Construct validation of NIH Toolbox Cognition Battery premorbid cognitive functioning scores in Black and White older Americans with and without mild cognitive impairment.

OBJECTIVE: Valid estimates of premorbid cognitive functioning (PMIQ) are crucial for the assessment of older adults at risk for Alzheimer's disease. We investigated the relationship between the NIH Toolbox-Cognition Battery's (NIHTB-CB) Oral Reading Recognition (ORR) subtest and Wechsler Test of Adult Reading scores (WTAR, convergent validity). We also compared ORR to NIHTB-CB Flanker scores, where null relationships were expected (discriminant validity). METHODS: The WTAR and NIHTB-CB were administered to 130 cognitively normal (CN) and 113 participants with mild cognitive impairment (MCI). Participants were community-dwelling, older Black and White adults, ages 55-88 years. Data analysis used uncorrected standard scores and Bayesian bivariate correlations. Supplemental materials include intraclass correlations. RESULTS: ORR and WTAR scores were strongly positively associated, while ORR and Flanker scores were unrelated. This pattern held when restricting analyses to the two cognitive status groups, the two racial groups, and the four race-by-diagnosis subgroups. CONCLUSION: The findings demonstrate convergent and discriminant validity and support NIHTB-CB ORR scores as valid estimates of scores on a PMIQ measure in older Black and White adults with and without MCI.

Metacognition in Community-Dwelling Older Black and African American Adults During the COVID-19 Pandemic.

BACKGROUND: Cognitive assessment of older adults typically includes symptom reports and objective evaluations. However, there is often poor agreement between these measures. Cultural norms, stress, and anxiety may also influence cognitive self-appraisal and performance. Little research describes how other factors affect the self-report/objective test discrepancies noted in the literature. OBJECTIVE: This study investigated whether the disparity between subjective cognitive concerns and objective cognitive performance is related to measures of anxiety and stress in older Black and African American adults. METHODS: Telephone screenings were administered to 206 older adults (ages 64-94) during the first year of the pandemic. Demographic data, objective memory (Telephone Interview for Cognitive Status [TICS-m]), an adaptation of the subjective memory measure, the Cognitive Change Questionnaire, emphasizing executive functioning in everyday life [CCQ-e]), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale-4 (PSS4) were measured. Metacognition Discrepancy Index (MDI) was calculated from the standardized residual after regressing TICS-m on CCQ-e scores to quantify the discrepancy between cognitive self-appraisal and objective cognitive functioning. RESULTS: Neither GAD-7 nor PSS-4 moderated the relationship between TICS-m and CCQ-e, and TICS-m scores weakly predicted subjective CCQ-e scores (F(1, 197)=4.37, p = 0.038, R2 = 0.022). The MDI correlated with stress and anxiety (rs = 0.294, 0.396, ps < 0.001). CONCLUSION: Discrepancies exist between objectively measured and self-evaluated cognition. Elevations in stress and anxiety are associated with greater overestimation of cognitive difficulties relative to objective performance. Pandemic-related stressors may have worsened anxiety and diminished self-appraisal of cognitive abilities for some individuals, while others may remain reluctant to acknowledge impairments. Social and emotional factors are meaningful considerations in assessing cognitive difficulties.

Meaning in challenging times: Sense of meaning supports wellbeing despite pandemic stresses.

The COVID-19 pandemic created stress and trauma for many individuals. Traumatic experiences often trigger reflection on meaning in life, with subsequent growth or despair. This study evaluates the role of meaning in life in buffering stressors in the early stages of the COVID-19 pandemic. The purpose of this study was to determine the extent to which the negative effects of COVID-19 stressors (self-perceived stress, emotional state, and cognitive adaptation to stress in the pandemic) are influenced by meaning in life in the context of the early stages of the pandemic. Further, this study described differences in meaning in life observed across demographic groups. Web-based surveys were completed by 831 Slovenian participants in April of 2020. Demographic data; perceptions of stressors related to lacking necessities, movement restrictions, and concerns at home; meaning in life; perceived overall health status; anxiety; emotional state; and perceived stress were measured. A moderately strong sense of meaning in life (M = 5.0, SD = 0.74, range 1-7) was reported by participants, and meaning in life was associated with enhanced wellbeing (B = 0.06-.28, p < .01). Both direct and indirect relationships were observed between stressors and wellbeing outcomes. The indirect effects of meaning in life were especially prominent in the relationship between stressors related to lacking necessities and concerns at home and outcomes of anxiety, perceived stress, and negative emotions, contributing 13-27% of the total observed effects. Increased meaning in life was observed across older age groups (F(5, 825) = 4.8, p < .001) and for those in partnered relationships (t(829) = -3.397, p <.001). A strong sense of meaning in life was associated with improved well-being, even for individuals who experienced pandemic-related stressors. Public health initiatives and media may help improve resilience to pandemic trauma by emphasizing the collective meaning in challenging situations.

Mild Cognitive Impairment in African Americans Is Associated with Differences in EEG Theta/Beta Ratio.

BACKGROUND: Identification of older individuals with increased risk for cognitive decline can contribute not only to personal benefits (e.g., early treatment, evaluation of treatment), but could also benefit clinical trials (e.g., patient selection). We propose that baseline resting-state electroencephalography (rsEEG) could provide markers for early identification of cognitive decline. OBJECTIVE: To determine whether rsEEG theta/beta ratio (TBR) differed between mild cognitively impaired (MCI) and healthy older adults. METHODS: We analyzed rsEEG from a sample of 99 (ages 60-90) consensus-diagnosed, community-dwelling older African Americans (58 cognitively typical and 41 MCI). Eyes closed rsEEGs were acquired before and after participants engaged in a visual motion direction discrimination task. rsEEG TBR was calculated for four midline locations and assessed for differences as a function of MCI status. Hemispheric asymmetry of TBR was also analyzed at equidistant lateral electrode sites. RESULTS: Results showed that MCI participants had a higher TBR than controls (p = 0.04), and that TBR significantly differed across vertex location (p < 0.001) with the highest TBR at parietal site. MCI and cognitively normal controls also differed in hemispheric asymmetries, such that MCI show higher TBR at frontal sites, with TBR greater over right frontal electrodes in the MCI group (p = 0.003) and no asymmetries found in the cognitively normal group. Lastly, we found a significant task aftereffect (post-task compared to pre-task measures) with higher TBR at posterior locations (Oz p = 0.002, Pz p = 0.057). CONCLUSION: TBR and TBR asymmetries differ between MCI and cognitively normal older adults and may reflect neurodegenerative processes underlying MCI symptoms.

Task aftereffect reorganization of resting state functional brain networks in healthy aging and mild cognitive impairment.

The view of the human brain as a complex network has led to considerable advances in understanding the brain's network organization during rest and task, in both health and disease. Here, we propose that examining brain networks within the task aftereffect model, in which we compare resting-state networks immediately before and after a cognitive engagement task, may enhance differentiation between those with normal cognition and those with increased risk for cognitive decline. We validated this model by comparing the pre- and post-task resting-state functional network organization of neurologically intact elderly and those with mild cognitive impairment (MCI) derived from electroencephalography recordings. We have demonstrated that a cognitive task among MCI patients induced, compared to healthy controls, a significantly higher increment in global network integration with an increased number of vertices taking a more central role within the network from the pre- to post-task resting state. Such modified network organization may aid cognitive performance by increasing the flow of information through the most central vertices among MCI patients who seem to require more communication and recruitment across brain areas to maintain or improve task performance. This could indicate that MCI patients are engaged in compensatory activation, especially as both groups did not differ in their task performance. In addition, no significant group differences were observed in network topology during the pre-task resting state. Our findings thus emphasize that the task aftereffect model is relevant for enhancing the identification of network topology abnormalities related to cognitive decline, and also for improving our understanding of inherent differences in brain network organization for MCI patients, and could therefore represent a valid marker of cortical capacity and/or cortical health.

Mild, moderate, and severe intensity cut-points for the Respiratory Distress Observation Scale.

BACKGROUND: The Respiratory Distress Observation Scale© (RDOS) is a means for assessing respiratory distress when a patient is unable to give a dyspnea self-report. Cut-point determination was needed to guide clinical application. METHOD: A Receiver Operating Characteristic (ROC) curve analysis was conducted in a prospective, observation study with inpatients ranked by nurse practitioners (NP) into levels of respiratory distress. A research assistant simultaneously measured RDOS blinded to NP ranking. RESULTS: Participants were 84 adults: mean age of 72.6 (SD = 15.2) years, 53.6% male, 77.4% African-American. NP ranking was distributed: none (30%), mild (26%), moderate (31%), and severe (13%) distress. RDOS scores ranged 0-13 (M = 4.8, SD = 3). NP ranking was significantly correlated with RDOS (rho = .91, p < .01). ROC curve analyses yielded cut-points: none = 0-2, any = 3, mild-moderate = 4-6, and severe ≥7 (p < .01). CONCLUSIONS: Intensity cut-point enhances the clinical utility of the RDOS.