An item response theory analysis of the Executive Interview and development of the EXIT8: A Project FRONTIER Study

Abstract

Introduction The EXIT25 is an effective measure of executive dysfunction, but may be inefficient due to the time it takes to complete 25 interview-based items. The current study aimed to examine psychometric properties of the EXIT25, with a specific focus on determining if a briefer version of the measure could comprehensively assess executive dysfunction. Method The current study applied a graded response model (a type of item response theory model for polytomous categorical data) to identify items that were most closely related to the underlying construct of executive functioning and best discriminated between varying levels of executive functioning. Participants were 660 adults ages 40 to 96 living in West Texas, who were recruited through an ongoing epidemiological study of rural health and aging, called Project FRONTIER. The EXIT25 was the primary measure examined. Participants also completed the Trail Making Test and Controlled Oral Word Association Test, among other measures, to examine the convergent validity of a brief form of the EXIT25. Results Eight items were identified that provided the majority of the information about the underlying construct of executive functioning; total scores on these items were associated with total scores on other measures of executive functioning and were able to differentiate between cognitively healthy, mildly cognitively impaired, and demented participants. In addition, cutoff scores were recommended based on sensitivity and specificity of scores. Conclusion A brief, eight-item version of the EXIT25 may be an effective and efficient screening for executive dysfunction among older adults.

The Mediating Role of Perceived Burdensomeness in Relations Between Domains of Cognitive Functioning and Indicators of Suicide Risk

“…Executive Interview (EXIT25; Royall, Mahurin, & Gray, 1992). The EXIT25 was developed as a brief screener for executive dysfunction in older adults, though it has been used in younger samples, including medical inpatients (Larson & Heinemann, 2010) and communitydwelling adults (Jahn, Dressel, Gavett, & O'Bryant, 2015). It is a 25-item structured interview that requires approximately 10 to 15 minutes to complete (Moorhouse, Gorman, & Rockwood, 2009;Royall et al, 1992).…”

“…The EXIT25 was not given in its original form due to removal of four items related to IRB concerns. Therefore, we also examined both models utilizing a validated short form of the measure, the EXIT8 (Jahn et al., ), which did not include any of the items removed for the current study. Using the EXIT8 in analyses did not change the significance of the direct or indirect paths for this measure.…”

A signal detection–item response theory model for evaluating neuropsychological measures

“…Applications of IRT are becoming increasingly common in neuropsychology, with papers now appearing in the Journal of Clinical and Experimental Neuropsychology (e.g., Jahn, Dressel, Gavett, & O’Bryant, 2015), Neuropsychology (e.g., Kenzik et al, 2015), and the Archives of Clinical Neuropsychology (e.g., Li, Root, Atkinson, & Ahles, 2016) among other current periodicals. Nonetheless, the methodology is still somewhat rare in comparison to other domains of clinical assessment (Thomas, 2017).…”

Texas Mexican American adult normative studies: Normative data for commonly used clinical neuropsychological measures for English- and Spanish-speakers

“…Given the size of the U.S. Mexican American population, clinical neuropsychological practitioners would greatly benefit from the provision of normative references on commonly utilized tests for this rapidly growing population. Such efforts to meet this growing need has resulted in initial psychometric analysis and normative references for the Clock Drawing Test (Menon, Hall, Hobson, Johnson, & O’Bryant, 2012), a Spanish-English equivalent version of the Boston Naming Test (Jahn et al, 2013) as well as an IRT-analysis of the Executive Interview (EXIT) which lead to the development of the EXIT8 (Jahn, Dressel, Gavett, & O’Bryant, 2015) based on data obtained from Mexican American and non-Hispanic white participants. Additionally, the SENAS was created specifically for administration of a Spanish-English equivalent neuropsychological instrument for Hispanics (Mungas, Reed, Crane, Haan, & González, 2004).…”