated that hemispheric asymmetries in alpha band measures distinguish between individuals with relatively high verbal aptitude and those with relatively high nonverbal aptitude. In particular, subjects with a verbal cognitive style tended to make greater use of the left parietal region during task performance, and subjects with a nonverbal style tended to make greater use of the right parietal region. These results help clarify relationships between task-related brain activity and individual differences in cognitive ability and style.

Adolescent↗

PubMed2002

Anxiety, cognitive performance, and cognitive decline in normal aging.

A sample of 704 cognitively intact individuals (M age = 63.7 years) performed a battery of cognitive tests on as many as three occasions, at approximately 3-year intervals. The authors used random effects models to analyze cross-sectional relationships between cognitive performance and state anxiety and longitudinal relationships between cognitive change and neuroticism, after controlling for gender, age, and education. Cross-sectionally, higher state anxiety was associated with poorer performance on Wechsler Adult Intelligence Scale Synonyms, WIT III Analogies, Koh's Block Design, two measures of visual learning (Names and Faces and Thurstone's Picture Memory), and, for men, CVB-Scales Digit Span Test and Card Rotations. In longitudinal models, the main effects for neuroticism were significant for Block Design, Symbol Digit, and Names and Faces, but there were no significant interactions among neuroticism, gender, and time. These results provide some support for Eysenck's processing efficiency theory but none for neuroticism as a risk factor for cognitive decline in normal aging.

Aged↗

PubMed2002

Social cognitive complexity and depression: cognitive complexity moderates the correlation between depression self-ratings and global self-evaluation.

The authors studied the psychometric characteristics of a standardized data-collection method for assessing the complexity of an individual's cognitions about self and other people (social cognitive complexity). A total of 437 college undergraduates were assessed using this method and concurrently assessed for depression, self-deception, impression management, self-esteem, and positive/negative affectivity. It was found that a measure of overall social cognitive complexity was internally consistent and demonstrated concurrent and discriminant validity. In particular, a composite measure of the complexity of both positive and negative cognitions of self and other was associated with greater self-reported depression, after controlling for the other variables studied (, impression management). It was also found that social cognitive complexity moderated the degree of global self-evaluation in self-reported depression, such that global self-evaluation accounted for a considerably higher amount of the variance of depression in low-complex individuals than it did in high-complex individuals.

Cognition↗