Normative data for the Tower of London (Drexel version) in the Quebec-French population aged between 50 and 88 years.

The Tower of London (ToL) is a neuropsychological test used to assess several executive functions such as strategical reasoning, mental planning, and problem-solving. Like other cognitive tests, performance on the ToL can vary according to age, level of education, sex, and cultural background of individuals. The present study aimed to establish normative data for the Drexel version of the ToL among French-Quebec people aged 50 years and over. The normative sample consisted of 174 healthy individuals aged 50-88 years, all from the province of Quebec, Canada. Analyses were performed to estimate the associations between age, sex, and education level on one hand, and ToL performance, on the other hand. Results indicated that Total Execution Time was associated with age, whereas the Total Type II Errors and Total Rule Violation score (Type I + II Errors) were associated with both age and education level. All other scores were not significantly associated with the demographic characteristics of the participants. Since the distributions of the data were all skewed, the normative data are presented in the form of percentile ranks. To conclude, the present norms will ease the detection of executive impairments in French-Quebec middle-aged and older adults.

Trail Making Tests A and B: regression-based normative data for Quebec French-speaking mid and older aged adults.

OBJECTIVE: The Trail Making Test (TMT) is mainly used to assess visual scanning/processing speed (part A) and executive functions (part B). The test has proven sensitive at detecting cognitive impairment during aging. However, previous studies have shown differences between normative data from different countries and cultures, even when corrected for age and education. Such inconsistencies between normative data may lead to serious diagnostic errors, thus, the development of local norms is warranted. The purpose of this study was to provide regression-based normative data for TMT-A and -B, tailored for a large sample of French-speaking adults from Quebec (Canada). METHOD: The normative sample consisted of 792 participants aged 50-91 years. Based on multiple linear regression, equations to calculate Z-scores were provided for TMT-A and -B, and for a contrast score which compared performance between TMT-A and -B. Percentiles, stratified by age, are presented for the number of recorded errors. RESULTS: Age was a significant predictor for TMT-A performance, while age and education were independently associated with performance on TMT-B. Gender did not have any effect on performance, in either condition. Education was the only significant predictor of the contrast score between TMT-B and TMT-A. Examiners should remain vigilant when two or more errors are recorded on the TMT-B since this was uncommon in the normative sample. CONCLUSIONS: Our TMT normative data improve the accurate detection of visual scanning/processing speed and executive function deficits in Quebec (Canada) French-speaking adults.

Object decision test (BORB): normative data for the adult Quebec population and performance in Alzheimer's disease and the semantic variant of primary progressive aphasia.

Object decision (OD) test is one subtest of the Birmingham Object Recognition Battery (BORB). It is useful for differential diagnosis among several neurodegenerative diseases. However, normative data provided with this battery count on very few subjects and do not control for the effect of age, which limits interpretability. The purpose of Study 1 was to provide normative data for the OD test of the BORB (version A-hard). The objectives of Study 2 were to establish the diagnostic validity of this task and predictive validity of the normative data in the case of the semantic variant of primary progressive aphasia (svPPA) and Alzheimer's disease (AD).Based on multiple linear regressions, equations to calculate Z-scores corrected for age were provided for 130 participants aged from 47 to 89 years. Performance of 20 healthy participants was compared to that of 14 individuals with svPPA and 18 with AD. After controlling for confounders, participants with svPPA had a lower total score than controls and AD participants. AD participants had a poorer performance than controls only when chimeric objects were considered. Among those with a deficit on the total score of the test, 94% (17/18, including 12 with svPPA) were correctly identified as having a pathological condition (svPPA or AD). This test could help refine differential diagnosis between svPPA and AD patients, especially before the deficits of episodic memory show up.

Utilization of healthcare services among elderly with cognitive impairment no dementia and influence of depression and anxiety: a longitudinal study.

OBJECTIVES: Little objective and nationally representative data are available concerning the influence of cognitive impairment no dementia (CIND) on utilization of healthcare services. The main objective was to compare the use of healthcare services over three years, between elders with current or incident CIND and those without CIND. A second objective was to evaluate the effect of depression and anxiety. METHODS: Cross-sectional and longitudinal data from a population-based survey of 2265 older adults living in Quebec (Canada) were used. CIND was identified using normative data for the Mini-Mental State Examination and was linked with medical records from public health insurance plan. Multinomial logistic regressions adjusted for relevant socio-demographic, social network and health-related confounders were conducted for each service. Interaction between CIND and depression/anxiety was also examined. MAIN RESULTS: Current CIND was a predictor of longer anxiolytic/sedative/hypnotic medication use. Incident CIND led to longer hospital stay. Depression raised the likelihood of frequenting geriatricians, psychiatrists or neurologists and emergency department, but lessened the likelihood of visiting general practitioners. The addition of the psychiatric conditions to the incident CIND did not increase the likelihood of consuming antidepressants, while the incident CIND cases without psychiatric conditions increased this likelihood. DISCUSSION: Compared to older adults without CIND, older adults with CIND have a distinct utilization of healthcare services. Multiple evaluations over many years may help to better understand the utilization of healthcare services in individuals with CIND. In the meantime, evaluations of these conditions at key moments could allow a more efficient use of health resources.

Normative data for phonemic and semantic verbal fluency test in the adult French-Quebec population and validation study in Alzheimer's disease and depression.

OBJECTIVE: Verbal fluency tasks are principally used to assess lexical access and have shown usefulness for differential diagnosis. The purpose of Study 1 was to provide normative data in the adult French-Quebec population (Canada) for semantic verbal fluency (animals), for two sets of phonemic verbal fluency (TNP and PFL), and for letter P alone (60 seconds per category/letter). The objectives of Study 2 were to establish the diagnostic and predictive validity of the present tasks and normative data in Alzheimer's disease (AD) and major depressive episode (MDE). METHOD: The normative sample consisted of 932 participants aged 19-91 years. Based on multiple linear regressions, equations to calculate Z-scores were provided. To assess validity, performance of 62 healthy participants was compared to 62 participants with AD and 41 with MDE aged over 50. RESULTS: Age and education, but not gender, predicted performance on each verbal fluency task. Healthy adults aged 50 and younger had a better performance on semantic than phonemic verbal fluency. In comparison to MDE, AD participants had lower performance on animals and TNP, but not on letter P. Ninety percent of people with a Z-score ≤ -1.50 on semantic verbal fluency had AD and the global accuracy was 76.6%. Test-retest reliability over one year was high for both animals (r = .711) and TNP (r = .790) in healthy older participants, but dropped for animals in people with AD (r = .493). CONCLUSIONS: These data will strengthen accurate detection of verbal fluency deficits in French-Quebec adults.

What to do with screening for distress scores? Integrating descriptive data into clinical practice.

OBJECTIVE: Implementation of routine Screening for Distress constitutes a major change in cancer care, with the aim of achieving person-centered care. METHOD: Using a cross-sectional descriptive design within a University Tertiary Care Hospital setting, 911 patients from all cancer sites were screened at the time of their first meeting with a nurse navigator who administered a paper questionnaire that included: the Distress Thermometer (DT), the Canadian Problem Checklist (CPC), and the Edmonton Symptom Assessment System (ESAS). RESULTS: Results showed a mean score of 3.9 on the DT. Fears/worries, coping with the disease, and sleep were the most common problems reported on the CPC. Tiredness was the most prevalent symptom on the ESAS. A final regression model that included anxiety, the total number of problems on the CPC, well-being, and tiredness accounted for almost 50% of the variance of distress. A cutoff score of 5 on the DT together with a cutoff of 5 on the ESAS items represents the best combination of specificity and sensitivity to orient patients on the basis of their reported distress. SIGNIFICANCE OF RESULTS: These descriptive data will provide valuable feedback to answer practical questions for the purpose of effectively implementing and managing routine screening in cancer care.

Gambling exposure in virtual reality and modification of urge to gamble.

The urge to gamble is a psychological, physiological, and emotional state involved in the maintenance of pathological gambling. The ability of repeated exposure to a virtual gambling environment to modify the urge to gamble and perceived self-efficacy (PSE) is investigated. Ten video lottery players move throughout a virtual bar with five video lottery terminals five times. The urge to gamble and PSE do not significantly vary during exposure to the gambling environment. However, the desire to gamble significantly increases when passing from the practice environment to the gambling environment. These findings suggest that virtual reality is viable for use in exposure, but that a sole 20-minute session does not set the extinction process into motion. Future studies should be conducted on virtual exposure over the course of several sessions, with the addition of a cognitive restructuring intervention.