OBJECTIVES:To compare associations between neurocognitive testing and two different self-report paradigms: (1) recall-based (PROMIS Cognitive Function) and (2) real-time, task-specific (NASA-Task Load Index [NASA-TLX]) among 56 patients with breast cancer. METHODS:This is a secondary analysis from a phase II, single-arm trial of memantine to prevent cognitive decline among patients receiving chemotherapy for breast cancer (NCT04033419). Before chemotherapy and 4 weeks after their final cycle, participants completed neuropsychological assessment and self-report measures. Memantine was administered between assessments. At pre-chemotherapy, multivariable linear regression evaluated associations between a unit-weighted, composite neurocognitive test score with PROMIS Cognitive Function and NASA-TLX, controlling for age, cancer stage, and cognitive reserve. Explanatory analyses examined associations within individual neurocognitive subtests. Multivariable regression explored the extent to which pre-treatment self-reported cognition predicted post-treatment performance. RESULTS:Pre-chemotherapy, higher NASA-TLX scores (greater perceived workload) were robustly associated with worse performance (β = -0.31 [-0.50, -0.12], p = .002). Relationships were strongest for executive function: Animal Fluency (IQR = 35): -3.3 (-5.8, -0.8), p = .011; COWA (IQR = 36) = -6.7 (-12.8, -0.7), p = .031; One Touch Stockings (IQR = 31): -0.70 (-1.0, -0.3), p < .001. Pre-treatment NASA-TLX was also associated with post-treatment performance in univariable but not multivariable models. PROMIS Cognitive Function and neurocognitive performance were not associated. CONCLUSIONS:The NASA-TLX and neurocognitive performance were strongly associated, particularly in the executive function domain. Future work involving the NASA-TLX in cancer populations, including its use in everyday contexts, will help clarify whether it may enhance CRCI characterization.
OBJECTIVES:Reading ability is commonly used as a proxy for educational quality but may be unsuitable for cross-cultural comparisons. This study aimed to evaluate a novel Brief Mathematics Achievement Test (BMAT) as a proxy measure of quality of education (QoE) in culturally and linguistically diverse populations. METHODS:Data on demographic variables, socioeconomic status (SES), country-level QoE, and performance on the BMAT and brief cognitive tests, were collected from 157 cognitively healthy participants (18-89 years) including native-born and immigrant populations in five European countries. RESULTS:No significant differences were found between females and males or between participants with native-born and immigrant backgrounds in BMAT scores. In correlation analyses, BMAT scores were strongly correlated with SES, level of education, and performance on a brief cognitive composite, moderately with student-teacher ratio, country income classification, and a quality of education index, and weakly with age. In regression models controlling for key demographic variables and socioeconomic status, BMAT scores were significantly associated with level of education and the QoE index, while showing no significant relationship with immigrant status. Also, after controlling for demographic variables, SES, and the quality of education index, BMAT scores were the only significant predictor of performance on the brief cognitive composite. CONCLUSIONS:These findings provide preliminary evidence supporting the potential utility of the BMAT as an objective proxy measure of QoE in culturally and linguistically diverse populations.
OBJECTIVES:Subjective cognitive decline (SCD) may represent the earliest observable stage of Alzheimer's disease (AD), yet identifying individuals at risk of progressing remains challenging. Cognitive dispersion, or intra-individual variability (IIV-D), may serve as a sensitive early marker. This study examined IIV-D across diagnostic groups, focusing on SCD and amnestic mild cognitive impairment (aMCI) progressors (SCD-p, aMCI-p; progressing to a more advanced disease stage) versus non-progressors (SCD-np, aMCI-np; not progressing to a more advanced stage). We expected greater IIV-D across groups (AD > aMCI > SCD > controls) and in progressors. METHODS:A total of 308 participants aged 65-94 (67 healthy controls [HC], 126 SCD, 79 aMCI, 36 AD) from the Consortium for the Early Identification of Alzheimer's Disease - Quebec (CIMA-Q) were included. SCD and aMCI participants were followed for up to eight years (34 SCD-p, 92 SCD-np; 29 aMCI-p, 50 aMCI-np). Analyses of covariance assessed baseline across- and verbal memory within-domain IIV-D, maximum discrepancy (MD), and domain-specific deviation. RESULTS:IIV-D increased with disease severity (HC = SCD < aMCI < AD). Among SCD participants, progressors showed greater episodic memory deviation than non-progressors, primarily driven by poorer Logical Memory delayed recall. In aMCI, progressors showed higher IIV-D across all indices (across- and within-domain, IIV-D and MD), with domain-specific differences limited to episodic memory. CONCLUSIONS:These findings indicate that IIV-D measures distinguish aMCI progressors from non-progressors, although they do not appear to enhance predictive accuracy for progression to AD and may not yet be a reliable marker at the SCD stage.
Abstract Objectives: Subjective cognitive decline (SCD) may represent the earliest observable stage of Alzheimer’s disease (AD), yet identifying individuals at risk of progressing remains challenging. Cognitive dispersion, or intra-individual variability (IIV-D), may serve as a sensitive early marker. This study examined IIV-D across diagnostic groups, focusing on SCD and amnestic mild cognitive impairment (aMCI) progressors (SCD-p, aMCI-p; progressing to a more advanced disease stage) versus non-progressors (SCD-np, aMCI-np; not progressing to a more advanced stage). We expected greater IIV-D across groups (AD > aMCI > SCD > controls) and in progressors. Methods: A total of 308 participants aged 65–94 (67 healthy controls [HC], 126 SCD, 79 aMCI, 36 AD) from the Consortium for the Early Identification of Alzheimer’s Disease – Quebec (CIMA-Q) were included. SCD and aMCI participants were followed for up to eight years (34 SCD-p, 92 SCD-np; 29 aMCI-p, 50 aMCI-np). Analyses of covariance assessed baseline across- and verbal memory within-domain IIV-D, maximum discrepancy (MD), and domain-specific deviation. Results: IIV-D increased with disease severity (HC = SCD < aMCI < AD). Among SCD participants, progressors showed greater episodic memory deviation than non-progressors, primarily driven by poorer Logical Memory delayed recall. In aMCI, progressors showed higher IIV-D across all indices (across- and within-domain, IIV-D and MD), with domain-specific differences limited to episodic memory. Conclusions: These findings indicate that IIV-D measures distinguish aMCI progressors from non-progressors, although they do not appear to enhance predictive accuracy for progression to AD and may not yet be a reliable marker at the SCD stage.
OBJECTIVES:Concussion, a common injury in contact sports, often leads to oculomotor symptoms. The King-Devick (K-D) is a rapid number naming test that evaluates saccadic eye movements, visual tracking, and processing speed. We studied the effects of age and dyslexia status on K-D outcome. The aim was to determine the threshold for a clinically meaningful change in K-D test outcome in adolescent athletes. METHODS:A total of 1506 Finnish athletes (mean age = 16.3, SD = 1.6) were assessed with K-D before the season. Twenty-eight percent (n = 416) participated in two consecutive baseline assessments one year apart, enabling reliable change analysis. Furthermore, results from 28 concussed athletes, assessed using the K-D test 3 days post injury, were compared to their own baseline data. RESULTS:We found that older athletes were faster in the K-D test, and dyslexic athletes (n = 95) were significantly slower than healthy controls. When evaluated 3 days post-concussion, 54% of the studied athletes were slower in the K-D test as compared to individual baseline. The clinically significant increase in the K-D test time, performed in Finnish, was 4.4 sec. The odds ratio for significantly decreased performance post-concussion was 3.3-fold, as compared to healthy controls. CONCLUSIONS:Age, dyslexia, and spoken language affect K-D test performance, so they should be addressed when clinically using the K-D test. Taking this into account and by using specific thresholds, the K-D test could be a cost-effective method in assessing the athletes' functional vision both at baseline and after concussion.
Objectives: This study examined age-specific associations between parent-reported executive function (EF) difficulties and internalizing/externalizing symptoms in children with neurofibromatosis type 1 (NF1), a genetic condition underrepresented in psychiatric research.Methods: Cross-sectional data of 1,049 observations from 803 children with NF1 (M age = 10.58 years, SD = 3.84, range = 3-18; 47.5% female; 67.5% from higher-education households; 36.6% with familial NF1) across nine U.S. and Australian institutions were integrated. Parents rated EF difficulties using the Behavior Rating Inventory of Executive Function and internalizing/externalizing symptoms using the Child Behavior Checklist and the Behavior Assessment System for Children. Time-varying effect modeling estimated age-specific associations between EF and internalizing/externalizing symptoms and tested moderation by sex and parental education.Results: Poorer functioning in all EF domains was associated with greater internalizing and externalizing symptoms from ages 3 to 18. The associations were largely consistent across ages as well as sex and parental education subgroups with a few differences: (1) emotional control and cognitive flexibility problems were more strongly associated with internalizing symptoms during middle and late adolescence; (2) inhibitory control was more strongly linked to externalizing symptoms in childhood; (3) stronger associations between EF and internalizing symptoms were observed among males in early adolescence.Conclusions: Parental complaints of EF difficulties are robustly linked to internalizing and externalizing problems from early childhood to late adolescence in children with NF1. Further longitudinal and experimental studies are needed to determine the directionality of these associations and whether EF represents a viable target for intervention.
OBJECTIVES:Psychologists are increasingly asked to assess intellectual functions in adults from diverse cultural and linguistic backgrounds. This study investigated the impact of acculturation and bilingualism on Wechsler Adult Intelligence Scale (WAIS)-IV performance among Arabic-Danish bilingual university students. METHODS:Forty-eight academically high-achieving participants (69% female), fluent in Danish and educated entirely in Denmark, were recruited in Greater Copenhagen and completed a demographic questionnaire, the Danish version of the WAIS-IV, and self-report measures of acculturation and bilingualism. RESULTS:Several WAIS-IV indexes and subtests were significantly associated with degree of bilingualism and acculturation, even after controlling for educational variables. Despite being academically high-achieving university students, participants scored below the national mean on most indexes and subtests. In fact, only performances on the Processing Speed Index, and the Coding and Symbol Search subtests were at the expected level. Notably, the lowest scores were observed on Block Design, which showed a strong correlation with Arabic acculturation scores. Finally, participants had index profiles that were more uneven than predicted based on the norms. CONCLUSIONS:These findings underscore the influence of cultural and linguistic factors on WAIS-IV performance and suggest that WAIS-IV may not fully capture the intellectual abilities of bilingual individuals, even when they are fluent in the test language and have the same educational experience as the norm population.
Background: Mathematical computation skills are a common vulnerability in those born very preterm (VP), but the underlying cognitive mechanisms have not been established. Using causal mediation methods, we aimed to investigate whether working memory, processing speed, and selective attention at 7 years of age could mediate the relationship between VP birth and mathematics computation performance at 13 and 20 years of age.Methods: Participants completed standardized measures of working memory, processing speed, and selective attention at 7 years. At 13 and 20 years, participants completed a standardized measure of mathematical computation. Using an interventional effects approach, we estimated the extent to which differences in mathematic performance could be reduced by hypothetically intervening on working memory, processing speed, and selective attention in childhood.Results: The VP group performed lower than the FT group on mathematic computation at 13 and 20 years. Improving working memory, processing speed, and selective attention separately in the VP group to the level of the FT group reduced the difference in mathematics performance at both 13 and 20 years. If all cognitive domains were to be simultaneously intervened on so that the VP group matched the FT group, there would be a reduction in difference in mathematic performance by 68.7% at 13 years and 44.1% reduction at 20 years.Conclusions: Findings from our causal mediation analyses suggest that interventions targeting working memory, processing speed, and selective attention in childhood for those born VP have potential for improving mathematical outcomes in adolescence born VP, especially if implemented concurrently.
Objectives: Clinical neuropsychology historically emphasized the assessment of "cold" cognitive functions, whereas emotional and motivational processes remain rarely evaluated. This point-of-view article argues for the inclusion of affective-motivational assessment into neuropsychological practice and outlines the key domains that should be routinely considered.Methods: Drawing on neuroscience and clinical research, we review four core affective-motivational domains: emotional reactivity, emotion regulation, emotion recognition, and social cognition. For each domain, we summarize self-report instruments and performance-based tasks. Beyond these domains, we discuss emotional-cognitive interference as a cross-cutting modulatory mechanism that may influence overall neuropsychological performance.Results: Evidence indicates that emotional and motivational processes shape cognitive functioning, predict functional outcomes, and contribute uniquely to diagnosis, rehabilitation adherence, and quality of life. Validated tools are available for assessing each domain, and many clinical conditions present affective and social disturbances that may be more disabling than cognitive deficits. Despite this, surveys consistently show that affective-motivational domains are rarely assessed in practice.Conclusions: Integrating emotional-motivational assessment is essential for achieving a comprehensive characterization of clinically relevant dimensions of everyday functioning. We propose a modular framework guided by referral questions and emphasize the need to develop a brief affective-motivational screener analogous to cognitive screeners such as the Mini-Mental State Examination or Montreal Cognitive Assessment. Systematic assessment of these domains can enhance diagnostic accuracy, strengthen rehabilitation planning, and more accurately reflect the complexity of everyday functioning.
Objectives: Few studies have examined the relationship between racial identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance. This study examined racial differences in baseline assessment performance before and after controlling for performance on a word-reading task as a proxy for education quality. We hypothesized that there would be racial differences in baseline performance but that controlling for education quality would reduce these differences. Methods: For this observational cross-sectional study, 875 collegiate athletes were grouped based on racial identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Education quality was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial differences in these cognitive domains before and after controlling for WTAR scores. Results: There were significant racial differences in both composite scores and in attention/processing speed IIV, p's < .001, f = 0.13-0.21. However, there were no significant racial differences in memory IIV, p = .97. After controlling for WTAR scores, there were no significant racial differences in the attention/processing (p = .530, f = 0.03) or memory (p = .183, f = 0.06) composite scores, and the relationship between racial identity and attention/processing speed IIV was less prominent (p = .014, f = 0.10). Conclusions: Results suggest that racial differences at baseline assessment can be largely accounted for by education quality as assessed by the WTAR, which underscores the importance of considering sociocultural context when assessing racially diverse athletes.
OBJECTIVES:Pulse pressure (PP) calculated as systolic minus diastolic blood pressure is a surrogate measure of arterial stiffness that may affect executive function; however, this relationship could be moderated by age and genetic risk for Alzheimer's disease (AD). We therefore examined relationships among PP, age, AD risk (i.e., APOE genotype) and executive function measured by the NIH Toolbox Cognition Battery (NIHTB-CB) in older adults. METHODS:PP was determined in 216 older adults without dementia (mean age: 77.5 ± 7.9 years, education: 16.8 ± 2.4 years, 55% women, 34.8% APOE ϵ4+) who were tested with the NIHTB-CB as part of the Advancing Reliable Measurement of Alzheimer's Disease and Cognitive Aging (ARMADA) study. RESULTS:Multiple linear regression revealed PP × Age × APOE genotype interaction effects for List Sorting Working Memory (β = 0.04; p = .007) and Picture Sequence Memory (β = 0.04; p = .006); higher PP was associated with worse scores in younger APOE ϵ4+ older adults (same pattern for fluid and total cognition composite scores). Higher PP was associated with lower Picture Vocabulary scores in ApoE ϵ4+ (PP X APOE interaction: β = -0.19; p = .022). Higher PP was associated with lower Flanker Inhibitory Control scores (β = -0.13; p = .005) across all participants. CONCLUSIONS:Arterial stiffness measured by PP in older adults is associated with worse performance on NIHTB-CB tests of executive function, working memory, and episodic sequence memory, particularly in younger APOE ϵ4 carriers. Arterial stiffness and AD risk may work synergistically in an age dependent manner to adversely affect cognition.
OBJECTIVE:To develop regression-based normative data for a set of widely used neuropsychological tests and to provide a freely accessible normative data calculator for use in Buenos Aires, Argentina. METHODS:Participants were drawn from a large clinical dataset and selected to reflect preserved global cognition, intact memory performance, and functional independence. Regression-based norms were developed for the Rey Auditory Verbal Learning Test, Verbal Fluency, Trail Making Test, and Digit Span tasks. For each model, predictors included age, sex, and years of education, as well as polynomial terms and interaction effects; final models were obtained via stepwise backward elimination procedures. Model assumptions were evaluated, and predictive performance was estimated using 10-fold cross-validation. RESULTS:393 participants met inclusion criteria. Age was negatively associated with verbal memory, fluency, and executive function, whereas higher educational attainment was associated with better performance. Women outperformed men in verbal memory and phonological fluency. Demographic variables explained between 2% and 23% of variance across tests. An open-access calculator was developed to facilitate individualized normative estimation in clinical settings. CONCLUSIONS:This study provides locally developed, regression-based norms for neuropsychological assessment in Buenos Aires - Argentina, addressing the lack of culturally relevant norms and limitations of traditional methods.
OBJECTIVES:In Part I, we adapted the Test d'Identification des Émotions Faciales (TIE-93), an emotion recognition test, from French into Dutch, Moroccan-Arabic, and Turkish. In Part II, the translated versions were piloted. METHODS:The procedures and challenges encountered during the translation and adaptation process are reported qualitatively. The translated versions were piloted, with performance on the TIE-93 compared across Dutch (n = 13), Surinamese (n = 15), Moroccan (n = 14), and Turkish (n = 16) healthy control groups. Second, we compared Surinamese, Moroccan, and Turkish healthy controls to matched patients (n = 20) with subjective cognitive decline, mild cognitive impairment, or dementia. Third, we compared Moroccan healthy controls from the Netherlands and France (n = 20). RESULTS:The challenges encountered during the translation process highlighted the difficulty of translating tests of social cognition, as emotional concepts are intricately linked to culture. As a result, literal translations often failed to maintain meaning equivalence; therefore, adaptations were necessary. Seventy-eight participants were included for piloting, and exploratory analyses were conducted. Healthy controls significantly outperformed patients, and Moroccan healthy controls from the Netherlands, who tested in their native language, significantly performed better than those from France. CONCLUSIONS:Results highlight challenges in cross-cultural test adaptation in social cognition, as achieving conceptual equivalence was complicated by cultural and linguistic nuances in emotion-related terms. Nevertheless, the TIE-93 shows clinical potential; this should be examined in larger samples.
OBJECTIVE:The goal of the present study is to understand whether youth with Noonan Syndrome Spectrum Disorder (NSSD) are at increased risk of neurocognitive difficulties when living in resource depleted communities. METHOD:Youth (5-17 years; Mage = 9.48 years) with NSSD (n = 140) and unaffected youth (4-15 years; Mage = 9.63 years; n = 85) were included. We ascertained the Child Opportunity Index Health and Environment Index (COI H/E) national-level Z-scores and assessed academic achievement and executive function. Multiple regressions were run to analyze the effects of diagnosis (whether the child had NSSD), COI H/E Z-scores, and diagnosis × COI H/E Z-score interaction on academic achievement (i.e., word reading, math, spelling, and sentence comprehension) and executive skills (i.e., performance-based working memory and processing speed and parent-rated measure of daily executive skills). RESULTS:Diagnosis was a significant predictor in each model. COI H/E Z-score was a significant predictor of spelling and a marginally significant predictor of sentence comprehension scores. There was a significant diagnosis × COI H/E Z-score interaction for working memory, and marginally significant interactions for spelling and sentence comprehension scores. Higher H/E Z-scores were associated with better working memory in the NSSD group and better academic achievement in the unaffected group. CONCLUSIONS:While the effects of NSSD are large on all assessed domains, there is an additional burden of resource depletion on working memory abilities of youth with NSSD. Academic achievement in the NSSD group was lower than the unaffected group across resource-depleted/enriched environments, demonstrating the profound effects of NSSD on academic functioning.
OBJECTIVES:The cognitive-behavioral model of body dysmorphic disorder (BDD) implicates impaired cognition; yet existing evidence of cognitive impairment in the disorder is often inconsistent. To date, cognitive performance in BDD has not been measured utilizing the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), a gold standard cognitive assessment in clinical settings. Accordingly, this study compared WAIS-IV performance between individuals with BDD and healthy controls. METHODS:Participants included 59 BDD patients and 56 controls. Cognitive performance was evaluated via the WAIS-IV, and clinical characteristics of the BDD group were examined via multiple clinician and self-report questionnaires. RESULTS:The BDD group demonstrated significantly poorer performance compared to the control group in the WAIS-IV index and subtests that reflect processing speed abilities (Processing Speed Index: d = -0.55, 95% CI [-0.92, -0.18], Symbol Search: d = -0.70, 95% CI [-1.07, -0.32], Coding: d = -0.79, 95% CI [-1.17, -0.41]), yet other indices were not significantly different. These impairments were not correlated with anxiety or BDD-YBOCS symptom severity. Reduced overall cognitive performance was primarily driven by impairments in processing speed. CONCLUSIONS:The study suggests that in BDD, processing speed is notably lower than other index scores, falling in the low average range. This may reflect difficulties with rapid visual processing, attention to detail, or motor speed. Performance in domains reflective of reasoning and verbal functioning were unimpaired relative to controls. This selective cognitive pattern in BDD may be driven by increased cognitive load associated with perfectionistic traits. This has clinical implications for cognitive-behavioral treatment.
OBJECTIVES:Neuropsychological (NP) tests are multi-domain in execution. Reliance on a single score representing specific domains obscures the detection of subtle cognitive changes and increases risk of inaccurate assessment. Rooted in the Boston Process Approach (BPA), the Framingham Heart Study (FHS) captures multi-dimensional errors and process features within and across NP tests. We examined these BPA variables in community-dwelling older adults. METHODS:We analyzed data from 2363 dementia-free participants aged 60 and above. Exploratory and confirmatory factor analyses used Kemeny covariance structures. Measurement invariance was estimated across age, sex, and education groups. We assessed the impact of demographics on latent factors, and the ability of these factors to predict future conversion to all-cause dementia. We trained machine learning (ML) models to compare NP and BPA data. RESULTS:Participants were older adults (mean age 71.5 ± 8.7 years), primarily female (54.2%), and non-Hispanic White (96.5%). The bifactor model was the only model with adequate fit (CFI = 0.96, RMSEA = 0.03). General and specific factors captured ability for accurate and strategic responses, test-specific variance, and nuanced executive and semantic processes distributed across tests. Higher general ability and stronger verbatim story recall were associated with a reduced likelihood of developing all-cause dementia (general: OR = 0.15, 95% CI [0.12-0.86]; recall: OR = 0.24, 95% CI [0.23-0.90]) over a median of 5.2 years. With NP/BPA data, ML models identified >99% of 222 converters. CONCLUSIONS:This study highlights the strengths of NP/BPA data. Multidimensional cognitive features may enhance sensitivity to early changes predictive of incipient dementia.
OBJECTIVES:Assessment for children with acquired brain injury (ABI) often includes measures of preinjury functioning; however, there is limited understanding of how social determinants of health (SDOH) are associated with preinjury measures. This study investigated the association of the Area Deprivation Index (ADI) with measures of preinjury functioning. METHODS:196 caregivers of children with ABI completed the Adaptive Behavioral Assessment System-3rd Edition (ABAS-III), and 188 children with ABI completed the Wide Range Achievement Testing-4th Edition or 5th Edition word reading subtest (WRAT-Word Reading). Two linear regressions were performed: 1) ADI × WRAT-Reading and 2) ADI × ABAS-III. RESULTS:The ADI demonstrated significant associations with the ABAS-III and WRAT-Reading scores. Children in lower deprivation areas demonstrated higher preinjury functioning and word reading scores. CONCLUSIONS:These findings have implications for recovery from brain injury, considerations for incorporating social determinants of health into neuropsychological evaluations, and implications for clinician interpretation of a child's testing.
In 2020, the American Academy of Clinical Neuropsychology (AACN) published consensus labels for the uniform description of normally distributed test results in the field of clinical neuropsychology. These consensus labels were developed in a North American context, but other countries have also struggled with the challenges of harmonizing verbal descriptive labels in neuropsychological reports. A recent effort in Norway has demonstrated that literal translations of the AACN labels do not always work in a different language and culture. Also, verbal labels may not be unequivocally understandable for patients, their significant others, and other healthcare professionals who refer patients for neuropsychological services. In this Commentary, we illustrate the process of coming to uniform descriptions for normally distributed test results for the Dutch language, spoken primarily in the Netherlands, the Flanders part of Belgium, the Dutch Caribbean, and Suriname. We also highlight the hurdles that need to be overcome to establish a global consensus.
OBJECTIVE:Episodic memory decline is among the earliest and most prominent cognitive changes observed in both normal aging and Alzheimer's disease. The Free and Cued Selective Reminding Test (FCSRT) enhances differentiation of memory deficits through controlled semantic encoding and cue-based retrieval. However, culturally appropriate normative data for Mandarin-speaking adult populations have been lacking. This study aimed to establish normative data for the Taiwan version of the FCSRT (T-FCSRT), examine demographic effects on test performance, and evaluate its psychometric properties and clinical applicability. METHOD:A total of 372 cognitively healthy adults aged 45-86 years were recruited using stratified sampling to reflect the Taiwanese population across sex, age, and education levels. Participants completed the T-FCSRT, and regression-based analyses were used to adjust for demographic effects. Reliability and validity were assessed using test-retest data and correlations with established neuropsychological measures. RESULTS:All T-FCSRT core indices were significantly influenced by age and education level, whereas sex effects were confined to immediate and delayed free-recall measures. The T-FCSRT demonstrated good test-retest reliability, criterion-related and construct validity, and regression-based percentile norms that provide population-representative benchmarks. CONCLUSION:The T-FCSRT demonstrates strong psychometric properties and provides culturally appropriate normative data for Mandarin-speaking adults in Taiwan. These findings support its utility for clinical assessment and research on episodic memory, enabling more accurate differentiation between normal and pathological aging.
OBJECTIVE:The quest for non-invasive and cost-effective biomarkers for mild cognitive impairment (MCI) and Alzheimer's disease (AD) has led to growing interest in resting-state functional magnetic resonance imaging (MRI). This study examined associations between whole-brain functional connectivity measures and cognitive performance across a spectrum of cognitive aging. METHOD:A total of 108 older adults (mean age 74.1 ± 5.7 years), comprised of cognitively intact individuals, participants with amnestic MCI, and those with mild dementia due to probable AD, underwent high-resolution structural MRI and resting-state functional MRI scans and cognitive testing with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Functional connectivity values were derived from a 17-network brain parcellation. Correlations were established between network connectivity values and RBANS Index scores. RESULTS:Analyses revealed that lower RBANS Attention Index and Total Scale scores were significantly associated with increased connectivity between the ventral attention, central executive network, and limbic and default mode networks. Lower RBANS total scores were also associated with functional connectivity strength between the dorsal default mode networks and lateral frontoparietal regions of the central executive network, with increased connectivity observed across the dementia spectrum (Intact-MCI-AD). CONCLUSIONS:These findings suggest that aberrant and potentially compensatory increases in functional connectivity may be linked to cognitive decline, supporting the utility of resting-state functional MRI as a promising biomarker for MCI and AD.
