Verbal fluency in a national sample: Telephone administration methods.

OBJECTIVES: Describe novel methods for ascertaining verbal fluency in a large national sample of adults, examine demographic factors influencing performance, and compare scores to studies using in-person assessment. METHODS/DESIGN: Participants were from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study of stroke in adults aged 45 years and older. Letter and semantic fluency were gathered, using Letter "F" and Animal Naming, via a telephone-based assessment with computer-assisted scoring of digital recordings. RESULTS: Initial letter and semantic fluency scores were obtained on 18 505 and 18 072 participants, respectively. For both fluency tests, scores were normally distributed. Younger age and more years of education were associated with better performances (p < 0.0001). The mean and standard deviation for matched subgroups, based on age, gender, and education, were quite comparable with scores reported out of samples using an in-person administration format. Telephone-based assessment also allowed for a level of quality control not available via in-person measurement. CONCLUSIONS: Telephone-based assessment of verbal fluency and computer-assisted scoring programs designed for this study facilitated large-scale data acquisition, storage, and scoring of protocols. The resulting scores have similar characteristics to those obtained by traditional methods. These findings extend validation of cognitive assessment methods, using survey research staff and computer-assisted technology for test administration.

Language and motor cortex response to comprehending accidental and intentional action sentences.

Understanding the meaning of others' actions involves mentally simulating those actions by oneself. Embodied theories of language espouse a prominent role for motor simulation in reading comprehension, especially when words, sentences, or narratives portray everyday actions. Inherent in these actions is the level of agency of the actor. Motor cortex activity in response to processing action verbs has been relatively well-established. What has been less explored, however, are: (1) the neural bases of determining whether an action is intentional or accidental (agency); and (2) whether agency influences level of motor simulation. This functional MRI study investigated how language and motor areas of the brain respond to sentences depicting intentional versus accidental action. 25 healthy adults read a series of sentences in the MRI scanner and determined whether the actions described were accidental or intentional. The main results include: (1) left hemisphere language areas (left inferior frontal gyrus, LIFG; left superior temporal gyrus, LSTG), premotor cortex (PM), and presupplementary motor area (pSMA) were strongly activated by both sentence types; (2) processing accidental action, relative to intentional action, elicited greater activity in LIFG, medial prefrontal cortex (MPFC), and left amygdala; no statistically significant activity was found in the opposite contrast; and (3) greater percent signal change was observed in LIFG while processing accidental action and in right precentral gyrus for intentional action. The results of this study support language and motor region involvement in action sentence comprehension in accordance with embodiment theories. Additionally, it provides new insight into the linguistic, integrative, and emotional demands of comprehending accidental action, its underlying neural circuitry, and its relationship to intentionality bias: the predisposition to ascribe purpose to action.

Performance of the NINDS-CSN 5-minute protocol in a national population-based sample.

In 2006, the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) Vascular Cognitive Impairment Harmonization Standards recommended a 5-Minute Protocol as a brief screening instrument for vascular cognitive impairment (VCI). We report demographically adjusted norms for the 5-Minute Protocol and its relation to other measures of cognitive function and cerebrovascular risk factors. We performed a cross-sectional analysis of 7199 stroke-free adults in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study on the NINDS-CSN 5-Minute Protocol score. Total scores on the 5-Minute Protocol were inversely correlated with age and positively correlated with years of education, and performance on the Six-Item Screener, Word List Learning, and Animal Fluency (all p-values <.001). Higher cerebrovascular risk on the Framingham Stroke Risk Profile (FSRP) was associated with lower total 5-Minute Protocol scores (p <.001). The 5-Minute Protocol also differentiated between participants with and without confirmed stroke and with and without stroke symptom histories (p <.001). The NINDS-CSN 5-Minute Protocol is a brief, easily administered screening measure that is sensitive to cerebrovascular risk and offers a valid method of screening for cognitive impairment in populations at risk for VCI.

The association of statin use and statin type and cognitive performance: analysis of the reasons for geographic and racial differences in stroke (REGARDS) study.

BACKGROUND: Statin use and type have been variably associated with impaired or improved cognitive performance. HYPOTHESIS: To assess the association of statin use and type (lipophilic vs hydrophilic) and cognitive impairment. METHODS: Cross-sectional analysis of 24 595 participants (7191 statin users and 17 404 nonusers) age > or = 45 years, from a population-based national cohort study (Reasons for Geographic And Racial Differences in Stroke) enrolled between January 2003 and October 2008, with oversampling from the southeastern Stroke Belt and African Americans. Statin use and type were documented in participants' homes by a trained health professional. Cognitive performance was assessed with a prior validated instrument of global cognitive status (Six-Item Screener). Cognitive impairment was defined as a score of < 4. RESULTS: Overall, an association of cognitive impairment and statin use was observed (8.6% of users vs 7.7% of nonusers had cognitive impairment, P = 0.014); but, after adjusting for variables known to be associated with cognition (age, gender, race, income, education level, and cardiovascular disease), the association was attenuated (odds ratio [OR]: 0.98, confidence interval [CI]: 0.87-1.10). No association was observed between statin type (lipophilic vs hydrophilic) and cognition (OR: 1.03, CI: 0.86-1.24), and there were no regional differences in cognitive impairment in statin users (8% in the Stroke Belt and 7.9% in other regions, P = 0.63). CONCLUSIONS: Statin use and type were marginally associated with cognitive impairment. After adjusting for known variables that affect cognition, no association was observed. No regional differences were observed. This large study found no evidence to support an association between statins and cognitive performance.