Objective: The aggregation of multiple performance validity tests (PVTs) into a summary validity determination is an established challenge in neuropsychology. The standard dichotomous accumulation approach relies upon binary recoding of continuous PVT scores and yields ambiguous outcomes in a sizable proportion of cases. This study evaluated Bayesian logistic regression as a framework for estimating the posterior probability of an invalid profile from continuous embedded PVT scores. Method: A retrospective sample of 233 military veterans was classified into Valid (n = 132), Ambiguous (n = 55), and Invalid (n = 46) groups based on three standalone PVTs. A Bayesian logistic regression model was trained on the Valid and Invalid groups using six embedded PVTs as continuous standardized predictors. The Ambiguous group was withheld from training and subsequently evaluated using model-derived posterior probability estimates. Results: The full six-predictor model yielded the highest posterior probability. PVTs varied in inclusion evidence. Probability distributions were consistently low in the Valid group, consistently high in the Invalid group, and markedly heterogeneous in the Ambiguous group. Conclusions: Bayesian logistic regression provides a viable framework for probabilistic PVT aggregation that preserves continuous score information, accounts for intercorrelation among predictors, and models genuine uncertainty when present. Validation in more diverse samples using sophisticated outcome measures is needed.
Objective: The Free and Cued Selective Reminding Test uses controlled learning to assess hippocampal-type memory impairment. This study culturally and linguistically adapted three Turkish verbal forms of the 16-item test (FCSRT-16TR) and characterized their psychometric properties, score-level comparability, and demographic reference estimates. Method: The complete-case reference sample comprised 285 cognitively unimpaired native Turkish-speaking adults aged 18-87 years. A pilot study (N = 45) refined the stimulus sets. Item response theory (IRT) analyses were conducted in a broader dataset with complete item-level responses (N = 387). Score-level comparability was examined using omnibus and two one-sided equivalence tests. Demographic models included age, education, and sex. Results: Score-level performance was broadly comparable across forms, although one total-free-recall contrast was borderline under the prespecified equivalence criterion. Continuous demographic models were developed for total free recall (TFR) and delayed free recall (DFR). Age showed significant nonlinear associations with both outcomes, whereas higher education and female sex predicted better performance. The models explained 35.2% and 25.2% of TFR and DFR variance, respectively. Under 10-fold cross-validation, predictive R2 values were .320 and .233, with root mean square error (RMSE) values of 4.39 and 1.68, respectively. Conclusions: The FCSRT-16TR provides three adapted Turkish verbal forms with broadly comparable score-level performance and demographically adjusted reference estimates for the principal free-recall outcomes. These estimates provide a language-specific reference framework for cognitively unimpaired Turkish-speaking adults but should not be interpreted as diagnostic cutoffs or evidence of within-person form interchangeability.
Objective: Compared to other components of social cognition, knowledge of social norms has received less attention in the scientific literature. While social cognitive and semantic memory deficits appear early in the course of Alzheimer's disease (AD), no study has examined knowledge of social norms at earlier stages of the disease. In addition, it is unclear whether the knowledge of social norms in AD is associated with socioemotional deficits, as may be seen in the behavioral variant of frontotemporal dementia (bvFTD). Method: This study included 136 participants with amnestic mild cognitive impairment (aMCI), 134 with AD, most of whom were younger than 65 years, 280 with bvFTD, and 361 older healthy controls (HC). All participants were selected from the National Alzheimer's Coordinating Center (NACC). They completed the Social Norms Questionnaire (SNQ), which assesses the tendency to break or overadhere to social norms. They also completed tests assessing executive, semantic, and socioemotional functions. Results: Between-group comparisons showed that individuals with AD and aMCI made significantly more Break and Overadhere errors than HC, while they demonstrated better social norms knowledge than individuals with bvFTD. In aMCI and AD, social norms overadherence errors were most consistently associated with executive functioning. In bvFTD, semantic memory was the most consistent correlate across all SNQ variables. Conclusions: These findings may help clinicians and researchers better understand social cognitive changes in patients, support the inclusion of social norms knowledge assessment within broader neuropsychological evaluations, and provide complementary insight into the cognitive correlates of social knowledge loss in major neurocognitive disorders.
Objective: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder associated with hyperandrogenism and insulin resistance. Although its reproductive and metabolic consequences are well established, research on the impact of PCOS on cognitive function remains inconsistent. This study aimed to evaluate the cognitive profiles across multiple domains in young, treatment-naïve patients with PCOS. Method: This cross-sectional study included 35 patients with PCOS (aged 18-35 years) and 30 age-matched healthy controls from Northern India. Participants underwent standardized computer-based psychometric testing using the Digit Span Test (DST), Trail Making Test (TMT), and Continuous Performance Test-Identical Pairs (CPT-IP) to assess their short-term memory, executive function, and attention. Results: Patients with PCOS demonstrated significantly lower performance in all DST metrics, including Two-Error Maximal Length (TEML; p < .0001; Hedges' g = 2.18; CI: 1.57-2.80) and Mean Span (MS; p < 0.0001; Hedges' g = 2.43; CI = 1.79-3.07), indicating decreased short-term and working memory. In the CPT-IP, the PCOS group showed significantly reduced hit rates and lower sensitivity scores (d', p < .0001, Hedges' g = 2.38; CI = 1.74-3.02), reflecting deficits in sustained attention and stimulus discriminability. While the PCOS group took longer to complete the TMT task both in trails 1 and 2, the differences in executive functioning did not reach statistical significance (p > .05). Conclusions: Young, treatment-naïve North Indian women with PCOS exhibit distinct cognitive decrements, particularly in the short-term memory and attention domains. While these initial findings are striking, larger long-term studies are required to confirm the true extent of these cognitive shifts.
OBJECTIVE:This study presents updated regression-based norms for verbal fluency tests: "FAS," "Animals," and "Supermarket" in older Norwegian adults. By examining the potential modulating effects and putative interaction effects of age, education, and sex, we aim to investigate cognitive aging and the effects of education. METHOD:The study includes 449 healthy participants, aged 70-92 years, from the NorFAST (n = 254) and HUNT (n = 195) studies. Regression-based norms for all three verbal fluency tasks were produced. Models were assessed for pertinent linear, curvilinear, or interaction effects of age, education, and sex. We compared our norms to previously published norms. RESULTS:The task "FAS" was predicted by education (b = 0.773, partial R2 = 0.117, p < .001) and sex (b = 1.110, partial R2 = 0.037, p < .001), and the task "Animals" was predicted by education (b = 0.313, partial R2 = 0.021, p < .01) and age (b = -0.123, partial R2 = 0.045, p < .001). Higher education and being female were associated with better performance, whereas older age was associated with poorer performance. Finally, for the task "Supermarket," we found an interaction effect between age and education (b = -0.063, partial R2 = 0.034, p < .01), but the major predictor was sex (b = 1.446, partial R2 = 0.068, p < .001). CONCLUSIONS:The norms were adjusted for the demographic variables that predicted the individual tasks. The illustrative norm comparison estimated similar mean performance but larger differences between the "exceptionally low" scores. The results also indicate that only processing speed declines with age, and that higher education has minimal effect on test-performance.
Objective: To evaluate rates of below cutoff performance (fail rates) for the Test of Memory Malingering Trial 1 (TOMM-1) and Reliable Digit Span (RDS) in a culturally and linguistically diverse community-based cognitive aging cohort. Methods: Cognitively and functionally normal adults from the Health and Aging Brain Study-Health Disparities (HABS-HD) cohort in the Dallas-Fort Worth area, free of major neurological, psychiatric, or cardiovascular conditions, were included. Fail rates were examined for TOMM-1 (≤41, ≤40) and RDS (≤6, ≤5) cutoffs, including combined thresholds, across demographic subgroups. Relative importance of sociodemographic variables was tested via regression. Results: In the normative sample, overall fail rates were higher for RDS (3.1-11.6%) than TOMM-1 (2.1-2.9%), with combined cutoffs yielding <1%. Higher fail rates occurred primarily among less educated (<12 years) and Spanish-speaking participants, with the highest among Spanish speakers on RDS (46.7%). Acceptable false-positive rates for the TOMM-1 (≤5.9%) and combined (≤3.2%) TOMM-1 and RDS were demonstrated across all evaluated groups. Language and education explained most variance in RDS scores (14.9%, 10.3%, respectively), while education and age explained most variance in TOMM-1 scores (2.3%, 1.4%, respectively). Demographic effects were more influential on RDS than on TOMM-1. Conclusions: Performance validity outcomes vary across community adults without external incentives, influenced by education and language.
Objective: Test adaptations for Spanish are typically 1:1 translations of traditional paper-and-pencil tests that prioritize the fidelity of the original measure and have not undergone cross-cultural adaptation. Mayo Test Development through Rapid Iteration, Validation, and Expansion-Español (Mayo Test Drive-Español) is an adaptation of digital cognitive tests (Stricker Learning Span, Symbols Test) for and by heterogeneous Spanish speaking populations via a mixed methods approach. Method: Participants who spoke Spanish as a first and/or primary language, living in or outside of the United States, were recruited for the Mayo Test Drive-Español registry to complete surveys assessing linguistic background, familiarity with cognitive testing, cognitive diagnoses, and technological accessibility. A subsample completed additional questionnaires and virtual focus groups including cognitive interviewing and direct feedback on test instructions/stimuli. Iterative adaptations and alternative sets of stimuli/instructions were presented to subsequent focus groups and underwent team review. Saturation was determined by team consensus. Professional transcriptions of focus groups were analyzed qualitatively. Results: A subsample of Mayo Test Drive-Español registry participants (n = 85) were enrolled into 10 focus groups (n = 38, 1-7 per group). 8 iterative revisions of test stimuli (including 54/92 words) and 9 iterative revisions of instructions were made based on focus group feedback, team meetings, and quality control procedures. Transcribed sessions were analyzed for themes related to the platform, paradigms/construct, instructions, and content. Conclusions: Mayo Test Drive-Español demonstrates the importance of early input from stakeholders (professionals, patients, community members) from various regions to improve the adaptation of cognitive measures for different languages and contexts. .
Objective: Neurofibromatosis Type 1 (NF1) is a neurocutaneous disorder caused by a variant in the NF1 gene. The condition can be diagnosed through endorsement of core clinical features; however, recent diagnostic criterion was modified to include the molecular confirmation of the NF1 gene. While recent studies reveal health disparities in NF1 disease surveillance, the relationships between sociodemographic and neighborhood-level factors with genetic testing among patients with NF1 remain unknown, despite its clinical utility in the early detection of NF1 and in the provision of essential prognostic information. Methods: This study includes a retrospective medical chart review for 86 pediatric patients with a diagnosis of NF1 who underwent a neuropsychological evaluation at an academic medical center. The relationship between NF1 clinical severity, neuropsychological functioning (intellectual quotient, day-to-day executive function difficulties, and adaptive behaviors), sociodemographic variables (identified race/ethnicity, sex, insurance type, English primary language status), and neighborhood opportunity (nationally-normed Childhood Opportunity Index) with genetic test completion and age of testing were examined. Results: Sociodemographic and neighborhood-opportunity factors were not associated with genetic test completion; however, those who underwent testing presented with more executive functioning difficulties (Z = 2.14, p = .032). Among those who completed genetic assays, poorer neighborhood opportunity was associated with delayed genetic testing (r = -0.30, p = .049), which in turn moderately, but not significantly, correlated with greater day-to-day adaptive functioning challenges (r = 0.37, p = .06). Conclusions: Distinct social determinants of health impact genetic test completion vs. timeliness of the procedure, highlighting the complex pathways social and neighborhood factors serve as barriers in NF1 diagnostic process and subsequent medical management.
Objectives: Cardiometabolic risk factors are prevalent in the United States, and their association with cognitive outcomes is well-established. Opportunities to elucidate the unique and combined contributions of cardiometabolic burden to cognition are abound. Importantly, investigating the cognitive changes incurred as burden increases has scientific and clinical implications. Methods: Older adults (M = 69.3, SD = 8.35) from the National Neuropsychology Network (N = 4222) were included. Cardiometabolic burden, defined via ICD-10 diagnostic codes, and performance on cognitive measures were the primary variables. Domain-level cognitive differences were calculated using a multigroup confirmatory factor analysis. Structural equation modeling evaluated associations between cardiometabolic burden and cognition, adjusting for demographic characteristics. Results: Relative to those without cardiometabolic burden, persons with one condition performed worse on measures of attention and working memory (p < .001, d = 0.24) and visuoconstructional and visuoperceptual abilities (p < .01, d = 0.19), persons with two conditions performed worse on measures of language (p < .01, d = 0.24), attention and working memory (p < .01, d = 0.23), executive function (p < .001, d = 0.22), and visuoconstructional and visuoperceptual abilities (p < .01, d = 0.23), and persons with three or more conditions performed worse across all domains except language and immediate memory (drange = 0.27-0.48). The impact of demographic characteristics on cognition differed by domain, but higher education was consistently associated with higher cognitive scores. Conclusions: Cognitive performance declined with increasing cardiometabolic burden. More education was associated with higher cognitive scores. Our findings contribute to the literature linking cardiometabolic risk management and cognitive health. Future studies should investigate whether targeting specific cardiometabolic risk factors would effectively improve cognitive function longitudinally.
Objective: Delusional syndromes of misidentification and/or reduplication (DSMRs) are based on the misidentification or duplication of people, places, objects, or events. A qualitative and comprehensive investigation was conducted to shed light on the core neurological and neuropsychological features and, neural correlates of all DSMRs, particularly Reduplicative Paramnesia for Place (RPP). Method: A detailed and systematic approach based on clinical, experimental, and neuroimaging data was carried out in a single case. We investigated the role played by the co-presence of an alteration of the sense of familiarity and damage to the critical belief evaluation system as a necessary condition for the generation of all DSMRs, and in particular for RPP. Results: Unlike most of previously described cases, RPP syndrome persists during the chronic phase in the context of a well-preserved global cognitive status whereas other forms of DSMRs tend to recover over time. In addition, there is a persistent alteration in the sense of familiarity and absence of critical evaluation of delusional beliefs. A structural disconnection analysis relates cortical-subcortical damaged areas and the corresponding white matter fasciculi with the clinical manifestation of DSMRs syndromes. Conclusions: The striato-capsular stroke coupled with subcortical damages and bifrontal cortical atrophy may explain the clinical manifestations and experimental data obtained and are in agreement with the bicomponential model hypothesis highlighting the role played by altered sense of familiarity in generating all DSMRs.
Objective: Older adults are at risk of medication nonadherence. However, clinical correlates of objective adherence are understudied in those with neurocognitive disorders who self-manage medications. Method: Eighty-three older adults with neurocognitive disorders who self-manage medications completed two months of adherence monitoring using pill counts and medication event monitoring systems (MEMS). Because some participants used MEMS inconsistently, MEMS analyses were restricted to Consistent Users (n = 65). Cognitive domains (Attention/Processing Speed [AP], Executive Functioning [EF], Memory), Medication Management Ability Assessment (MMAA) performance, and self-reported compensatory strategy use were examined as correlates. Results: Suboptimal adherence was common: 46% demonstrated ≤90% pill count adherence (16% <80%), and 39% demonstrated ≤90% MEMS adherence (23% <80%). Inconsistent MEMS Users showed poorer Memory performance but comparable pill count adherence to Consistent MEMS Users, suggesting memory affected successful device integration rather than medication-taking behavior. Clinical correlates of adherence varied: pill count accuracy related to AP and MMAA, whereas MEMS accuracy related to EF. Although AP and EF were related to the MMAA, only MMAA performance uniquely predicted high- and low-adherence group classification. Compensatory strategy use was commonly reported but unrelated to overall adherence; yet, those with high adherence showed relationships between more frequent strategy use and AP/EF when performance was lower. Conclusions: Performance-based assessments identify cognitively impaired older adults at risk for medication nonadherence. While compensatory strategies are utilized, effectiveness may vary by insight into weaknesses and/or strategy quality. Difficulties in AP, EF, and MMAA performance may therefore signal need for medication monitoring to guide targeted interventions to support adherence.
Objective: Young-onset dementia (YOD; onset < 65 years) frequently presents with phenotypes that involve specific cognitive domains whilst relatively sparing episodic memory, such as behavioral variant frontotemporal dementia (bvFTD), posterior cortical atrophy (PCA), and primary progressive aphasias (PPA). We hypothesized that standard neuropsychological batteries may fail to identify these phenotypes and tested their ability to pick up cognitive deficits for YOD phenotypes based on their clinical criteria. Methods: In this observational study, we included 2,056 consecutive YOD patients from the Amsterdam Dementia Cohort, who were seen at Alzheimer Center Amsterdam, Amsterdam UMC between 2010 and 2023. Domain scores were created based on a neuropsychological battery comprising tests in memory, executive, visuospatial, and language. Using three qualitative strategies-normative domain-based classification, alignment with simulated clinical reasoning, and intra-individual profiling-we categorized patients in cognitive domain groups based on either count, kind, or severity of domain impairments. Results: Across approaches, typical (i.e., amnestic) Alzheimer's disease, PCA, and semantic variant PPA (svPPA) were relatively well recognized, yet bvFTD, logopenic variant PPA (lvPPA), and nonfluent variant PPA (nfvPPA) remained poorly detected. Intra-individual profiling added some nuance by confirming memory, visuospatial, and semantic deficits in typical AD, PCA, and svPPA, respectively, but unexpectedly highlighted executive impairments in nfvPPA and to a lesser extent in lvPPA. Conclusions: Our standard neuropsychological battery reliably identified key impairments in typical AD, PCA, and svPPA, but underperformed for bvFTD, lvPPA, and nfvPPA. Our findings underscore the need to augment test batteries with targeted social cognition and language measures to aid differential diagnosis in YOD.
Objective: Evaluations for attention-deficit/hyperactivity disorder (ADHD) in adulthood typically incorporate both self-report questionnaires and performance-based cognitive testing. Extant research has demonstrated weak or absent relationships between self-report and performance-based measures assessing the same or similar behavioral dimensions of ADHD (e.g., attention, planning); however, this dissociation remains understudied for impulsivity. This study examined the relationship between self-report and performance-based impulsivity measures in adults undergoing ADHD evaluation. Method: A clinical sample of 283 adults referred for ADHD evaluation completed the Minnesota Multiphasic Personality Inventory-3 Impulsivity scale (MMPI-3 IMP), Clinical Assessment of Attention Deficit-Adult (CAT-A), and Conners Continuous Performance Test-Third Edition (CPT-3). Regression analyses and correlational methods examined relationships between self-report and performance-based impulsivity measures. Results: MMPI-3 IMP scores did not significantly predict CPT-3 impulsivity variables. Logistic regressions demonstrated that MMPI-3 IMP scores had 83.6% classification accuracy in predicting normal vs. abnormal impulsivity performance but did not significantly predict elevated CPT-3 impulsivity. Parallel CAT-A analyses essentially mirrored MMPI-3 IMP findings. MMPI-3 IMP scores and CAT-A current and childhood impulsivity scores were moderately correlated, with significant concordance between MMPI-3 IMP and CAT-A current and childhood impulsivity scale elevations. Conclusion: Present findings align with prior literature indicating the MMPI-3 Impulsivity scale may not adequately capture and behavioral impulsivity measured by the CPT-3. Dissociation between MMPI-3 IMP and CPT-3 performance, coupled with convergence among self-report measures, indicates these modalities capture distinct aspects: subjective behavioral tendencies versus objective inhibitory control. Findings reinforce the need for multimodal ADHD assessment approaches.
Social cognition is a core cognitive domain commonly impaired in many clinical conditions including dementia, brain injury and schizophrenia. Yet, clinicians rarely formally assess social cognition as tests are too long to be added to already lengthy assessments. Additionally, reliable tests suitable for clinical practice, as opposed to research settings, are lacking. The Awareness of Social Inference Test (TASIT) is recognized by experts as one of the leading social cognition tests for transdiagnostic and cross-cultural assessment. OBJECTIVE:Here we aimed to make a super short version (TASIT SS) which would be suitable for brief screening in clinical populations. METHODS:Social cognition was assessed in 135 individuals diagnosed with dementia (DEM), 150 adults with acquired brain injury (ABI) and 67 healthy adults (HA) using Parts 1 and 2 of the original TASIT. Rasch analysis was used to identify a small subset of items and subsequent analyses examined construct validity. RESULTS:The new TASIT SS includes five items assessing responses to 4 videos. Infit and outfit values ranged from 0.8-1.2. Correlations with TASIT ranged from .65-.69 and correlations with cognitive measures were small. Effect sizes between HA and clinical groups were large (DEM) to medium (ABI). CONCLUSIONS:Using an empirical approach, we were able to devise TASIT SS, which is suitable for use in dementia and acquired brain injury populations. Administration time is <5 mins, while maintaining psychometric properties of TASIT making it an important new addition to the suite of tests developed for assessment of social cognition in clinical practice.
Objective: The use of ecological momentary assessment (EMA) to measure within-person fluctuations in cognitive performance has increased in recent years. However, many of the measures employed lack strong methodological foundations. This study evaluated the within-person reliability of test-based and self-reported momentary cognitive assessments and examined associations between test-based and self-reported momentary cognitive functioning, among older adults. Method: Fifty-four participants (aged 65+) completed a 10-day testing period, during which they completed three assessments daily, measuring self-reported (three items) and test-based (1-back test and spatial dot memory test) cognitive functioning on a smartphone. Within-person reliability was evaluated by examining measurement variability within and across assessments. Associations between self-reported and test-based momentary cognitive functioning were analyzed using general(ized) linear mixed models. Results: Among the momentary measures, the self-report items, 1-back test response time, and spatial dot memory test response time demonstrated adequate within-person reliability, while spatial dot memory test accuracy exhibited low reliability. Self-reported momentary cognitive functioning was only significantly associated with the spatial dot memory test span. Conclusions: Establishing within-person reliability is crucial when selecting cognitive assessments in EMA research. Furthermore, momentary measures of test-based and self-reported cognitive functioning were not consistently associated and should not be used interchangeably. Beyond the empirical findings, this study highlights key practical lessons for cognitive EMA research, including the need to consider practice effects, task difficulty, the number of trials, and the outcomes that are used.
Objectives: Performance in verbal learning tests conflates two distinct executive mechanisms: the ability to generate a semantic strategy and the ability to maintain it over time. Deconstructing verbal learning performance may help in the design of personalized cognitive rehabilitation interventions. Methods: We analyzed verbal learning performances of 558 people with MS and 501 healthy controls. The initiation index (first successful semantic cluster) and the cessation index (trial where clustering was permanently abandoned) were calculated. Linear and multinomial logistic regressions adjusted for age, sex and education were used to map learning trajectories. Results: People with MS were less likely to employ semantic clustering (OR = 0.26, 95% CI 0.13-0.51), were significantly more likely to delay strategy initiation (Trial 5 vs. Trial 1: OR = 4.46, 95% CI 2.16-9.20, p < 0.001) and to abandon strategies prematurely (Trial 2 vs. Trial 5: OR = 34.83, 95% CI 4.65-260.74, p < 0.001). People with RRMS often demonstrated successful initiation followed by rapid strategy decay, whereas people with the progressive forms exhibited a primary failure to generate strategies. Higher education provided a protective effect on strategy initiation, supporting the cognitive reserve model. Conclusion: A distinct dissociation emerged, indicating that verbal learning deficits in MS may be driven by a failure of endurance or a failure of acquisition. Cognitive rehabilitation could be enriched with cognitive endurance training, mainly applicable in early disease stages, and compensatory scaffolding is often needed in people with -progressive forms.
Objective: Intra-individual variability in executive functions (EF), assessed both behaviorally and via self-report, may serve as a predictor of instrumental activities of daily living (IADLs), whereas mean self-reported EF levels typically do not. No prior research has simultaneously examined associations among (a) day-to-day mean levels and fluctuations of EF self-report, (b) day-to-day mean levels and fluctuations of EF performance, and (c) performance of IADL tasks at home. This study examined the extent to which EF performance and EF self-report (both mean levels and daily fluctuations) relate to each other and to at-home IADL performance. Method: One-hundred and twenty-seven community dwelling older adults responded to daily questions about their EF abilities and completed daily EF and IADL tasks, all independently at home across 18 days. Results: IADL performance was predicted by overall mean EF performance and by the magnitude of fluctuations in both EF performance and EF self-report, with all three variables contributing uniquely to the model and together accounting for 27% of IADL variance (reflecting a large effect size), although fluctuations in self-report did not survive covariate analyses. Mean levels of self-reported EF did not correlate with performance on EF or IADL tasks. Conclusion: Both mean levels and fluctuations in EF performance across days uniquely contributed to the prediction of daily functioning, demonstrating incremental validity of each variable. Self-report of EF (both fluctuations and mean levels) did not incrementally improve prediction beyond covariates.
Objective: Face recognition ability is critical for social interaction and daily functioning, yet remains understudied in mild cognitive impairment (MCI). The present study examined face recognition performance in MCI using a novel assessment tool incorporating dynamic stimuli, better reflecting the demands of real-world face recognition, and compared its neuropsychological correlates to those of a widely used static test. Method: Individuals with MCI (n = 46) and cognitively intact (CI) older adults (n = 42) completed two face recognition measures: EGEFACE, a recently developed test employing dynamic and static stimuli, and the Benton Face Recognition Test (B-FRT). A comprehensive neurocognitive battery was also administered. Results: Individuals with MCI performed significantly worse than CI group on both tests. The easy block of EGEFACE yielded a larger effect size in differentiating the groups (d = 0.65) than the B-FRT (d = 0.52). While B-FRT scores were linked to a broad range of functions, EGEFACE performance showed a more focused relationship with specific cognitive domains. However, these associations underscore the inherent interdependence of functions, consistent with the interactive organization of the brain. Conclusions: EGEFACE, particularly its easy block, offers a novel approach to assessing face recognition with enhanced real-world applicability. The correlational profiles suggest that while dynamic stimuli may provide a more refined perspective on face-specific processing, this ability remains fundamentally embedded within an integrated neurocognitive network. Dynamic assessment serves as a valuable complement to traditional tools for evaluating the multifaceted cognitive changes in older adults at risk for decline.
Objective: To reevaluate the psychometric properties and contemporary relevance of the 1969 Lawton and Brody Instrumental Activities of Daily Living (iADL) Scale in older adults. Methods: Data from 3552 participants and co-participants in the Texas Alzheimer's Research and Care Consortium cohort were analyzed. Lawton and Brody iADL Scale items were analyzed in a sample with no cognitive disorder, mild cognitive impairment, and dementia. Graded response models assessed item discrimination and difficulty, with differential item functioning (DIF) analyses examining demographic effects. Expert reviewers evaluated item content for cultural and technological relevance. Results: Items assessing shopping, food preparation, and transportation were most sensitive to mild functional impairment, while the total scale had limited detection of subtle functional decline. Statistical DIF emerged on 75% of items, whereas clinically meaningful DIF for several demographic groupings emerged on the transportation item. Expert reviewers identified outdated content, particularly for telephone and financial items, reflecting technological shifts. Broader changes in normative behaviors and sample demographics may further challenge scale applicability. Conclusions: The Lawton and Brody iADL Scale remains foundational but shows limited sensitivity for early functional decline. Outdated items and evolving socioeconomic and technological contexts underscore the need for refinement to enhance unbiased early detection and maintain longitudinal comparability. Updating the instrument to reflect modern demands could strengthen functional assessment in Alzheimer's disease and related disorders research and clinical trials.
