INTRODUCTION: While olfactory decline is a promising non-invasive early marker of amnestic mild cognitive impairment (aMCI), research in underrepresented populations is limited. We evaluated the NIH Toolbox Odor Identification Test (NIHTB-OIT) in older African Americans. METHODS: Participants included 93 healthy agers (81.7% female; Mage=73.85, SDage=5.06) and 52 individuals with aMCI (69.2% female; Mage=74.37, SDage=5.26). NIHTB-OIT scores were analyzed using two-way ANCOVAs, adjusting for age and education. Receiver Operating Characteristic (ROC) analysis assessed diagnostic utility. APOE ε4 status was examined in a subset (64.8%). RESULTS: Healthy agers scored significantly higher than the aMCI group (p =.019), and females outperformed males (p =.031). ROC analysis showed significant diagnostic discrimination (AUC] = .626, p = .010). No significant differences were observed by APOE ε4 status or diagnosis-by-sex interactions. DISCUSSION: The NIHTB-OIT differentiates aMCI from healthy aging in African American older adults. Its brevity, standardized scoring, and diagnostic sensitivity support its clinical utility in diverse populations.

IntroductionDecision-making is a complex form of cognitive function that declines with age and is highly susceptible to impairment from dementia due to Alzheimer’s and related neurogenerative diseases. Emotions and other non-cognitive assets are also believed to influence decision-making ability. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative seeks to understand how measures of emotion and non-cognitive influences of decision-making (ENC DM) have been used in research and clinical settings. The scoping review examined the recent literature on decision-making measures involving emotion and non-cognitive domains in aging samples.MethodsUsing a well-established scoping review methodology framework we conducted a systematic search across six databases—Embase (Elsevier), MEDLINE (Ovid), PsycINFO (EbscoHost), Cochrane Library, Web of Science (Clarivate), and Scopus (Elsevier)—to identify studies published between January 2018 and November 2023 that met our predefined eligibility criteria. In line with recommended best practices, sample selection was carried out in two-stages: First, two reviewers independently screened titles and abstracts for relevance; second, full-text articles were reviewed, and data were extracted from those that met the inclusion criteria.ResultsThe final dataset included 232 articles and, among them, 143 unique emotion and non-cognitive decision-making measures. Twenty-eight percent of manuscripts used measures with a clinical sample, 26% used measures with a normative adult sample, and 47% used measures with both clinical and non-clinical samples. The five most frequent measures used were: Iowa Gambling Task, Balloon Analogue Risk Task, Delay Discounting Task, Decisional Conflict Scale, and Cambridge Gambling Task.DiscussionResults of the most common decision-making measures reflect a preference for assessing risk-taking and impulsivity in the sphere of non-cognitive and emotion function. Such trends were also found in clinical samples of older adults with neurodegenerative diseases. These findings inform the larger ARMCADA project in the development of reliable and validated measurement of decision-making among older adults. It will also support researchers studying older adults’ decision-making skills and their vulnerability to diseases that cause cognitive impairment and dementia, with an understanding of the current assessments used to track ENC DM.Systematic review registrationhttps://bmjopen.bmj.com/content/14/12/e084178

Abstract Background Brain health is the state of optimal brain functioning across cognitive, sensory, social-emotional, behavioral, and motor domains, supporting individuals to achieve their full potential at every stage of life. Diet is a modifiable factor that plays a fundamental role in supporting brain health. Although many systematic reviews have examined individual nutrients or bioactive food components (BFCs) in relation to cognitive and related brain health outcomes, no comprehensive umbrella review has yet synthesized this evidence across nutrients, BFCs, life stages, intake levels, and brain health outcomes. To our knowledge, this will be the first umbrella review to systematically map and synthesize evidence across nutrients, BFCs, life stages, intake levels, and brain health domains in generally healthy individuals free from major chronic medical, neurological, psychiatric, and neurodegenerative conditions. Methods This umbrella review will follow the Joanna Briggs Institute (JBI) methodology. A comprehensive search will be conducted in Embase (Elsevier), MEDLINE (Ovid), Web of Science (Clarivate), PsycINFO (EBSCO), CINAHL (EBSCO), and Cochrane Database of Systematic Reviews (Wiley) to identify systematic reviews published between January 1, 2016 and March 2, 2026 that meet eligibility criteria. Two trained reviewers will independently screen titles/abstracts and full texts, with data extraction performed only from the retained reviews. The methodological quality of included reviews will be appraised using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2), and the overlap of primary studies across reviews will be evaluated using the Corrected Covered Area (CCA) method. The results will be reported in adherence to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Discussion This umbrella review will provide an integrated summary of existing systematic review evidence on nutrients and BFCs in relation to cognitive and related brain health outcomes in generally healthy populations. Findings will guide the development of age-specific, evidence-based dietary strategies to promote optimal brain health across the lifespan and support public health recommendations and future dietary guidelines. Systematic review registration PROSPERO CRD420251186632.

Executive function (EF) supports goal-directed behavior, yet little is known about how different scoring algorithms influence the measurement of executive function performance in pediatric Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. We compared four algorithms: Accuracy, Speed, Rate Corrected Score (RCS), and Linear Integrated Speed-Accuracy Score (LISAS) in 51 children with ADHD (23.5% female; Mage = 12.9, SDage = 2.8) and 102 matched controls (23.5% female; Mage = 12.8, SDage = 3.1) using the NIH Toolbox Dimensional Change Card Sort (DCCS) and Flanker Inhibitory Control and Attention (Flanker) tests. Results showed that while RCS and Speed demonstrated high internal consistency across tasks, Accuracy and LISAS indices were less reliable, particularly during cognitive flexibility trials in the ADHD group. Children with ADHD exhibited lower Accuracy and higher switching costs on the DCCS, whereas no group differences were observed on the Flanker task. Group differences in cognitive flexibility were detected by accuracy-based metrics but remained obscured by scores based on speed alone. Findings suggest that integrated methods, particularly accuracy-dominant metrics like RCS, may offer reliable, clinically sensitive alternatives to single-metric scores. Their utility depends on task demands, emphasizing that relying solely on response speed may underestimate cognitive flexibility deficits in ADHD.

Background:Though often not routinely assessed in older adults, declines in decision-making (DM) abilities are often observed in aging and may lead to adverse outcomes in multiple aspects of daily functioning. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative seeks to address these issues. This scoping review investigates the current published literature on existing DM measures in aging samples, with emphasis on the domain of functional outcomes, defined as skills or behaviors related to one's ability to live independently. Methods:We identified studies published between 2018-2023 using key words related to DM abilities and functional outcomes in aging populations through multiple databases. Titles and abstracts were first reviewed by two reviewers, full texts were then screened, and data were extracted from included articles. Results:The scoping review identified 16,278 articles across domains with adults aged 45 and older. After screening and extraction, 705 total articles were included; 301 were related to functional outcomes and, from these, 231 distinct measures were identified. Mode of administration of most measures were self-administered with supervision, followed by examiner-administered, and most were conducted with clinical samples (e.g., MCI/AD, chronic health conditions, and Parkinson's disease, or clinical samples and a control group). Discussion:The goal of the current scoping review is to provide a comprehensive examination of the current DM measures in older adults; this article focuses on the domain of functional outcomes. This scoping review guides a project to create and validate measures that can efficiently assess DM abilities in older adults across the cognitive aging spectrum.

The demand for remote assessment tools has increased, yet there is a lack of standardized adaptations for remote administration. This pilot study investigates the equivalency of in-person and remote cognitive assessments using the NIH Toolbox Cognition Battery (NIHTB-CB) among children aged 7 to 17 years. Forty-seven children (51.1% female; Mage = 12.26, SDage= 3.23) were assessed in two formats: in-person at a study site and remotely from home, with the order of assessments counterbalanced. The NIHTB-CB was used for in-person evaluations, while a newly developed version, the NIH Toolbox Participant/Examiner (NIHTB-P/E) App, was used for remote assessments through built-in teleconferencing features. The results showed considerable consistency between in-person and remote scores across all NIHTB-CB tests. Certain differences were noted, including longer test durations for remote assessments and potential practice effects on some measures. Overall, preliminary findings from this pilot study support thefeasibility of administering the NIHTB-CB remotely using the NIHTB-P/E App, providing a viable option to traditional in-person cognitive assessments in pediatric populations.

OBJECTIVE:To assess the reliability and fidelity of caregiver- and examiner-administered anthropometric measurements in English- and Spanish-speaking children aged 0-17 years. METHODS:Participants (N = 199; median age, 4.69 years; interquartile range, 1.58-10.37; 46.7% male) were recruited in 6 sites across the United States in May-August 2023. Examiners were trained by a pediatric nurse; caregivers received well-developed administration materials. The key anthropometric outcomes assessed were infant length/child height, weight, percent body fat (PBF), head size, and waist circumference. Concordance between caregiver/examiner measurements was assessed using interrater reliability estimates, technical error of measurement (TEM), and mean absolute difference (MAD). Secondary outcomes included reported ease of use and language used. RESULTS:High concordance was observed between caregivers and examiners, with reliability coefficients ranging from 0.91 to >0.99 and intraclass correlation coefficient values from 0.92 to >0.99 across all assessments and age groups. The TEM was low (height = 2.10 cm, weight = 0.39 kg, PBF = 2.33%; head circumference = 0.73 cm, waist circumference = 3.65 cm) as were MAD estimates (height = 2.12 cm, 95% confidence interval [CI], 1.82-2.42; weight = 0.35 kg, 95% CI, 0.29-0.41; PBF = 2.39%, 95% CI, 1.89-2.88; head size = 0.71 cm, 95% CI, 0.54-0.89; waist circumference = 3.15 cm, 95% CI, 2.41-3.88). CONCLUSIONS:Across multiple metrics, there was high concordance between caregiver- and examiner-administered measurements, providing evidence of interchangeability between remote and in-person assessments of anthropometric outcomes. Remote anthropometric assessment appears feasible and low burden and has comparably high validity and reliability to in-person methods.

Background:Cognitive impairment (CI) and related conditions are known to affect decision-making (DM), particularly in older adult populations. The intersection of CI and DM ability is crucial in end-of-life (EoL) care, where there is a confluence of heterogenous preferences and values often across different constituents (e.g., healthcare providers, family members, and proxies). Standardized questionnaires are necessary to characterize patients' EoL decisions, preferences, and readiness, but the extent of available measures is widely unknown. Objective:This scoping review aims to summarize the current state of the literature regarding EoL decision-making measures. This effort supports the development of the Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative, which seeks to develop a decision-making battery for use in older adults. Methods:Following the Arksey and O'Malley framework, we conducted a scoping review for multiple domains of DM in studies published between January 2018 and November 2023. Any paper that assessed or characterized DM in participants 45 years and older was extracted for the DM domain, population characteristics, and DM measures. Results:An initial search identified 16,286 articles, of which 705 were classified as assessing DM. Of those, 34 articles included measures of the EoL domain, and 28 unique measures were identified. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the Decisional Conflict Scale (DCS), and the Decision Regret Scale (DRS) were the only assessments used more than once in the scoping review. Many studies assessed clinical populations, including those with CI/dementia (12%), cancer (24%), and chronic conditions (16%). Findings show that measures used at the end of life emphasize decisional preferences, efficacy, and conflict. Conclusion:Overall, this review highlights the lack of DM ability measures that can assess older adults' capacity to make decisions regarding EoL-specific issues (e.g., life-sustaining treatment and pain management).

Older African Americans are at increased risk compared with older White adults to have dementia of the Alzheimer’s type, yet few studies have investigated African-American performance on standardized neuropsychological batteries such as the NIH Toolbox Cognition Battery (NIHTB-CB). This study aimed to characterize the performance of NIHTB-CB tests and composites in an African American sample of COGNITIVELY healthy agers and those diagnosed CLINICALLY with amnestic Mild Cognitive Impairment (aMCI). As part of the larger Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA) Study, we assessed 94 African-American healthy agers (81.9% female; M age = 73.9, SD age = 5.06; 53.4% with 4-year college degree or graduate-level education) and 60 African-American PARTICIPANTS with an MCI diagnosis (70% female; M age = 75.30, SD age = 5.94, 45% with higher education degree). The NIHTB-CB was administered by trained examiners and completed a series of tests: the Crystallized Cognition Composite included Oral Reading Recognition (reading and pronunciation) and Picture Vocabulary (receptive vocabulary), and the Fluid Cognition Composite included List Sort Working Memory (LSWM; working memory), Picture Sequence Memory (PSM; episodic memory), Pattern Comparison Processing Speed (PC; processing speed), Dimensional Change Card Sort (DCCS; executive function/set-shifting), Flanker Inhibitory Control and Attention (Flanker; executive function/inhibition/attention). In a series of ANOVAs using Bonferroni corrections, we investigated the differences in unadjusted scale scores, adjusting for age, education, sex as a biological variable, and study site. Partial eta-squared ( η p 2 ) estimates were calculated to determine the effect size of the individual NIHTB-CB tests/composites ( η p 2 0.01-small, 0.06-medium, 0.14-large). Compared to COGNITIVELY healthy agers, those with aMCI scored significantly lower on all NIHTB-CB measures except for DCCS and PC. Large effect sizes were observed in particular for PV ( η p 2 =.12), LSWM ( η p 2 =.0.09), LSWM ( η p 2 =.0.09), Flanker ( η p 2 =.0.08), and PSM ( η p 2 =.0.08). These differences were independent of sex or age effects, with the exception of LSWM and PSM, where an increase in age predicted lower performance. Nearly all measures within the NIHTB-CB, including the Composite scores, significantly differentiate between healthy controls and individuals with aMCI among older African-American adults. This is a highly educated sample, so true differences in the general population are likely of larger magnitudes.

Olfactory decline is correlated with cognitive decline in aging. The National Institutes of Health Toolbox Odor Identification Test (NIHTB-OIT) is an established measure of olfaction ability. While it distinguishes differences in English-speaking samples with varying cognitive abilities, its validation has not been completed for Spanish-speaking and LatinX populations, who are far more likely to develop Alzheimer's than non-Latinos. We evaluated the NIHTB-OIT results from a cross-sectional sample of Spanish-speaking older adults. In the context of Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA) Study, we evaluated 239 Spanish-speaking adults aged 53 to 89: 115 normal controls (NC) (70.2% female; M age  = 73.19, SD age  = 4.99), 104 patients with mild cognitive impairment (MCI) diagnosis (68% female; M age  = 76.56, SD age  = 6.23), and 20 patients with Dementia of Alzheimer Type (DAT) diagnosis (70% female; M age  = 76.95, SD age  = 7.76). The NIHTB-OIT was administered by trained examiners using scratch-and-sniff cards for odor identification. Participants’ performance is evaluated based on correct responses, with total raw scores ranging between 0 and 9. We analyzed the data using ANOVA for main effects and interactions, and Welch Two Sample t-tests for sex differences. Results indicated main effects of age ( F (1, 230) = 13.27, p  < .001, ηp2  = .055), diagnosis ( F (1, 230) = 3.59, p  = .029, ηp2  = .030), and sex ( F (1, 230) = 6.21, p  = .013, ηp2  = .026). Older adults had lower scores on the NIHTB-OIT. No pairwise comparison was significant across normal controls, MCI, and DAT groups. We observed sex differences only for the healthy agers ( p  < .001), with female participants ( M  = 6.24, SD  = 1.56) having higher scores than males ( M  = 5.32, SD  = 1.70). There was no significant interaction between age and diagnosis, while the interaction between age and cognitive status was significant. Finally, a three-way interaction was observed between age, sex, and cognitive status (see Figure 1). Among Spanish-speaking older adults, clinical groups displayed different trajectories in their performance on the NIHTB-OIT by both cognitive status and gender, suggesting heterogeneous clinical manifestations in odor detection ability with increasing age.

Deficits in decision-making (DM) can lead to adverse outcomes across multiple domains such as financial management and medical care. By hindering such DM abilities, cognitive impairment (CI) often affects quality of life. Routine screening for CI, however, does not include systematic and comprehensive assessment of DM ability. While there are many measures of DM ability, there is considerable heterogeneity in what constructs are measured and the populations in which they have been validated. This scoping review assessed what decision-making measures were present in the literature and their validation evidence, across the domains of financial, functional outcomes, health care, end-of-life, and affective. We adhered to established scoping review methodology and included keywords pertaining to measurement, technology, decision-making, and age across a variety of databases. A total of 16278 articles were identified, and of those, 1654 passed title and abstract screening, and were deemed eligible for full-text review. Seven-hundred eighty six studies were included for consideration of full-text extraction; currently, 581 were identified for full-text extraction. Preliminary findings suggest that across domains, there were more measures for functional outcomes (25%), health-care decision-making (19%), followed by financial decision-making (15%), affective (15%), and end-of-life (3%), though there were many measures rated as encompassing more than one category. Measures are overwhelmingly in-person (69%), while 16% could be administered remotely, although many of them were computer-based tasks. Common decision-making tasks included tests of risk (e.g., gambling tasks), semi-structured interviews of assessment, and brief cognitive screenings. Such measures were presented with a variety of clinical populations. Many measures of decision-making ability identified were used in laboratory or research settings, or measured one construct. Future work will investigate adaptation, validation, and development of existing decision-making measures, for early detection of preclinical dementia.

BackgroundCognitive decline in older adults affects key functions such as memory, concentration, planning, reasoning, and decision-making (DM). This decline in cognitive abilities compromises basic DM skills, with growing evidence that DM can decline before noticeable impairment or an official cognitive impairment diagnosis, adversely impacting quality of life and leading to negative outcomes in financial management and daily activities.ObjectiveThis scoping review aims to identify and evaluate existing measures of financial decision-making (FDM) abilities in clinical and community-dwelling populations aged 45 and older.MethodsWe conducted a systematic search in EMBASE (Elsevier), PsycINFO, PubMed, MEDLINE, PsychARTICLES, and Web of Science for studies published between January 2018 and November 2023. The multi-domain scoping review yielded 16,278 records. Title and abstract, as well as full-text screenings, respectively, were completed by two reviewers and conflicts were resolved by PhD level researchers. We then extracted data from the full-text articles.ResultsThe scoping review yielded 154 articles with 96 unique measures. The most frequently used measures were variations of the Iowa Gambling Task (IGT), The Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS), the Decision-making Competence Assessment Tool (DMCAT), the temporal discounting paradigm, and the Short Form version of the Financial Capacity Instrument (FCI-SF). Commonly used measures of financial decision-making (FDM) often assessed specific aspects, such as risk-taking behavior and basic financial knowledge.DiscussionMany of the FDM measures found in this scoping review were developed for use in laboratory settings, and less is known about potential for clinical use adaptation. Future work addressing this measurement gap could significantly enhance early interventions to ameliorate or mitigate decline, thereby improving financial management and quality of life for at-risk individuals.

We investigated age-related differences and commonalities in earliest memories, focusing on retrieval speed, recollection type (remember vs. know), retrieval type (direct vs. generative), age at the time of the event, and phenomenological characteristics. The sample consisted of 131 adults: 68 young adults (48.5% males; Mage = 20.29, Sage = 1.53) and 63 older adults (47.6% males; Mage = 68.43, SDage = 4.11). They reported their earliest memories, estimated their age at the time, indicated recollection and retrieval types, and rated event characteristics (e.g., importance, vividness). Results showed that older adults were significantly more likely to classify their memories as remembered and directly retrieved, whereas young adults had a more balanced distribution of the classifications. Directly retrieved memories were accessed more rapidly than generatively retrieved ones, and young adults demonstrated shorter retrieval latencies than older adults. Additionally, older adults dated their earliest memories to later age and rated them as significantly more vivid, emotionally intense, and personally meaningful. Recollection type was not associated with retrieval latency but linked to higher vividness and confidence. Overall, our findings demonstrate potential age-related shifts in the retrieval and subjective evaluation of earliest autobiographical memories.

BACKGROUND:Olfactory decline is correlated with cognitive decline in aging. The National Institutes of Health Toolbox Odor Identification Test (NIHTB-OIT) is an established measure of olfaction ability. While it distinguishes differences in English-speaking samples with varying cognitive abilities, its validation has not been completed for Spanish-speaking and LatinX populations, who are far more likely to develop Alzheimer's than non-Latinos. We evaluated the NIHTB-OIT results from a cross-sectional sample of Spanish-speaking older adults. METHODS:In the context of Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA) Study, we evaluated 239 Spanish-speaking adults aged 53 to 89: 115 normal controls (NC) (70.2% female; Mage = 73.19, SDage = 4.99), 104 patients with mild cognitive impairment (MCI) diagnosis (68% female; Mage = 76.56, SDage = 6.23), and 20 patients with Dementia of Alzheimer Type (DAT) diagnosis (70% female; Mage = 76.95, SDage = 7.76). The NIHTB-OIT was administered by trained examiners using scratch-and-sniff cards for odor identification. Participants' performance is evaluated based on correct responses, with total raw scores ranging between 0 and 9. We analyzed the data using ANOVA for main effects and interactions, and Welch Two Sample t-tests for sex differences. RESULTS:Results indicated main effects of age (F(1, 230) = 13.27, p < .001, ηp2 = .055), diagnosis (F(1, 230) = 3.59, p = .029, ηp2 = .030), and sex (F(1, 230) = 6.21, p = .013, ηp2 = .026). Older adults had lower scores on the NIHTB-OIT. No pairwise comparison was significant across normal controls, MCI, and DAT groups. We observed sex differences only for the healthy agers (p < .001), with female participants (M = 6.24, SD = 1.56) having higher scores than males (M = 5.32, SD = 1.70). There was no significant interaction between age and diagnosis, while the interaction between age and cognitive status was significant. Finally, a three-way interaction was observed between age, sex, and cognitive status (see Figure 1). CONCLUSIONS:Among Spanish-speaking older adults, clinical groups displayed different trajectories in their performance on the NIHTB-OIT by both cognitive status and gender, suggesting heterogeneous clinical manifestations in odor detection ability with increasing age.

Effective antiretroviral treatment has transformed HIV into a manageable chronic condition. In Tanzania, about 1.7 million people are living with HIV (PLWH), with 79

The NIH Toolbox® for Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB) is a brief neuropsychological assessment tool created as part of the NIH Neuroscience Blueprint. Since its inception, NIHTB-CB has been widely used in a variety of clinical and research settings, including large-scale epidemiological studies. The NIHTB-CB was recently updated and re-normed to Version 3 (V3). We describe the approach to establish normative reference values. The NIHTB-CB tests were administered to a large English-speaking sample of n = 3,904 (average age = 25.7 years, 52.1% female) individuals from the U.S. population, stratified by age, race and ethnicity, sex assigned at birth, and education level within the four U.S. census regions. Normative data were raked via iterative proportional fitting (e.g., by sex assigned at birth, race, ethnicity, and educational attainment nested within geographic region) to derive sampling weights that match the demographic proportions from the U.S. Census targets. Through regression-based continuous norming and bootstrap techniques, age-adjusted and age-and-education-adjusted normative scores were created for individual measure-level and composite scores.

BackgroundAs hypertension becomes more prevalent, remote assessment of blood pressure (BP) has been proposed as a method to improve BP management in the pediatric population. We investigated the reliability of at-home BP monitoring in children ages 3–17.MethodsThis study was conducted at six sites across the United States. Children participated in three BP measurements on one occasion by caregivers at home and, on another separate occasion, by trained examiners in a clinic setting. The results were averaged and classified according to the 2017 Pediatric Hypertension Guidelines as normal BP, elevated BP, stage 1 hypertension, or stage 2 hypertension. We collapsed participants with elevated BP, stage 1 hypertension, or stage 2 hypertension into one group: above-normal. We examined the agreement between the caregivers’ and examiners’ BP readings and the ease of the measurement process.ResultsOne hundred eighteen (118) children participated in this study (48.3% male; mean age 9.65 ± 4.52 years). Most caregivers (78%−93%) and examiners (88%−99%) rated elements of BP measurement as “easy” or “very easy”. Caregiver and examiners’ agreement on BP classification as normal or above-normal ranged from 75.00% to 90.16% across age groups. Caregiver and examiner BP concordance significantly differed by age group (p = .03) and was lower among children with above-normal BPs.ConclusionsOverall, most aspects of the remote BP measurement process were rated as easy, suggesting that remote monitoring of BP in children is feasible. Concordance of BP measurements by caregivers and examiners was high for children in the normal BP range. More research is needed on the reliability of home BP monitoring across the pediatric age range for those with above-normal BP.

IntroductionDeclines in decision-making (DM) ability are often observed with increasing age and pose significant risk for negative health, financial, and functional outcomes. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative aims to improve measurement of DM ability in aging to facilitate early detection of cognitive and functional decline. This scoping review summarizes the extant literature on DM measures in aging, focusing specifically on measures relevant to healthcare decision-making (HCDM).MethodsWe identified articles published between 2018 and 2023 using keywords related to DM abilities in aging populations. Titles and abstracts were first reviewed by two trained reviewers, followed by full-text review and extraction. Results of the current scoping review are reported in adherence to PRISMA-ScR guidelines.ResultsThe scoping review identified 16,286 articles across multiple domains of decision-making, 705 of which met criteria for extraction, and 246 of which were related to healthcare decision-making. There were 86 unique measures across these articles, and 18 of these measures directly targeted decision-making ability. Most measures were administered to clinical groups in English and in-person with a trained examiner. Measures of healthcare DM ability tended to consist of semi-structured interviews or performance-based items, though there were also several self-report measures.DiscussionThe most commonly used measures to assess HCDM ability require trained administration of a semi-structured interview to assess ability to reason about health-related scenarios and are often time-intensive. Creation of a streamlined, standardized measure to assess HCDM ability will benefit both research and clinical care for the aging population.

Older Hispanic/LatinX populations are at increased risk compared with older White adults to develop dementia, yet few studies have characterized their performance on standardized neuropsychological batteries such as the NIH Toolbox Cognition Battery (NIHTB-CB). We investigated the differences of NIHTB-CB tests and composites in a 100% Spanish-speaking and Hispanic sample of healthy agers, compared to those diagnosed with amnestic Mild Cognitive Impairment (aMCI) and mild dementia of the Alzheimer's Type (mDAT). As part of the larger Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA) Study, we assessed 125 healthy agers (87.2% female; M age  = 73.2, SD age  = 4.99), 123 with an aMCI diagnosis (63.4% female; M age  = 76.50, SD age  =  6.30), and 28 with mild DAT (64.3% female; M age  = 75.60, SD age  =  7.62). The NIHTB-CB was administered by trained examiners included Oral Reading Recognition (ORR), Picture Vocabulary (PV), List Sort Working Memory (LSWM) Picture Sequence Memory (PSM), Pattern Comparison Processing Speed (PC), Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (Flanker) tests. In a series of ANOVAs, we investigated the differences in unadjusted scale scores, adjusting for age, education, sex as a biological variable, and study site. Compared to healthy agers, those with aMCI scored significantly lower on all NIHTB-CB measures and composites, with high standardized mean differences for LSWM (Diff = -11.73, 95% CI=[-14.88, -8.57]), PCPS (Diff = -8.62, 95% CI=[-12.44, -4.8]), DCCS (Diff = -8.19, 95% CI=[-10.95, -5.43]), and PV (Diff = -8.02, 95% CI=[-10.64, -5.39]). Observed differences between the healthy ager and mild DAT group were even higher, as expected: LSWM (Diff = -14.29, 95% CI=[-20.55, -8.02]), PCPS (Diff = -17.71, 95% CI=[-24.25, -11.17]), DCCS (Diff = -11.34, 95% CI=[-16.27, -6.41]), and PV (Diff = -12.57, 95% CI=[-16.93, -8.22]). The NIHTB-CB differentiated between aMCI and mild DAT only on PCPS and PV. These differences were independent of sex or age effects, except for PCPS, where an increase in age predicted lower performance. Nearly all measures within the NIHTB-CB significantly differentiate between healthy controls and individuals with aMCI, and healthy agers and individuals with mDAT among older Spanish-speaking adults.

This study examined the trait-variance in autobiographical memory recollection (AMR). Participants (N = 397) provided ratings on eight autobiographical memories elicited using cue words. Multilevel random coefficients modeling revealed that 43% of the variance in memory ratings was due to individual differences, while the remaining 57% was related to other factors. Scores on the Brief Autobiographical Recollection Test (Brief ART; Berntsen et al.), a measure of metacognitive evaluations of autobiographical memory, were significantly correlated with mean memory ratings. However, they only explained 34% of the variance in mean ratings, and 15% of the variance in the ratings of individual memories, suggesting that metacognitive evaluations do not fully coincide with actual memory experiences. These findings suggest that AMR is a complex phenomenon influenced by both stable individual differences and situational factors. Multilevel modeling provides a rigorous approach to gaining a more nuanced understanding of AMR by disentangling various sources of variance.