Healthy older adult performance on a modified version of the Cognistat (NCSE): demographic issues and preliminary normative data.

Normative data for a healthy sample of older adults (n = 108) ranging in age from 60 to 96 are provided for the Cognistat, a mental status exam previously known as the Neurobehavioral Cognitive Status Examination (NCSE). A Cognistat Composite Score is also introduced that is intended to be used as a marker of general cognitive impairment, allowing the Cognistat to be used to match patients in terms of the severity of their cognitive dysfunction. The "screen and metric" approach of the Cognistat was abandoned in order to improve the reliability and standardization of this measure by administering the entire metric to all patients. The impact of demographic variables on Cognistat performance was examined, demonstrating that both age and education contribute uniquely to a number of Cognistat subtests as well as to the Cognistat Composite Score. This study highlights the importance of matching an examinee's demographic background to the normative sample with which his or her test score is being compared. Normative data were stratified accordingly by age and by both age and education. Current results indicate that the Cognistat is sensitive to normal aging and promises greater sensitivity to the impact of age than the commonly employed Mini-Mental State Examination (MMSE).

Differences in executive functioning between Alzheimer's disease and subcortical ischemic vascular dementia.

The present study examined the performance of 114 individuals (62 males, 52 females) on a variety of tests purported to measure executive abilities. Participants were diagnosed with possible or probable Alzheimer's disease (AD), subcortical ischemic vascular dementia (SVaD), or were normal controls (NoDx). Groups were matched for age and education, and clinical groups were matched for severity of dementia. Multivariate and univariate analyses of variance were performed which indicated that the AD and SVaD patients differed from the NoDx on all measures of executive functioning. Further, the AD group made significantly more episodic memory errors than the SVaD group. On the other hand, consistent with previous research, the SVaD group performed significantly better than the AD group on recognition memory, but not on free recall measures. Present findings suggest that AD patients have more executive self-monitoring problems than SVaD patients do, but SVaD patients have more retrieval problems (executive memory search), suggesting a fractionation of executive abilities. Thus, differences between dementia groups depend on the nature of the executive function assessed.

Demographic characteristics and normative observations for derived-trail making test indices.

OBJECTIVE: The Trail Making Test (TMT) is a psychomotor task that is used routinely in clinical evaluations and consists of two parts: TMT-A and TMT-B. The purpose of the present study was to examine the relations of two derived-TMT indices with age, education, and gender and to establish normative data. BACKGROUND: Prior research has suggested that these derived indices provide purer measures of the executive skills required to complete TMT-B. It has also been suggested that these scores can be effectively used to detect cognitive impairment, and that they are relatively free from the impact of age. METHOD: Difference scores (B minus sign A) and ratio scores (B:A) were computed from the TMT performance of 285 adults who have no history of substance abuse or psychiatric or neurologic disorder and who are not currently being treated with any type of psychotropic medication. RESULTS: Subjects ranged in age from 18 to 90 years and in education level from 6 to 20 years. For the entire sample, (B minus sign A) scores ranged from 6 to 248 seconds (M, 62.15; SD, 49.44), and (B:A) scores ranged from 1.23 to 9.54 (M, 2.81; SD, 1.13). Significant correlations were noted with age and (B minus sign A) and (B:A) scores, accounting for 28% and 6% of the variance, respectively. Subjects were assigned to one of eight age groups, which were formed by decade. Univariate analyses of variance were significant for (B minus sign A) (p < 0.0001) and (B:A) (p < 0.0004) scores. Post hoc analyses indicated that the two oldest age groups had significantly larger (B minus sign A) scores than the younger age groups. However, post hoc analyses with (B:A) scores indicated that only the 70-79-year-old age group significantly differed from the three youngest age groups. No other age groups significantly differed from another on this measure. CONCLUSIONS: Normative data are presented for clinical use, and recommendations are made for future research. In addition, the current results suggest that normal aging has a significant impact on cognitive flexibility and indicate that previous suggestions for impairment cut-off scores based on the (B:A) ratio may result in erroneous classification of healthy older adults.