The relationship between the mini-mental state examination and cognitive functioning in normal elderly adults: a componential analysis

The relationship between the Mini-Mental State Examination (MMSE) and selected cognitive performance indices was examined in a sample of 251 non-demented adults over 75 years of age. MMSE items were divided into I 1 binomial content domains and an examination of these revealed that only seven had sufficient variability to predict cognitive performance. A factor analysis with these items yielded three factors, reflecting memory, spatial skill, and the ability to follow commands. After controlling for age and education, these factor scores were included as predictors of specific cognitive tasks including two measures of free recall, and two measures of visuospatial skill. The memory factor score was a strong predictor of the two free recall tasks and block design. The spatial factor score contributed to the prediction of the two visuospatial measures, as well as free recall of organizable words. The results suggest that, in normal ageing, the predictive value of the MMSE is due to subset of cognitively demanding items that are heavily influenced by both memory and visuospatial skills.     

Limitations of true score variance to measure discriminating power: Psychometric simulation study.

Demonstrating a specific cognitive deficit usually involves comparing patients' performance on 2 or more tests. The psychometric confound occurs if the psychometric properties of these tests lead patients to show greater cognitive deficits in 1 domain. One way to avoid the psychometric confound is to use tests with a similar level of discriminating power, which is a test's ability to index true individual differences in classic psychometric theory. One suggested way to measure discriminating power is to calculate true score variance (L. J. Chapman & J. P. Chapman, 1978). Despite the centrality of these formulations, there is no systematic examination of the relationship between the observable property of true score variance and the latent property of discriminating power. The authors simulated administrations of free response tests and forced choice tests by creating different replicable ability scores for 2 groups, across a wide range of various psychometric properties (i.e., difficulty, reliability, observed variance, and number of items), and computing an ideal index of discriminating power. Simulation results indicated that true score variance had only limited ability to predict discriminating power (explained about 10% of variance in replicable ability scores). Furthermore, the ability varied across tests with wide ranges of psychometric variables, such as difficulty, observed variance, reliability, and number of items. Discriminating power depends on a complicated interaction of psychometric properties that is not well estimated solely by a test's true score variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Home alone: the role of cognition in return to independent living

OBJECTIVE: To identify unique predictors of the ability to return to living alone in geriatric patients undergoing medical rehabilitation. DESIGN: Of 900 consecutive geriatric patients entering medical rehabilitation, 372 were identified as living alone before admission. Data were collected on functional status, cognition, demographics, and discharge disposition. SETTING: A freestanding medical rehabilitation facility. All patients were admitted to a geriatric rehabilitation unit. PATIENTS: Patients aged 60 to 99, identified as having lived alone before admission, were included. As standard procedure, patients underwent functional and cognitive assessment, and medical records were reviewed. MAIN OUTCOME MEASURE: Logistic regression analysis was used to evaluate predictors of discharge disposition, including demographic variables, medical burden, the Functional Independence Measure (FIM), and the Dementia Rating Scale (DRS). RESULTS: Both the FIM and DRS provided significant and unique variance in prediction of discharge disposition. Patients discharged home alone performed similarly to those discharged with supervision on FIM motor items but higher on FIM social cognition items, emphasizing the strong role of cognition in discharge disposition. Patients discharged home alone scored above suggested cutoff scores on the DRS, indicating generally intact cognitive functioning, whereas those discharged with supervision scored below suggested cutoffs. CONCLUSION: Results emphasize the importance of cognition in the ability to return to completely independent living after medical rehabilitation in geriatric patients.     

An investigation of the measurement properties of the Spot-the-Word test in a community sample.

Intellectual ability is assessed with the Spot-the-Word (STW) test (A. Baddeley, H. Emslie, & I. Nimmo Smith, 1993) by asking respondents to identify a word in a word-nonword item pair. Results in moderate-sized samples suggest this ability is resistant to decline due to dementia. The authors used a 3-parameter item response theory model to investigate the measurement properties of the STW in a large community-dwelling sample (n=2,480) 60 to 64 years of age. A number of poorly performing items were identified. Substantial guessing was present; however, the number of words correctly identified was found to be an accurate index of ability. Performance was moderately related to a number of tests of cognitive performance and was effectively unrelated to visual acuity and to physical or mental health status. The STW is a promising test of ability that, in the future, may be refined by the deletion or replacement of poorly functioning items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can racial differences in cognitive test performance be reduced by presenting problems in a social context?

It is well documented that African Americans tend to score lower on cognitive ability tests than White Americans. The cause of this performance difference is still being hotly debated and actively researched. Recently, J. E. Helms (1992) argued that cognitive ability tests fail to adequately assess African American intelligence because they do not account for the emphasis placed on social relations and the effect of social context on reasoning in the African American culture. To evaluate this argument, racial subgroup performance differences on Wason conditional reasoning items presented in the standard abstract form and in a social relationship form were examined. Contrary to Helms's argument, results indicate that presenting Wason conditional reasoning items in a social context did not reduce the difference between African American and White American Performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-Analysis of Intellectual and Neuropsychological Test Performance in Attention-Deficit/Hyperactivity Disorder.

Cognitive measures are used frequently in the assessment and diagnosis of attention-deficit/hyperactivity disorder (ADHD). In this meta-analytic review, the authors sought to examine the magnitude of differences between ADHD and healthy participants on several commonly used intellectual and neuropsychological measures. Effect sizes for overall intellectual ability (Full Scale IQ; FSIQ) were significantly different between ADHD and healthy participants (weighted d = .61). Effect sizes for FSIQ were significantly smaller than those for spelling and arithmetic achievement tests and marginally significantly smaller than those for continuous performance tests but were comparable to effect sizes for all other measures. These findings indicate that overall cognitive ability is significantly lower among persons with ADHD and that FSIQ may show as large a difference between ADHD and control participants as most other measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced cognitive ability in alcohol dependence: Examining the role of covarying externalizing psychopathology.

Reduced executive cognitive ability is associated with alcohol dependence (AD) and other comorbid externalizing disorders. Working memory capacity, short-term memory, conditional associative learning, and intelligence were assessed in a sample (N = 477) with variation in lifetime histories of externalizing problems (conduct disorder, adult antisocial behavior, substance problems); this included a subsample (n = 285) with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis of AD. Individuals with both AD and a history of childhood conduct disorder (CCD) scored lower on cognitive measures compared to those with AD and no history of CCD. Structural equation models showed that reduced ability in all cognitive domains was predicted by a latent externalizing factor reflecting covariation among lifetime problems with alcohol, drugs, childhood conduct, and adult antisocial behavior and was not uniquely related to any one problem. Further, for those with AD, the externalizing factor was associated with reductions in all the domains of cognitive ability. The results suggest that the reduced executive cognitive ability observed in AD individuals is partly accounted for by a general latent externalizing factor rather than alcohol-related problems per se. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matched tasks for measuring single-word, referent communication: The performance of patients with schizophrenic and affective disorders.

Developed an objective index of cognitive slippage, an important sign of vulnerability to schizophrenia. In an investigation by E. E. Smith (1970), 2 sets of multiple-choice test items that presumably tap this problem were developed. In the present study, new items were developed, and subsets of each type were matched for mean and distribution of item difficulty and for reliability. The tests were then administered to 37 schizophrenics, 22 patients with affective disorders, and 38 normal Ss (mean ages 22–38 yrs). The difference scores (for the 2 types of items) of the schizophrenics were greater than those of normal Ss, but the schizophrenics did not differ from the affectively disordered Ss. Thus, the previously developed procedure does seem to reflect a genuine cognitive problem rather than a mere statistical artifact. However, the problem is also observed in some patients with affective disorders that are presumably not part of the schizophrenic spectrum. The value of the tasks will depend on their relationship to other measures of schizotypic traits such as anhedonia. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational reserve: Lifetime motivational abilities contribute to cognitive and emotional health in old age.

The authors recently developed the concept of motivational reserve, which implies a set of motivational abilities that provide individuals with resilience to neuropathological damage. This study investigated how lifetime motivational abilities are associated with current cognitive status, mild cognitive impairment, and psychological well-being in old age. A community sample of 147 participants without dementia between 60 and 94 years of age, stratified for age group, sex, and education, completed motivation and well-being questionnaires and cognitive tests. A new procedure was used to estimate their midlife motivational and cognitive abilities on the basis of their main occupation using the Occupational Information Network (O*NET) system. O*NET-estimated motivational abilities predicted cognitive status, psychological well-being, and odds of mild cognitive impairment, even when age, sex, education, and cognitive ability were controlled. Although O*NET-estimated cognitive abilities were not significant predictors, scores on a measure of crystallized intelligence were associated with current cognitive status and odds of mild cognitive impairment. Findings suggest that motivational reserve acts as a protective factor against the manifestation of cognitive impairment and emotional problems in later life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressed mood does not explain neuropsychological deficits in HIV-infected persons.

The relationship of depressed mood to cognitive disturbance in HIV infection was examined in a sample of 139 homosexual men. Ss were grouped according to the classification of the Centers for Disease Control: 39 were in Group IV, 62 were in Group II or Group III, and 38 were HIV-negative. Ss completed the Profile of Mood States and 10 neuropsychological tests. Analysis employing a classification approach indicated that, although symptoms of depression and neuropsychological impairment were more common in Ss who were HIV-positive, particularly those classified as Group IV, there were no systematic relationships between depression and neuropsychological impairment. Depressed mood and cognitive disturbance each seem to have unique associations to HIV illness status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of learning and performance in an associative memory/substitution task: Task constraints, individual differences, volition, and motivation.

The way that cognitive abilities, learning task characteristics, and motivational and volitional processes combine to explain individual differences in performance and learning was investigated. A substitution task was studied over practice, and it was discovered that students used 2 different strategies: a learning strategy focused on memorization and a performance strategy in which students persisted in scanning items. Five experiments investigated strategy differences and the ability and motivational correlates of task performance. First, ability correlates of performance and strategy use were demonstrated. Next, reducing task difficulty increased use of the learning strategy. With periodic memory tests, effective reliance on the learning strategy was increased, and task performance correlations with reasoning ability were lowered. Finally, a combination of self-focus and goal-setting interventions increased both general performance levels and use of the learning strategy. Results are discussed in terms of the goal of developing a more comprehensive understanding of learner differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Industrial/organizational psychology as applied to human resources management.

Argues that the issue of increasing productivity in the use of human resources while providing equality of opportunity to minorities and women will be a major concern of industrial/organizational (I/O) psychologists in the 1980's. A primary short-term goal of I/O psychology must be to change The Uniform Guidelines on Employee Selection Procedures, which are inconsistent with current research knowledge and professional practice. I/O psychology will increase its use of cognitive ability tests and job simulations for selection and promotion. However, this renewed interest in cognitive ability tests may also force the use of quotas or different cutoffs until the differences between groups on cognitive ability tests decline or disappear. It is hoped that organizations will make long-range personnel decisions that will have a significant impact on I/O psychology in performance appraisal and career management areas. (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intelligence, training, and employment.

Validity coefficients of cognitive ability tests for predicting job performance are impressive. Nevertheless, a need exists to supplement cognitive ability tests with additional predictors to maximize validity and utility and to minimize adverse impact, even for tests that are unbiased according to psychometric criteria. An agenda for research and practice is presented that includes building on the existing validity of cognitive ability tests for job selection by expanding both the set of constructs used to predict job performance and the set of performance criteria used to quantify job performance. Even greater benefits are likely to be associated with advances in knowledge about effective training. Such advances will require substantial investment in well-designed, large-scale studies and facile adaptation of lessons from other domains, such as cognitive psychology, to the organizational-training context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents' beliefs about their children's cognitive abilities.

Examined mothers' judgments of their children's cognitive abilities and the relation between such judgments and the child's developmental level. 49 1st-grade children responded to tasks drawn from either the Piagetian literature or the Stanford-Binet IQ tests. Ss also completed a vocabulary test drawn from the Peabody Picture Vocabulary Test (PPVT). Subsequently, each S's mother was asked various questions about probable response, both for her own child and for children in general. Results reveal that mothers were more accurate in predicting their child's success or failure on the IQ items than on the Piaget items. In both conditions, overestimations of ability were more common than underestimations. Estimates of age of mastery also showed overestimation, in some cases by several years. Data collected from 12 fathers indicate that fathers' patterns of response were similar to those of their wives. The correlations between accurate predictions by the mother and correct answers by the child were .85 in the Piaget condition and .49 in the IQ condition. Findings are compatible with the match hypothesis, which posits that the mother's knowledge of her child enables her to create an optimally challenging environment. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis.

A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean correlations ranged from .35 to .65. Caregiver reports of driving ability and cognitive variables were correlated significantly only on measures of mental status and visuospatial skills. When studies using a control group were excluded, moderate mean correlations were observed for visuospatial skills and on-road or non-road measures, and for mental status with non-road tests. Other effects were small or nonsignificant. Implications for basing driving recommendations on neuropsychological testing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult age differences in recall of performed and nonperformed items.

Memory for performed cognitive activities (e.g., psychometric tests of intelligence), for performed brief actions (e.g., hand wave), and for nonperformed items (e.g., written words) was assessed for 102 older and 101 younger adults. Although enactment improved recall, the beneficial effects of enactment were the same for both age groups. In fact, more than 80% of the age-related variance in memory for performed items was shared with memory for nonperformed items. Working memory and perceptual speed were important to the age differences in memory for both types of items. Performed and nonperformed items showed different serial position effects. However, the correlation between memory for the 2 types of items was high, especially for older adults, suggesting that the 2 types of memory share many common processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Item analyses of age relations on reasoning tests.

Analyses at the level of individual items were conducted on 11 data sets representing various combinations of participant samples and tests of reasoning. The magnitude of the relations between age and solution accuracy did not vary systematically across a wide range of item difficulty, although there was some evidence for independent age-related influences on the more difficult items. The results were tentatively interpreted as reflecting the operation of at least 2 types of age-related effects on tests reasoning, 1 common to all items and 1 sensitive to the greater processing demands associated with more difficult items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do neurocognitive ability and personality traits account for different aspects of psychosocial outcome after traumatic brain injury?

Objective: To examine the contributions of demographic, injury, cognitive, and personality characteristics to psychosocial outcome 8 years after traumatic brain injury (TBI). Design: Multiple regression analyses were used to estimate the variance explained by putative "predictors" of psychosocial outcome. Participants: Thirty-nine TBI survivors and 39 family member informants. On the basis of Glasgow Coma Scale scores and Accident Injury Severity (head) ratings, the patients' brain injuries ranged from mild to critical in severity. Main Outcome Measures: One self-report measure combined putative markers of social role engagement, such as marital status and earned income. Another, based on informant ratings using the Katz Adjustment Scale, was conceptualized as reflecting behavioral adjustment. Results: Whereas cognitive functioning explained significant unique variation in social role engagement, it did not account for variance in behavioral adjustment. Conversely, whereas 3 personality trait ratings explained significant incremental variance in behavioral stability, only 1 did the same with respect to social role engagement. Conclusions: Social role engagement and behavioral adjustment appear to represent 2 related but distinguishable aspects of TBI outcome that are associated with different patient characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Age and Hypertension Status on Cognition: The Veterans Affairs Normative Aging Study.

The authors examined the influence of age and hypertensive status (normotensive, controlled, untreated, or uncontrolled) on several cognitive tests via multiple regression in 357 nondemented, community-dwelling older men (mean age = 67 years) whose hypertensive status was stable over 3 years and who had no medical comorbidities. Age was negatively associated with performance on all but 1 test. Age interacted with hypertensive status on verbal fluency and word list immediate recall; older uncontrolled hypertensives exhibited significantly larger age decrements on these tests compared with normotensives. These findings suggest that uncontrolled hypertension produces specific cognitive deficits beyond those attributable to age alone. These and previous findings illustrate that health conditions such as hypertension should be regularly considered in studies of "normal" cognitive aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing consumer and clinician values for alternative functional states: application of a new feature trade-off consensus building tool

OBJECTIVE: To present the Features-Resource Trade-Off Game (Features Game) as a new method for comparing preferences for alternative outcomes among different groups of people. DESIGN: The Features Game is illustrated by comparing preferences for recovery among the 18 functional status items making up the Functional Independence Measure. Methods involved trading levels of independence (resources) across the different items (features). SETTING: Ten community-dwelling consumers with physical disabilities and 10 rehabilitation clinicians participated in four separate expert panels-two in Houston and two in Philadelphia. MAIN OUTCOME MEASURES: Five sets of hierarchical stages defined by the four separate panels specifying the profiles of function believed to most foster independent living. RESULTS: Cognitive and communication skills were selected preferentially over the recovery of physical tasks by all panels, but, in comparison to clinicians, consumers were more willing to accept mild deficits in cognitive skills as trade for realizing earlier recovery of physical abilities. CONCLUSION: The overwhelming choice of cognitive and communication abilities over physical abilities suggests a need to enhance therapeutic efforts in those areas. More subtle differences in consumer and clinician preferences emphasize the importance of establishing consumer-oriented goals.