Background: Difficulties in inhibition and self-monitoring are early features of incipient Alzheimer’s disease and may manifest as susceptibility to proactive semantic interference. However, due to limitations of traditional memory assessment paradigms, recovery from interference effects following repeated learning opportunities has not been explored. Objective: This study employed a novel computerized list learning test consisting of repeated learning trials to assess recovery from proactive and retroactive semantic interference. Design: The design was cross-sectional. Setting: Participants were recruited from the community as part of a longitudinal study on normal and abnormal aging. Participants: The sample consisted of 46 cognitively normal individuals and 30 participants with amnestic mild cognitive impairment. Measurements: Participants were administered the Cognitive Stress Test and traditional neuropsychological measures. Step-wise logistic regression was applied to determine which Cognitive Stress Test measures best discriminated between diagnostic groups. This was followed by receiver operating characteristic analyses. Results: Cued A3 recall, Cued B3 recall and Cued B2 intrusions were all independent predictors of diagnostic status. The overall predictive utility of the model yielded 75.9% sensitivity, 91.1% specificity, and an overall correct classification rate of 85.1%. When these variables were jointly entered into receiver operating characteristic analyses, the area under the curve was .923 (p<.001). Conclusions: This novel paradigm’s use of repeated learning trials offers a unique opportunity to assess recovery from proactive and retroactive semantic interference. Participants with mild cognitive impairment exhibited a continued failure to recover from proactive interference that could not be explained by mere learning deficits.
The Coronavirus Disease 2019 (COVID-19) pandemic prompted the need for a teleneuropsychology protocol for the cognitive assessment of older adults, who are at increased risk for both COVID-19 and dementia. Prior recommendations for teleneuropsychological assessment did not consider many of the unique challenges posed by COVID-19. The field is still in need of clear guidelines and standards of care for the assessment of older adults under the current circumstances. Advantages of teleneuropsychological assessment during the COVID-19 pandemic include reduced risk of contracting the virus, eliminating travel time and reducing cost, and more rapid access to needed services. Challenges include disparities in technology access among patients, reduced control over the testing environment, impeded ability to make behavioral observations, and limited research on valid and reliable cognitive assessment measures. The aim of this perspective review is to propose a teleneuropsychological protocol to facilitate neuropsychological assessment utilizing a virtual platform. The proposed protocol has been successful with our clinical and research populations and may help neuropsychologists implement teleneuropsychology services without compromising validity or reliability. However, there is increasing need for research on teleneuropsychological assessment options for both clinical and research purposes.
<b><i>Introduction:</i></b> Among persons with amnestic mild cognitive impairment (aMCI), intrusion errors on subscales that measure proactive semantic interference (PSI) may be among the earliest behavioral markers of elevated Alzheimer’s disease brain pathology. While there has been considerable cross-sectional work in the area, it is presently unknown whether semantic intrusion errors are predictive of progression of cognitive impairment in aMCI or PreMCI (not cognitively normal but not meeting full criteria for MCI). <b><i>Methods:</i></b> This study examined the extent to which the percentage of semantic intrusion errors (PIE) based on total responses on a novel cognitive stress test, the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), could predict clinical/cognitive outcomes over an average 26-month period in older adults initially diagnosed with aMCI, PreMCI, and normal cognition. <b><i>Results:</i></b> On the LASSI-L subscale sensitive to PSI, a PIE cut point of 44% intrusion errors distinguished between those at-risk individuals with PreMCI who progressed to MCI over time compared to individuals with PreMCI who reverted to normal on longitudinal follow-up. Importantly, PIE was able to accurately predict 83.3% of aMCI individuals who later progressed to dementia. <b><i>Discussion:</i></b> These preliminary findings indicate that PIE on LASSI-L subscales that measure PSI may be a useful predictor of clinical progression overtime in at-risk older adults.
Background: Semantic intrusion errors on memory tests may represent very early cognitive changes associated with elevated Alzheimer's disease pathology within the brain, including amyloid- (A). Subscales that measure proactive semantic interference (PSI) and intrusions related to PSI on the Loewenstein Acevedo Scales of Semantic Interference and Learning (LASSI-L) have been associated with high levels of brain amyloid load, structural changes on brain MRI in Hispanic and non-Hispanic groups. It is presently unknown whether intrusion errors or other measures of the LASSI-L can differentiate between African-American (AA) older adults diagnosed with amnestic mild cognitive impairment (aMCI) or classified as cognitively normal (CN). Objective: This study examined the extent to which a high percentage of semantic intrusion errors on LASSI-L subscales susceptible to PSI and other LASSI-L measures could differentiate between AA aMCI and CN groups. Methods: Forty-eight AA older adults were recruited (27 CN and 21 aMCI) and received a through clinical and neuropsychological evaluation. The LASSI-L was administered independent of diagnostic classification. Results: With and without statistical adjustment for literacy, AA aMCI participants scored lower on all LASSI-L measures. ROC analyses revealed an area under the curve exceeding 90% and correctly classified 86% of AA aMCI with 82% specificity for AA CN participants. Conclusions: Percentage of intrusion errors on the LASSI-L subscales susceptible to PSI differentiated AA aMCI from AA CN. This adds to emerging evidence indicating that the LASSI-L may be culturally appropriate and can differentiate between aMCI and CN in diverse ethnic/cultural groups.
Introduction: There is increasing evidence that susceptibility to proactive semantic interference (PSI) and the failure to recover from PSI (frPSI) as evidenced by intrusion errors may be early cognitive markers of both preclinical and prodromal Alzheimer's disease (AD). Methods: One hundred forty‐five participants were administered extensive clinical and neuropsychological evaluations including the Loewenstein‐Acevedo Scales for Semantic Interference and Learning (LASSI‐L), a sensitive cognitive stress test measuring PSI and frPSI. Participants also underwent structural magnetic resonance imaging (MRI) and amyloid positron emission tomography/computed tomography (PET/CT) imaging. Results: PSI and frPSI errors were much more prevalent in the mild cognitive impairment (MCI)‐AD (amyloid positive) group than the other diagnostic groups. The number of intrusion errors observed across the other MCI groups without amyloid pathology and those with normal cognition were comparable. Discussion: Semantic intrusion errors on the LASSI‐L occur much less frequently in persons who have different types of non–AD‐related MCI and may be used as an early cognitive marker of prodromal AD.
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