The AD8: a brief informant interview to detect dementia.

BACKGROUND: Brief measures that accurately discriminate normal cognitive aging from very mild dementia are lacking. Cognitive tests often are insensitive to very mild dementia. Informant-based measures may be more sensitive in detecting early dementia. OBJECTIVE: To identify informant-reported clinical variables that differentiate cognitively normal individuals from those with very mild dementia. METHODS: A 55-item battery of informant queries regarding an individual's cognitive status was derived from a semistructured interview and a consensus panel of dementia experts. The battery was evaluated with informants for 189 consecutive participants of a longitudinal study of memory and aging and compared with an independently obtained Clinical Dementia Rating (CDR) score for the participant. Multiple regression and receiver operator characteristic curves assessed subsets of the items to discriminate between CDR 0 (no dementia) and CDR 0.5 (very mild dementia). RESULTS: The final version (AD8) querying memory, orientation, judgment, and function was administered to an additional sample of 112 CDR 0 and 68 CDR 0.5 participants. Using a cut-off of two items endorsed, the area under the curve was 0.834, suggesting good to excellent discrimination, sensitivity was 74%, and specificity was 86% (prevalence of 0.38 for very mild dementia). Inclusion of 56 additional individuals with mild to severe dementia (increasing dementia prevalence to 0.53) increased sensitivity to 85%. CONCLUSIONS: The AD8 is a brief, sensitive measure that reliably differentiates between nondemented and demented individuals. Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.

Understanding of informed consent by demented individuals.

BACKGROUND: The informed consent process is central to the conduct of research but may be difficult for cognitively impaired participants to understand. The authors developed a brief test addressing the elements of informed consent for a specific minimum-risk nontreatment research protocol. OBJECTIVE: To evaluate and document understanding of informed consent by elderly research participants across a range of dementia severity. METHODS: The elements of informed consent regarding participation in a longitudinal study of healthy aging and dementia were reviewed with both demented (n = 250) and nondemented (n = 165) participants who then completed a short test requiring yes-no responses to assess understanding of these elements. Demented participants had very mild, mild, or moderate dementia as staged by the Clinical Dementia Rating. RESULTS: After adjusting for education, performance on the test varied with dementia severity in mean differences and by correlation. All nondemented and very mildly demented participants and 92% of mildly demented participants provided correct answers for at least 8 of 10 true-false items, whereas only 67% of the moderately demented participants achieved this level of accuracy. CONCLUSIONS: Demented individuals, very mild and mild, understood informed consent information for this nontreatment research study. Understanding notably declined in the moderate stage of dementia. Brief tests may be useful as one method to assess understanding of the consent process for specific studies.

The clock drawing test is a poor screen for very mild dementia.

OBJECTIVE: To determine whether performance on the clock drawing test varies as a function of dementia severity and particularly whether it differentiates cognitively normal older adults from those with very mild dementia. METHODS: Clock drawings were obtained during the initial clinical assessments of 75 participants in a longitudinal study of healthy aging and dementia of the Alzheimer type (15 cognitively normal, 25 with very mild dementia, 21 with mild dementia, and 14 with moderate to severe dementia, as staged by the Clinical Dementia Rating). Each clock drawing later was judged blindly and independently by two raters according to six commonly used sets of scoring criteria. RESULTS: The same pattern of results was obtained for all six scoring methods. Inter-rater reliability was consistently high. Spearman correlations indicated that as dementia severity increased, clock drawing performance decreased. Analyses of variance revealed that although those with mild or moderate/severe dementia performed significantly worse on the clock drawing test than did individuals who had very mild dementia or who were cognitively normal, the latter two groups did not differ significantly. Sensitivity and specificity analyses revealed that all methods could distinguish between normal aging and dementia of at least mild severity. However, sensitivity for detecting very mild dementia was poor. CONCLUSION: Although the clock drawing test can be scored reliably and can differentiate cognitively normal older adults from those with at least mild dementia of the Alzheimer type, it does not appear to be a useful screening instrument for detecting very mild dementia.

Gender segregation in childhood: a test of the interaction style theory.

The authors investigated the play/interaction-style theory of gender segregation with a sample of 39 children aged 2 to 5 years (primarily Caucasian). According to this theory, children prefer playmates with styles of play or interaction that are similar to their own. Because such styles are sex differentiated, same-sex playmate preference (i.e., gender segregation) results. The authors observed children during free play to determine preferred playmates and gender segregation level, and they used teacher ratings to derive play/interaction-style scores. The authors used a multiple regression approach to path analysis to analyze effects of sex of participant, participants' play/interaction-style scores, playmates' play/interaction-style scores, and degree of gender segregation to determine their effects on one another. The authors observed significant levels of gender segregation, with highly aggressive or active children displaying less segregation than their peers did. However, gender segregation was not associated with a preference for playmates with similar play or interaction styles.

Demand characteristics and self-report measures of imaginary audience sensitivity: implications for interpreting age differences in adolescent egocentrism.

Self-consciousness during early adolescence has been explained as an outcome of adolescent egocentrism, in which adolescents create an imaginary audience (IA) of attentive, critical peers. The possibility that such self-consciousness might result from contact with peers who are more attentive and critical than those encountered during childhood or adulthood has not been considered. Study 1 tested whether young adults, who are not theoretically susceptible to IA, could be made to receive high scores on IA and self-consciousness measures by having them complete a procedure in 1 of 3 laboratory conditions-a critical audience, a noncritical audience, or no audience. However, participants in the critical-audience condition received significantly lower IA and self-consciousness scores than participants in the no-audience condition did. Study 2 tested whether the directions given to Study 1 participants might have been responsible for the unexpected findings. Results indicated that participants instructed to give mature-sounding responses received lower IA/self-consciousness scores than did those asked to report their honest opinions. Together, the results of Studies 1 and 2 indicated that survey measures of IA are subject to demand characteristics and highlighted the need to interpret with caution age differences in IA as traditionally assessed.

The development of sex typing in middle childhood.

The present study examined the development of sex typing during middle childhood, using a sample of 558 children aged 5-12 years. The purpose of the study was to provide information about the developmental course and stability of various aspects of sex typing during this period and to examine the relative contributions of cognitive and environmental factors to sex-role development. Multiple measures of sex typing were obtained, including indices of personal preference, knowledge of stereotypes, and flexibility in the domains of activities, occupations, and traits. We also collected information about the child's cognitive maturity, exposure to sex-typed models at home, and socioeconomic status. Results supported the need for an integrative theory of sex-role development, incorporating factors emphasized by cognitive-developmental, schematic-processing, and social learning theories. Knowledge of stereotypes, flexibility, and sex-typed personal preferences all increased with age during middle childhood. There were also individual differences in sex typing that were stable over a 1-year period. Distinct "cognitive" and "affective" aspects of sex typing were identified using a principal components analysis. Cognitive elements (flexibility and knowledge of stereotypes) were largely a function of the child's cognitive maturity level, although social-environmental factors such as father's presence in the home also had some effect. Affective elements (sex-typed preferences for activities, occupations, and peers), on the other hand, were related more consistently to sex typing of the home environment. Children whose mothers frequently modeled "reversed" sex-role behaviors (i.e., traditionally "masculine" household and child-care tasks) were less sex typed in their own preferences. However, cognitive factors were also important, in that children who believed gender stereotypes to be flexible were less sex typed in their choices of activities, occupations, and peers. In sum, both cognitive maturation and socialization experiences contribute to the development of sex typing during middle childhood. Potential practical implications of these findings, as well as implications for stereotyping in other social domains such as race and ethnicity, are discussed.