Judgment in older adults: development and psychometric evaluation of the Test of Practical Judgment (TOP-J).

This article reports on the development and validation of a novel, objective test of judgment for use with older adults. The Test of Practical Judgment (TOP-J) is an open-ended measure that evaluates judgment related to safety, medical, social/ethical, and financial issues. Psychometric features were examined in a sample of 134 euthymic individuals with mild Alzheimer's disease (AD), amnestic mild cognitive impairment (MCI), or cognitive complaints but intact neuropsychological performance (CC), and demographically-matched healthy controls (HC). Measures of reliability were adequate to high, and TOP-J scores correlated with select measures of executive functioning, language, and memory. AD participants obtained impaired TOP-J scores relative to HCs, while MCI and CC participants showed an intermediate level of performance. Confirmatory factor analyses were consistent with a unidimensional structure. Results encourage further development of the TOP-J as an indicator of practical judgment skills in clinical and research settings. Longitudinal assessments are being performed to examine predictive validity of the TOP-J for cognitive progression in our clinical groups.

Regional brain atrophy in cognitively intact adults with a single APOE epsilon4 allele.

OBJECTIVE: To determine whether cognitively intact adults with the APOE epsilon3/epsilon4 genotype show reduced gray matter density on voxel-based morphometry (VBM) vs those homozygous for the epsilon3 allele. METHODS: Participants were healthy, cognitively intact, right-handed adults, age 19 to 80, who completed genotyping, neuropsychological testing, and MRI. Forty-nine participants had the epsilon3/epsilon3 genotype and 27 had the epsilon3/epsilon4 genotype. Gray matter data were analyzed using the general linear model as implemented in the Statistical Parametric Mapping package, adjusting for age and sex. RESULTS: The epsilon3/epsilon4 participants showed lower gray matter density than the epsilon3/epsilon3 participants in right medial temporal and bilateral frontotemporal regions as well as other areas. There were no regions in which epsilon3/epsilon4 participants showed higher gray matter density than epsilon3/epsilon3 participants. CONCLUSIONS: Regionally reduced gray matter density is detectable in cognitively intact adults with a single copy of the APOE epsilon4 allele.

Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI.

OBJECTIVE: To examine the neural basis of cognitive complaints in healthy older adults in the absence of memory impairment and to determine whether there are medial temporal lobe (MTL) gray matter (GM) changes as reported in Alzheimer disease (AD) and amnestic mild cognitive impairment (MCI). METHODS: Participants were 40 euthymic individuals with cognitive complaints (CCs) who had normal neuropsychological test performance. The authors compared their structural brain MRI scans to those of 40 patients with amnestic MCI and 40 healthy controls (HCs) using voxel-based morphometry and hippocampal volume analysis. RESULTS: The CC and MCI groups showed similar patterns of decreased GM relative to the HC group on whole brain analysis, with differences evident in the MTL, frontotemporal, and other neocortical regions. The degree of GM loss was associated with extent of both memory complaints and performance deficits. Manually segmented hippocampal volumes, adjusted for age and intracranial volume, were significantly reduced only in the MCI group, with the CC group showing an intermediate level. CONCLUSIONS: Cognitive complaints in older adults may indicate underlying neurodegenerative changes even when unaccompanied by deficits on formal testing. The cognitive complaint group may represent a pre-mild cognitive impairment stage and may provide an earlier therapeutic opportunity than mild cognitive impairment. MRI analysis approaches incorporating signal intensity may have greater sensitivity in early preclinical stages than volumetric methods.

Verb generation priming involves conceptual implicit memory.

Brain activation patterns differ and generation latencies are reduced when generating verbs to repeated nouns (Raichle et al., 1994). Amnesic participants show normal magnitude of priming (Seger et al., 1997). Despite its importance in neuropsychology, verb generation priming is not well characterized psychologically. Six behavioral studies found that verb generation priming was specific to the verb rather than to the noun or the noun-verb pair, was equivalent after overt or covert generation and after reading verbs or generating verbs, was affected by levels of processing, and transferred completely across languages in bilinguals. These results indicate that verb generation priming involves priming of particular responses and happens at a conceptual level. These findings provide new insights about the significance of brain imaging and neuropsychological studies involving verb generation priming.

Preserved verb generation priming in global amnesia.

In the verb generation task, participants are presented with nouns and generate for each one an appropriate verb. Raichle et al. (Cerebral Cortex, 1994, 4, 8-26) found that when participants generated verbs to repeated nouns, generation latencies were reduced and different patterns of brain activation were present. In order to examine whether verb generation priming is dependent or independent of declarative memory, verb generation priming was compared between 13 amnesic (seven with alcoholic Korsakoff's syndrome, six with other etiologies) and 19 control participants (10 with a history of alcoholism). Both amnesic and control participants became faster across blocks on repeated nouns and slowed when novel nouns were introduced. Priming was verb specific for both groups: it was equivalent whether generated to a repeated or a novel noun. Verb generation priming, therefore, can occur independently of declarative memory.